Patient-specific risk factors of adverse drug events in adult inpatients - evidence detected using the Global Trigger Tool method.

AIMS AND OBJECTIVES To identify the prevalence, preventability, and severity of adverse drug events in randomly selected adult hospital inpatients, and to study the association between adverse drug events and patient-specific factors. BACKGROUND Adverse drug events represent one of the major concerns in patient safety. DESIGN A retrospective record review. METHODS The study was conducted in an 800-bed university hospital in Finland within a 12-month period. Retrospective reviews of randomly selected discharged patients' (n = 463) records using the Global Trigger Tool method were undertaken. The prevalence, preventability, and severity of adverse drug events were studied, and the association between patient-specific factors and adverse drug events were examined using a binary logistic regression model and Pearson's chi-squared tests. RESULTS A total of 180 adverse drug events were detected in 125 (27%) patients, of which 74 (41·1%) were preventable, and 94·4% caused temporary harm. An abnormal level of potassium in the blood was the most frequent adverse drug event (n = 37). The risk of adverse drug events increased with the length of hospital stay and the increased number of drugs patients used. The patients with coronary diseases (n = 130) had a 2·5 times higher risk of experiencing adverse drug events. In addition, the risk of adverse drug events during hospitalisation increased together with the co-morbidity of patients. CONCLUSIONS Adverse drug events were experienced by a quarter of inpatients, while severe adverse drug events were rare. The risk of adverse drug events increased with patients' prolonged hospital stay, polypharmacy, and morbidity. In addition, information of the usefulness of the Global Trigger tool can be used for future development of the method. RELEVANCE TO CLINICAL PRACTICE Patient-specific risk factors were identified using the Global Trigger Tool method revealing that more efficient monitoring of inpatients with these risk factors may be profitable for decreasing adverse drug events.

[1]  K. Årestedt,et al.  Assessment of adverse events in medical care: lack of consistency between experienced teams using the global trigger tool , 2012, BMJ quality & safety.

[2]  James G Wright,et al.  The development of a comorbidity index with physical function as the outcome. , 2005, Journal of clinical epidemiology.

[3]  C. Landrigan,et al.  Temporal trends in rates of patient harm resulting from medical care. , 2010, The New England journal of medicine.

[4]  Walter Verbrugghe,et al.  Adverse drug events in intensive care units: a cross-sectional study of prevalence and risk factors. , 2011, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[5]  David Metcalfe,et al.  Risk Factors for Hospital Admissions Associated with Adverse Drug Events , 2013, Pharmacotherapy.

[6]  J. Mira,et al.  What makes hospitalized patients more vulnerable and increases their risk of experiencing an adverse event? , 2011, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[7]  C. Landrigan,et al.  Performance characteristics of a methodology to quantify adverse events over time in hospitalized patients. , 2011, Health services research.

[8]  David C. Classen,et al.  Development and Evaluation of the Institute for Healthcare Improvement Global Trigger Tool , 2008 .

[9]  Maria Unbeck,et al.  Is detection of adverse events affected by record review methodology? an evaluation of the “Harvard Medical Practice Study” method and the “Global Trigger Tool” , 2013, Patient Safety in Surgery.

[10]  Matthew G. Johnson,et al.  Measuring hospital adverse events: assessing inter-rater reliability and trigger performance of the Global Trigger Tool. , 2010, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[11]  D. Bates,et al.  Medication administration errors by nurses: adherence to guidelines. , 2013, Journal of clinical nursing.

[12]  Yoon-Seok Chang,et al.  Characteristics associated with the occurrence of adverse events: a retrospective medical record review using the Global Trigger Tool in a fully digitalized tertiary teaching hospital in Korea. , 2014, Journal of evaluation in clinical practice.

[13]  D. Gilder,et al.  Large-scale deployment of the Global Trigger Tool across a large hospital system: refinements for the characterisation of adverse events to support patient safety learning opportunities , 2011, Quality and Safety in Health Care.

[14]  G A Noskin,et al.  Active surveillance using electronic triggers to detect adverse events in hospitalized patients , 2006, Quality and Safety in Health Care.

[15]  J. James.  A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care , 2013, Journal of patient safety.

[16]  B. Franklin,et al.  Testing a trigger tool as a method of detecting harm from medication errors in a UK hospital: a pilot study , 2010, The International journal of pharmacy practice.

[17]  D. Kennerly,et al.  Description and Evaluation of Adaptations to the Global Trigger Tool to Enhance Value to Adverse Event Reduction Efforts , 2013, Journal of patient safety.

[18]  M. Boermeester,et al.  Adverse drug events in surgical patients: an observational multicentre study , 2013, International Journal of Clinical Pharmacy.