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Ruiz-López PM, Fuente-Bartolomé MDL, Pérez-Zapata AI, Rodríguez-Cuéllar E, Martín-Arriscado-Arroba C, Nogueras MG, Segurola CL, Sánchez ÁT. Analysis of adverse events in general surgery. Multicenter study. Cir Esp 2024; 102:76-83. [PMID: 37967648 DOI: 10.1016/j.cireng.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/09/2023] [Indexed: 11/17/2023]
Abstract
INTRODUCTION Knowledge of adverse events (AE) in acute care hospitals is a particularly relevant aspect of patient safety. Its incidence ranges from 3% to 17%, and surgery is related to the occurrence of 46%-65% of all AE. MATERIAL AND METHODS An observational, descriptive, retrospective, multicenter study was conducted with the participation of 31 Spanish acute-care hospitals to determine and analyze AE in general surgery services. RESULTS The prevalence of AE was 31.53%. The most frequent types of AE were infectious (35%). Higher ASA grades, greater complexity and urgent-type admission are factors associated with the presence of AE. The majority of patients (58.42%) were attributed a category F event (temporary harm to the patient requiring initial or prolonged hospitalization); 14.69% of AE were considered severe, while 34.22% of AE were considered preventable. CONCLUSIONS The prevalence of AE in General and GI Surgery (GGIS) patients is high. Most AE were infectious, and the most frequent AE was surgical site infection. Higher ASA grades, greater complexity and urgent-type admission are factors associated with the presence of AE. Most detected AE resulted in mild or moderate harm to the patients. About one-third of AE were preventable.
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Affiliation(s)
- Pedro M Ruiz-López
- Instituto de Investigación Biomédica, I+12, Hospital Universitario 12 de Octubre, Spain
| | - Marta de la Fuente-Bartolomé
- Facultativo Especialista de Área, Servicio de Cirugía General y Aparato Digestivo, H. Universitario Infanta Elena, Madrid, Spain.
| | - Ana Isabel Pérez-Zapata
- Facultativo Especialista de Área, Servicio de Cirugía General y Aparato Digestivo, H. Royo Vilanova, Spain
| | - Elías Rodríguez-Cuéllar
- Facultativo Especialista de Área, Servicio de Cirugía General y Aparato Digestivo, H. Universitario 12 de Octubre, Spain
| | | | - Manuel Giner Nogueras
- Facultativo Especialista de Área, Servicio de Cirugía General y Aparato Digestivo, H. Clínico San Carlos, Spain
| | - Carmelo Loinaz Segurola
- Jefe de Sección, Servicio de Cirugía General y Aparato Digestivo, H. Universitario 12 de Octubre, Spain
| | - Ángel Tejido Sánchez
- Facultativo Especialista de Área, Servicio de Utología, H. Universitario 12 de Octubre, Spain
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Wu S, Yin Q, Wu L, Wu Y, Yu N, Yan J, Bian Y. Establishing a trigger tool based on global trigger tools to identify adverse drug events in obstetric inpatients in China. BMC Health Serv Res 2024; 24:72. [PMID: 38225629 PMCID: PMC10789046 DOI: 10.1186/s12913-023-10449-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 12/06/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Pregnant women belong to the special population of drug therapy, and their physiological state, pharmacokinetics and pharmacodynamics are significantly different from the general population. Drug safety during pregnancy involves two generations, which is a hot issue widely concerned in the whole society. Global Trigger Tool (GTT) of the Institute for Healthcare Improvement (IHI) has been wildly used as a patient safety measurement strategy by several institutions and national programs, and the effectiveness had been demonstrated. But only one study reports the use of GTT in obstetric delivery until now. The aim of the study is to establish triggers detecting adverse drug events (ADEs) suitable for obstetric inpatients on the basis of the GTT, to examine the performance of the obstetric triggers in detecting ADEs experienced by obstetric units compared with the spontaneous reporting system and GTT, and to assess the utility and value of the obstetric trigger tool in identifying ADEs of obstetric inpatients. METHODS Based on a literature review searched in PubMed and CNKI from January of 1997 to October of 2023, retrospective local obstetric ADEs investigations, relevant obstetric guidelines and the common adverse reactions of obstetric therapeutic drugs were involved to establish the initial obstetric triggers. According to the Delphi method, two rounds of expert questionnaire survey were conducted among 16 obstetric and neonatological physicians and pharmacists until an agreement was reached. A retrospective study was conducted to identity ADEs in 300 obstetric inpatient records at the Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital from June 1 to September 30, 2018. Two trained junior pharmacists analyzed the first eligible records independently, and the included records reviewed by trained pharmacist and physician to identify ADEs. Sensitivity and specificity of the established obstetric triggers were assessed by the number of ADEs/100 patients and positive predictive value with the spontaneous reporting system (SRS) and GTT. Excel 2010 and SPSS22 were used for data analysis. RESULTS Through two rounds of expert investigation, 39 preliminary triggers were established that comprised four modules (12 laboratory tests, 9 medications, 14 symptoms, and 4 outcomes). A total of 300 medical records were reviewed through the obstetric triggers, of which 48 cases of ADEs were detected, with an incidence of ADEs of 16%. Among the 39 obstetric triggers, 22 (56.41%) were positive and 11 of them detected ADEs. The positive predictive value (PPV) was 36.36%, and the number of ADEs/100 patients was 16.33 (95% CI, 4.19-17.81). The ADE detection rate, positive trigger rate, and PPV for the obstetric triggers were significantly augmented, confirming that the obstetric triggers were more specific and sensitive than SRS and GTT. CONCLUSION The obstetric triggers were proven to be sensitive and specific in the active monitoring of ADE for obstetric inpatients, which might serve as a reference for ADE detection of obstetric inpatients at medical institutions.
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Affiliation(s)
- Shan Wu
- Department of Pharmacy, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Maternal and Child Health Hospital of Shuangliu District, Chengdu, China
| | - Qinan Yin
- Department of Pharmacy, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Liuyun Wu
- Department of Pharmacy, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yue Wu
- Department of Pharmacy, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Nan Yu
- Chengdu First People's Hospital, Chengdu, China
| | - Junfeng Yan
- Department of Pharmacy, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Yuan Bian
- Department of Pharmacy, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
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Mortaro A, Moretti F, Pascu D, Tessari L, Tardivo S, Pancheri S, Marta G, Romano G, Mazzi M, Montresor P, Naessens JM. Adverse Events Detection Through Global Trigger Tool Methodology: Results From a 5-Year Study in an Italian Hospital and Opportunities to Improve Interrater Reliability. J Patient Saf 2021; 17:451-457. [PMID: 28598897 DOI: 10.1097/pts.0000000000000381] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Global Trigger Tool (GTT) has been proposed as a low-cost method to detect adverse events (AEs). The validity of the methodology has been questioned because of moderate interrater agreement. Continuous training has been suggested as a means to improve consistency over time. We present the main findings of the implementation of the Italian version of the GTT and evaluate efforts to improve the interrater reliability over time. METHODS The Italian version of the GTT was developed and implemented at the San Bonifacio Hospital, a 270-bed secondary care acute hospital in Verona, Italy. Ten clinical records randomly selected every 2 weeks were reviewed from 2009 to 2014. Two-stage interrater reliability assessment between team members was conducted on 2 subsamples of 50 clinical records before and after the implementation of specific review rules and staff training. RESULTS Among 1320 medical records reviewed, a total of 366 AEs were found with at least 1 AE on 20.2% of all discharges, 27.7 AEs/100 admissions, and 30.6 AEs/1000 patient-days. Adverse events with harm score E and F were respectively 58.2% (n = 213) and 38.8% (n = 142). First round interrater reliability was comparable with other international studies. The interrater agreement improved significantly after intervention (κ interrater I = 0.52, κ interrater II = 0.80, P < 0.001). CONCLUSIONS Despite the improvements in the interrater consistency, overall results did not show any significant trend in AEs over time. Future studies may be directed to apply and adapt the GTT methodology to more specific settings to explore how to improve its sensitivity.
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Affiliation(s)
- Alberto Mortaro
- From the University of Verona, Department of Diagnostic and Public Health
| | - Francesca Moretti
- From the University of Verona, Department of Diagnostic and Public Health
| | - Diana Pascu
- Health Care Trust 20, San Bonifacio Hospital, Medical Board, Verona, Italy
| | - Lorella Tessari
- Health Care Trust 20, San Bonifacio Hospital, Medical Board, Verona, Italy
| | - Stefano Tardivo
- From the University of Verona, Department of Diagnostic and Public Health
| | - Serena Pancheri
- From the University of Verona, Department of Diagnostic and Public Health
| | - Garon Marta
- From the University of Verona, Department of Diagnostic and Public Health
| | - Gabriele Romano
- From the University of Verona, Department of Diagnostic and Public Health
| | - Mariangela Mazzi
- From the University of Verona, Department of Diagnostic and Public Health
| | - Paolo Montresor
- Health Care Trust 20, San Bonifacio Hospital, Medical Board, Verona, Italy
| | - James M Naessens
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota
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Kaibel Val R, Ruiz López P, Pérez Zapata AI, Gómez de la Cámara A, de la Cruz Vigo F. [Detection of adverse events in thyroid and parathyroid surgery using trigger tool and Minimum Basic Data Set (MBDS)]. J Healthc Qual Res 2020; 35:348-354. [PMID: 33115613 DOI: 10.1016/j.jhqr.2020.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/28/2020] [Accepted: 08/17/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To compare the ability of the trigger tool) and the Minimum Basic Data Set (MBDS) in detecting adverse events (AE) in hospitalized surgical patients with thyroid and parathyroid disease. METHODS A descriptive, cross-sectional observational study, retrospective and cross-sectional study was conducted from May 2014 to April 2015 analysing retrospectively data on of patients submitted to thyroidectomy and parathyroidectomy in order to detect AE through the identification of triggers (an event often associated to an AE) and the MBDS. triggers and AE were located by systematic review of clinical documentation. The MBDS was got from the data base. Once an AE was detected, it was characterized. RESULTS 203 AE were identified in 251 patients, being the 90.04% detected by trigger tool and 10.34% by MBDS. 126 patients had at least one AE (50.2%). Without the cases in which uncontrolled pain was the only AE, the percentage of patients that suffering AE was 38.65%. 187 AE were considered preventable and 16 AE were considered unpreventable. The trigger tool and the MBDS demonstrated a sensitivity of 91.27 and 13.49%, a specificity of 4.8 and 100%, a positive predictive value of 49,15 and 100%, and a negative predictive value of 35.29 and 53.42%, respectively. The triggers with more predictive power in AE detection were «antiemetic administration» and «calcium administration». CONCLUSIONS Trigger tool shows higher sensitivity for detecting AE than the MBDS. All the detected AE were considered low severity and most of them were preventable.
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Affiliation(s)
| | - P Ruiz López
- Unidad de Calidad, Hospital Universitario 12 de Octubre, Madrid, España
| | - A I Pérez Zapata
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario 12 de Octubre, Madrid, España.
| | - A Gómez de la Cámara
- Unidad de Apoyo a la Investigación, Hospital Universitario 12 de Octubre, Madrid, España
| | - F de la Cruz Vigo
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario 12 de Octubre, Madrid, España
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Silva MDDG, Martins MAP, Viana LDG, Passaglia LG, de Menezes RR, Oliveira JADQ, da Silva JLP, Ribeiro ALP. Evaluation of accuracy of IHI Trigger Tool in identifying adverse drug events: a prospective observational study. Br J Clin Pharmacol 2018; 84:2252-2259. [PMID: 29874704 PMCID: PMC6138496 DOI: 10.1111/bcp.13665] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/27/2018] [Accepted: 05/31/2018] [Indexed: 11/28/2022] Open
Abstract
AIMS Adverse drug events (ADEs) can seriously compromise the safety and quality of care provided to hospitalized patients, requiring the adoption of accurate methods to monitor them. We sought to prospectively evaluate the accuracy of the triggers proposed by the Institute for Healthcare Improvement (IHI) for identifying ADEs. METHODS A prospective study was conducted in a public university hospital in 2015 with patients over the age of 18. Triggers proposed by IHI and clinical alterations suspected to be ADEs were searched daily. The number of days in which the patient was hospitalized was considered as unit of measure to evaluate the accuracy of each trigger. RESULTS A total of 300 patients were included in this study. Mean age was 56.3 years (standard deviation (SD) 16.0), and 154 (51.3%) were female. The frequency of patients with ADEs was 24.7% and with at least one trigger was 53.3%. From those patients who had at least one trigger, the most frequent triggers were antiemetics (57.5%) and 'abrupt medication stop' (31.8%). The sensitivity of triggers ranged from 0.3 to 11.8% and the positive predictive value ranged from 1.2 to 27.3%. Specificity and negative predictive value were greater than 86%. Most patients identified by the presence of triggers did not have ADEs (64.4%). No triggers were identified in 40 (38.5%) ADEs. CONCLUSIONS IHI Trigger Tool did not show good accuracy in detecting ADEs in this prospective study. The adoption of combined strategies could enhance effectiveness in identifying patient safety flaws. Further discussion might contribute to improve trigger usefulness in clinical practice.
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Affiliation(s)
- Maria das Dores Graciano Silva
- Hospital das ClínicasUniversidade Federal de Minas GeraisAv. Prof. Alfredo Balena, 110, Santa EfigêniaBelo HorizonteMinas Gerais30130‐100Brazil
- Faculdade de MedicinaUniversidade Federal de Minas GeraisAv. Prof. Alfredo Balena, 190, Santa EfigêniaBelo HorizonteMinas Gerais30130‐100Brazil
| | - Maria Auxiliadora Parreiras Martins
- Hospital das ClínicasUniversidade Federal de Minas GeraisAv. Prof. Alfredo Balena, 110, Santa EfigêniaBelo HorizonteMinas Gerais30130‐100Brazil
- Faculdade de MedicinaUniversidade Federal de Minas GeraisAv. Prof. Alfredo Balena, 190, Santa EfigêniaBelo HorizonteMinas Gerais30130‐100Brazil
- Faculdade de FarmáciaUniversidade Federal de Minas GeraisAv. Pres. Antônio Carlos, 6627, PampulhaBelo HorizonteMinas Gerais31270‐901Brazil
| | - Luciana de Gouvêa Viana
- Hospital das ClínicasUniversidade Federal de Minas GeraisAv. Prof. Alfredo Balena, 110, Santa EfigêniaBelo HorizonteMinas Gerais30130‐100Brazil
- Faculdade de MedicinaUniversidade Federal de Minas GeraisAv. Prof. Alfredo Balena, 190, Santa EfigêniaBelo HorizonteMinas Gerais30130‐100Brazil
| | - Luiz Guilherme Passaglia
- Hospital das ClínicasUniversidade Federal de Minas GeraisAv. Prof. Alfredo Balena, 110, Santa EfigêniaBelo HorizonteMinas Gerais30130‐100Brazil
- Faculdade de MedicinaUniversidade Federal de Minas GeraisAv. Prof. Alfredo Balena, 190, Santa EfigêniaBelo HorizonteMinas Gerais30130‐100Brazil
| | - Renata Rezende de Menezes
- Hospital das ClínicasUniversidade Federal de Minas GeraisAv. Prof. Alfredo Balena, 110, Santa EfigêniaBelo HorizonteMinas Gerais30130‐100Brazil
- Faculdade de MedicinaUniversidade Federal de Minas GeraisAv. Prof. Alfredo Balena, 190, Santa EfigêniaBelo HorizonteMinas Gerais30130‐100Brazil
| | - João Antonio de Queiroz Oliveira
- Hospital das ClínicasUniversidade Federal de Minas GeraisAv. Prof. Alfredo Balena, 110, Santa EfigêniaBelo HorizonteMinas Gerais30130‐100Brazil
- Faculdade de MedicinaUniversidade Federal de Minas GeraisAv. Prof. Alfredo Balena, 190, Santa EfigêniaBelo HorizonteMinas Gerais30130‐100Brazil
| | - Jose Luiz Padilha da Silva
- Hospital das ClínicasUniversidade Federal de Minas GeraisAv. Prof. Alfredo Balena, 110, Santa EfigêniaBelo HorizonteMinas Gerais30130‐100Brazil
- Faculdade de MedicinaUniversidade Federal de Minas GeraisAv. Prof. Alfredo Balena, 190, Santa EfigêniaBelo HorizonteMinas Gerais30130‐100Brazil
| | - Antonio Luiz Pinho Ribeiro
- Hospital das ClínicasUniversidade Federal de Minas GeraisAv. Prof. Alfredo Balena, 110, Santa EfigêniaBelo HorizonteMinas Gerais30130‐100Brazil
- Faculdade de MedicinaUniversidade Federal de Minas GeraisAv. Prof. Alfredo Balena, 190, Santa EfigêniaBelo HorizonteMinas Gerais30130‐100Brazil
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Toribio-Vicente MJ, Chalco-Orrego JP, Díaz-Redondo A, Llorente-Parrado C, Plá-Mestre R. [Detection of adverse events using trigger tools in 2hospital units in Spain]. J Healthc Qual Res 2018; 33:199-205. [PMID: 31610975 DOI: 10.1016/j.jhqr.2018.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 05/08/2018] [Accepted: 05/23/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Adverse events (AE) related to health care are frequent due to the nature of this activity, and for this reason, it is necessary to develop methods to detect them and prevent their recurrence. One of these methods uses what are called trigger tools, which are markers that allow AE to be identified retrospectively for subsequent analysis. OBJECTIVES To evaluate the usefulness of a trigger tools system to detect AE related to patient safety in Internal Medicine and General Surgery units of a tertiary referral hospital. As secondary objectives, measurements were made of the rate of AE, its prevalence in admissions, as well as a description of the different types of AE, and to evaluate the time spent using this tool. MATERIAL AND METHODS A retrospective descriptive study of patients admitted to the units of Internal Medicine and General Surgery and discharged during 2016. Inclusion criteria were hospital stay over 24h and the presence of a complete clinical record of the studied acute episode. Patients admitted to short-stay units were excluded. A verification questionnaire was designed to registry key study variables and associated AE. RESULTS The study included 118 patients from Internal Medicine and 115 from General Surgery. The presence of at least one trigger was detected in 86 (72.9%) Internal Medicine and 56 (48.7%) General Surgery patients. Of these, 13 (15.1%) were associated with the presence of an AE in Internal Medicine and 34 (60.7%) in General Surgery. The trigger tool system failed to detect 7 AE, 4 of them in Internal Medicine. The median of triggers identified in each patient was 1.5 (IQR p25-p75: 1-2.5) in Internal Medicine and 2 (IQR p25-p75: 1-4) in General Surgery. In total, 262 positive triggers were detected, of which 157 corresponded to Internal Medicine, most of them related to early emergency re-admission after discharge. Most of the identified AEs required re-hospitalisation or extending the length of stay. CONCLUSIONS Trigger tools systems are useful for the detection and characterisation of AE, which helps to analyse and implement improvement measures.
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Affiliation(s)
- M José Toribio-Vicente
- Servicio de Medicina Preventiva y Gestión de Calidad, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - Juan Pablo Chalco-Orrego
- Servicio de Medicina Preventiva y Gestión de Calidad, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Alicia Díaz-Redondo
- Servicio de Medicina Preventiva y Gestión de Calidad, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - César Llorente-Parrado
- Servicio de Medicina Preventiva y Gestión de Calidad, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Rosa Plá-Mestre
- Servicio de Medicina Preventiva y Gestión de Calidad, Hospital General Universitario Gregorio Marañón, Madrid, España
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[Performance and optimisation of a trigger tool for the detection of adverse events in hospitalised adult patients]. GACETA SANITARIA 2017; 31:453-458. [PMID: 28545741 DOI: 10.1016/j.gaceta.2017.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 01/23/2017] [Accepted: 01/24/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To characterise the performance of the triggers used in the detection of adverse events (AE) of hospitalised adult patients and to define a simplified panel of triggers to facilitate the detection of AE. METHOD Cross-sectional study of charts of patients from a service of internal medicine to detect EA through systematic review of the charts and identification of triggers (clinical event often related to AE), determining if there was AE as the context in which it appeared the trigger. Once the EA was detected, we proceeded to the characterization of the triggers that detected it. Logistic regression was applied to select the triggers with greater AE detection capability. RESULTS A total of 291 charts were reviewed, with a total of 562 triggers in 103 patients, of which 163 were involved in detecting an AE. The triggers that detected the most AE were "A.1. Pressure ulcer" (9.82%), "B.5. Laxative or enema" (8.59%), "A.8. Agitation" (8.59%), "A.9. Over-sedation" (7.98%), "A.7. Haemorrhage" (6.75%) and "B.4. Antipsychotic" (6.75%). A simplified model was obtained using logistic regression, and included the variable "Number of drugs" and the triggers "Over-sedation", "Urinary catheterisation", "Readmission in 30 days", "Laxative or enema" and "Abrupt medication stop". This model showed a probability of 81% to correctly classify charts with EA or without EA (p <0.001; 95% confidence interval: 0.763-0.871). CONCLUSIONS A high number of triggers were associated with AE. The summary model is capable of detecting a large amount of AE, with a minimum of elements.
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