Adverse events in women giving birth in a labor ward: a retrospective record review study

Background Childbirth could negatively affect the woman’s health through adverse events. To prevent adverse events and increase patient safety it is important to detect and learn from them. The aim of the study was to describe adverse events, including the preventability and severity of harm during planned vaginal births, in women giving birth in the labor ward. Methods The study had a descriptive design with a retrospective birth record review to assess the preventability of adverse events using the Swedish version of the Global Trigger Tool. The setting was a labor ward in Sweden with low-risk and risk childbirths. Descriptive statistics, Pearson’s Chi-square test and Student’s t-test were used. Results A total of 38 adverse events (12.2%) were identified in 311 reviewed birth records. Of these, 28 (73.7%) were assessed as preventable. Third- or fourth-degree lacerations and distended urinary bladder were most prevalent together with anesthesia-related adverse events. The majority of the adverse events were classified into the harm categories of ‘prolonged hospital care’ (63.2%) and ‘temporary harm’ (31.6%). No permanent harm were identified, but over two-thirds of the adverse events were assessed as preventable. Conclusions This first study using Global Trigger Tool in a labor ward in Sweden identified a higher incidence of adverse events than previous studies in obstetric care. No permanent patient harm was found, but over two-thirds of the adverse events were assessed as preventable. The results draw particular attention to 3rd-or 4th-degree lacerations, distended urinary bladder and anesthesia-related adverse events. The feedback on identified adverse events should be used for systematic quality improvement and clinical recommendations how to prevent adverse events must be implemented.

Evaluation of Performance of IHI Global Trigger Tool in Identification of Adverse Drug Events: A Prospective Observational Study

Aims: The study aims to evaluate the performance of the Institute for Healthcare Improvement (IHI) global trigger tool in the identification of adverse drug events. Study design: Prospective observational study. Place and duration of study: The study was conducted in a General Medicine department of a secondary care referral hospital located in rural, resource-limited settings of Bathalapalli, Anantapur district, Andhra Pradesh, India. The study was conducted for a period of six months, from June 2019 to November 2019. Methodology: A pre-designed data collection form was used to collect the data from the study participants. The required data was obtained from the patient case sheet, lab reports, treatment charts, daily nursing notes, daily physician notes, and direct patient interviews. The global trigger tool developed by IHI was used for the rapid review of inpatient medical records and to generate clues for the identification of ADEs. Descriptive statistics were used to represent the findings of demographics, clinical characteristics, ADE profiles, IHI triggers, and clinical alterations. ADE incidence was shown in a measure of ADE per 1000 patient days. IHI global trigger tool performance in detecting ADE was measured by sensitivity, specificity, positive predictive value, and negative predictive value. Results: A total of 192 patients were enrolled in the study. Among them, 225 triggers and 123 ADEs were detected. The incidence of ADEs in the inpatients estimated by the IHI method was estimated as; 20.2 ADEs per 1000 patient days,64.0ADEs per 100 admissions, 56.2percent of admissions with ADE. Majority of ADEs are shown possible relationship with drug (60; 48.7%), level-2 severity (49; 39.8%), and not preventable (52; 42.2%). Most IHI global triggers showed high sensitivity, specificity, positive predictive value, and negative predictive value for detecting ADEs. Conclusion: The study shows that most of the triggers in the IHI Trigger tool have shown good accuracy in identifying ADEs. Thus, using the IHI Trigger Tool to identify ADEs can help to improve patient safety. Therefore, the study recommends incorporating IHI global trigger tool in routine, conventional ADE screening techniques to improve the detection rate and promote drug safety.

Accuracy of triggers in the identification of adverse drug events in hospitalized elderly

Objective: Evaluate trigger accuracy for identifying adverse drug events (ADEs) in hospitalised elderly. Methods: Two hundred patients 60 years old from a medical clinic within a private hospital were followed-up. For ADE identification the adapted Global Trigger Tool tracker methodology was used. Causality was determined using the Naranjo Algorithm. Results: Of the 200 elderly patients included in the study, 106 were females (53%), the average age was 79 years, and the average length of hospital stay was approximately ± 10 days. Selected triggers were identified 1,457 times. The group of triggers with the best performance regarding its analysis accuracy was evolution triggers, with sensitivity of 69% and positive predictive value of 68%. In the individual performance analysis, the evolution tracker allergy, allergic reaction, pruritus achieved 100% performance for both sensitivity and positive predictive value. A total of 165 ADs were identified. Of these, 18% were phlebitis and 16% were hypoglycaemia. Drugs associated with ADE included insulin (15%) and Clarithromycin (9%). Conclusion: The triggering methodology has been effective for identifying ADEs. In addition, determination best trigger for constructing an ADE identification tool for hospitalised elderly was performed.

Characterising the types of paediatric adverse events detected by the global trigger tool – CareTrack Kids

Introduction A common method of learning about adverse events (AEs) is by reviewing medical records using the global trigger tool (GTT). However, these studies generally report rates of harm. The aim of this study is to characterise paediatric AEs detected by the GTT using descriptive and qualitative approaches. Methods Medical records of children aged 0–15 were reviewed for presence of harm using the GTT. Records from 2012–2013 were sampled from hospital inpatients, emergency departments, general practice and specialist paediatric practices in three Australian states. Nurses undertook a review of each record and if an AE was suspected a doctor performed a verification review of a summary created by the nurse. A qualitative content analysis was undertaken on the summary of verified AEs. Results A total of 232 AEs were detected from 6,689 records reviewed. Over four-fifths of the AEs (193/232, 83%) resulted in minor harm to the patient. Nearly half (112/232, 48%) related to medication/intravenous (IV) fluids. Of these, 83% (93/112) were adverse drug reactions. Problems with medical devices/equipment were the next most frequent with nearly two-thirds (32/51, 63%) of these related to intravenous devices. Problems associated with clinical processes/procedures comprise one in six AEs (38/232, 16%), of which diagnostic problems (12/38, 32%) and procedural complications (11/38, 29%) were the most frequent. Conclusion Adverse drug reactions and issues with IVs are frequently identified AEs reflecting their common use in paediatrics. The qualitative approach taken in this study allowed AE types to be characterised, which is a prerequisite for developing and prioritising improvements in practice.

Establishment of a pediatric trigger tool based on Global Trigger Tool to identify adverse drug events of children: experience in a Chinese hospital

Background The Global Trigger Tool (GTT),which is a method using “triggers” to review medical record retrospectively to identify possible adverse events. Several studies showed that the GTT was effective. However, there were only a few localized trigger tools that had been established to detect pediatric adverse drug events (ADEs) in China. This study aimed to establish a pediatric trigger tool based on GTT, to examine the performance by detecting pediatric inpatients ADEs in a Chinese hospital (a retrospective review), and to investigate the factors associating with the occurrence of ADEs. Methods The triggers were established by three steps including literature search, triggers extraction and revision, and experts investigation. A retrospective cohort study was conducted to detect ADEs by using 200 pediatric inpatient records of Sichuan Provincial People’s Hospital. Results Thirty-three preliminary triggers were established, and 2 rounds of experts investigation were conducted. Finally, 33 triggers were established. In the retrospective review, the positive trigger rate was 64.0%, while the positive predictive value (PPV) was 24.9%. The occurrence of inpatients with ADEs was 20.5%. ADEs/100 admissions were 49.0. ADEs/1000 patient days were 46.89. The most common ADE categories were leukocyte disorders, skin disorders and platelet disorders. The severity of 39 ADEs was grade 1, 55 ADEs was grade 2, 4 ADEs was grade 3. The highest frequency of ADE-related drugs was antineoplastic, followed by antibacterial. The length of stay and the leukemia in the diagnosed diseases were positively correlated with ADEs. Conclusions The 33 pediatric triggers may detect ADEs effectively, but still need to be optimized. This study may provide some references for further research in order to improve the rationality and safety of medication.

Automated Fall Detection Algorithm With Global Trigger Tool, Incident Reports, Manual Chart Review, and Patient-Reported Falls: Algorithm Development and Validation With a Retrospective Diagnostic Accuracy Study

Background Falls are common adverse events in hospitals, frequently leading to additional health costs due to prolonged stays and extra care. Therefore, reliable fall detection is vital to develop and test fall prevention strategies. However, conventional methods—voluntary incident reports and manual chart reviews—are error-prone and time consuming, respectively. Using a search algorithm to examine patients’ electronic health record data and flag fall indicators offers an inexpensive, sensitive, cost-effective alternative. Objective This study’s purpose was to develop a fall detection algorithm for use with electronic health record data, then to evaluate it alongside the Global Trigger Tool, incident reports, a manual chart review, and patient-reported falls. Methods Conducted on 2 campuses of a large hospital system in Switzerland, this retrospective diagnostic accuracy study consisted of 2 substudies: the first, targeting 240 patients, for algorithm development and the second, targeting 298 patients, for validation. In the development study, we compared the new algorithm’s in-hospital fall rates with those indicated by the Global Trigger Tool and incident reports; in the validation study, we compared the algorithm’s in-hospital fall rates with those from patient-reported falls and manual chart review. We compared the various methods by calculating sensitivity, specificity, and predictive values. Results Twenty in-hospital falls were discovered in the development study sample. Of these, the algorithm detected 19 (sensitivity 95%), the Global Trigger Tool detected 18 (90%), and incident reports detected 14 (67%). Of the 15 falls found in the validation sample, the algorithm identified all 15 (100%), the manual chart review identified 14 (93%), and the patient-reported fall measure identified 5 (33%). Owing to relatively high numbers of false positives based on falls present on admission, the algorithm’s positive predictive values were 50% (development sample) and 47% (validation sample). Instead of requiring 10 minutes per case for a full manual review or 20 minutes to apply the Global Trigger Tool, the algorithm requires only a few seconds, after which only the positive results (roughly 11% of the full case number) require review. Conclusions The newly developed electronic health record algorithm demonstrated very high sensitivity for fall detection. Applied in near real time, the algorithm can record in-hospital falls events effectively and help to develop and test fall prevention measures.

Establishment of a Pediatric Trigger Tool Based on Global Trigger Tool to Identify Adverse Drug Events of Children: Experience in a Chinese hospital

Background: The Global Trigger Tool (GTT)，which is a method using “triggers” to review medical record retrospectively to identify possible adverse events. Several studies showed that the GTT was effective. However, there were only a few localized trigger tools that had been established to detect pediatric adverse drug events (ADEs) in China. This study aimed to establish a pediatric trigger tool based on GTT, to examine the performance by detecting pediatric inpatients ADEs in a Chinese hospital (a retrospective review), and to investigate the factors associating with the occurrence of ADEs. Methods: The triggers were established by three steps including literature search, triggers extraction and revision, and experts investigation. A retrospective cohort study was conducted to detect ADEs by using 200 pediatric inpatient records of Sichuan Provincial People's Hospital.Results: 33 preliminary triggers were established, and 2 rounds of experts investigation were conducted. Finally, 33 triggers were established. In the retrospective review, the positive trigger rate was 64.0%, while the positive predictive value (PPV) was 24.9%. The occurrence of inpatients with ADEs was 20.5%. ADEs/100 patients were 49.0. ADEs/1000 patients days were 46.89. The most common ADE categories were leukocyte abnormalities, skin lesions and platelet abnormalities. The severity of 39 ADEs was grade 1, 55 ADEs was grade 2, 4 ADEs was grade 3. The highest frequency of ADE-related drugs was antineoplastic, followed by antibacterial. The length of stay and the leukemia in the diagnosed diseases were positively correlated with ADEs. Conclusion: The 33 pediatric triggers may detect ADEs effectively, but still need to be optimized. This study may provide some references for further research in order to improve the rationality and safety of medication.