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Domingues ÍP, Costa MRD. [Update of triggers for detection of adverse drug events in hematologic patients]. CAD SAUDE PUBLICA 2023; 39:e00077923. [PMID: 38126560 PMCID: PMC10740396 DOI: 10.1590/0102-311xpt077923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/10/2023] [Accepted: 08/21/2023] [Indexed: 12/23/2023] Open
Abstract
The use of triggers for the active search and detection of adverse drug events (ADEs) has been gaining ground within pharmacovigilance services. Thus, the main objective of the study was to propose a new list of triggers to be used in a center specialized in hematology in Rio de Janeiro, Brazil. The update of the list of triggers consisted of revising the current list, with the exclusion and inclusion of new triggers. To verify the performance of the new list of triggers, a cross-sectional study was conducted in which the new triggers were used to investigate the occurrence of ADEs in patients attended in the emergency unit or hospitalized from January to March 2022. For each suspected ADEs, the patient's profile and adverse drug reactions (ADRs) were characterized regarding causality and severity. The performance of the triggers and their ability to capture ADEs were estimated using the following indicators: frequency of the trigger per 100 medical records, frequency of ADEs per 100 records, and positive predictive value (PPV). To evaluate the overall performance of the proposed new list, the PPV was estimated. A total of 374 prescriptions for triggers were identified in 186 medical records. The most efficient in the detection of possible ADEs were: lidocaine, loperamide, bisacodyl, filgrastim and glycerin clyster. The overall PPV of the new suggested list was 48% versus 10% of the previous list. This study demonstrated the importance of an updated list of triggers for the monitoring of ADEs and improvement of the care provided.
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Affiliation(s)
- Íris Pilegi Domingues
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
- Instituto Estadual de Hematologia Arthur de Siqueira Cavalcanti, Rio de Janeiro, Brasil
| | - Milene Rangel da Costa
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
- Instituto Nacional de Cardiologia, Rio de Janeiro, Brasil
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Scarpis E, Cautero P, Tullio A, Mellace F, Farneti F, Londero C, Cocconi R, Brunelli L. Are adverse events related to the completeness of clinical records? Results from a retrospective records review using the Global Trigger Tool. Int J Qual Health Care 2023; 35:mzad094. [PMID: 37952101 DOI: 10.1093/intqhc/mzad094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 09/15/2023] [Accepted: 11/09/2023] [Indexed: 11/14/2023] Open
Abstract
Clinical record (CR) is a tool for recording details about the patient and the most commonly used source of information for detecting adverse events (AEs). Its completeness is an indicator of the quality of care provided and may provide clues for improving professional practice. The primary aim of this study was to estimate the prevalence of AEs. The secondary aims were to determine the completeness of CRs and to examine the relationship between the two variables. We retrospectively reviewed randomly selected CRs of patients discharged from the Academic Hospital of Udine (Italy) in the departments of general surgery, internal medicine, and obstetrics between July and September 2020. Evaluation was performed using the Global Trigger Tool and a checklist to evaluate the completeness of CRs. The relationship between the occurrence of AEs and the completeness of CRs was analyzed using nonparametric tests. A binomial logistic regression analysis was also performed. We reviewed 291 CRs and identified 368 triggers and 56 AEs. Among them, 16.2% of hospitalizations were affected by at least one AE, with a higher percentage in general surgery. The most common AEs were surgical injuries (42.6%; 24) and care related (26.8%; 15). A significant positive correlation was found between the length of hospital stay and the number of AEs. The average completeness of CRs was 72.9% and was lower in general surgery. The decrease in CR completeness correlated with the increase in the total number of AEs (R = -0.14; P = .017), although this was not confirmed by regression analysis by individual departments. Our results seem to suggest that completeness of CRs may benefit patient safety, so ongoing education and involvement of health professionals are needed to maintain professional adherence to CRs.
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Affiliation(s)
- Enrico Scarpis
- Dipartimento di Area Medica, Università degli Studi di Udine, Udine 33100, Italia
| | - Peter Cautero
- Dipartimento di Area Medica, Università degli Studi di Udine, Udine 33100, Italia
| | - Annarita Tullio
- SOC Istituto di Igiene ed Epidemiologia Valutativa, Azienda Sanitaria Universitaria Friuli Centrale, Udine 33100, Italia
| | - Flavio Mellace
- Dipartimento di Area Medica, Università degli Studi di Udine, Udine 33100, Italia
| | - Federico Farneti
- SOC Rischio Clinico, Qualità e Accreditamento, Azienda Sanitaria Universitaria Friuli Centrale, Udine 33100, Italia
| | - Carla Londero
- SOC Rischio Clinico, Qualità e Accreditamento, Azienda Sanitaria Universitaria Friuli Centrale, Udine 33100, Italia
| | - Roberto Cocconi
- SOC Rischio Clinico, Qualità e Accreditamento, Azienda Sanitaria Universitaria Friuli Centrale, Udine 33100, Italia
| | - Laura Brunelli
- Dipartimento di Area Medica, Università degli Studi di Udine, Udine 33100, Italia
- SOC Rischio Clinico, Qualità e Accreditamento, Azienda Sanitaria Universitaria Friuli Centrale, Udine 33100, Italia
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Lattard C, Baudouin A, Larbre V, Herledan C, Cerutti A, Cerfon MA, Kimbidima R, Caffin AG, Vantard N, Schwiertz V, Ranchon F, Rioufol C. Clinical and economic impact of clinical oncology pharmacy in cancer patients receiving injectable anticancer treatments: a systematic review. J Cancer Res Clin Oncol 2023; 149:7905-7924. [PMID: 36853384 DOI: 10.1007/s00432-023-04630-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 02/01/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Clinical pharmacy can reduce drug-related iatrogenesis by improving the management of adverse effects of drugs, limiting drug-drug interactions, and improving patient adherence. Given the vulnerability of cancer patients and the toxicity of injectable anticancer drugs, clinical pharmacy service (CPS) could provide a significant clinical benefit in cancer care. This review aims to synthesize existing evidence on clinical pharmacy's impact on patients treated with intravenous anticancer drugs. METHODS A comprehensive search was performed in the PubMed/Medline database from January 2000 to December 2021, associating the keywords: clinical pharmacy, pharmaceutical care, pharmacist, oncology, and chemotherapy. To be eligible for inclusion, studies have to report clinical pharmaceutical services for patients treated with intravenous chemotherapy with a clinical and/or economic impact. RESULTS Forty-one studies met the selection criteria. Various CPS were reported: medication reconciliation, medication review, and pharmaceutical interview with patient. There was a lack of randomized study (n = 3; 7.3%). In one randomized controlled trial, pharmaceutical intervention significantly improved quality of life of patients receiving pharmaceutical care during injectable anticancer drugs courses. Economical results appear to show positive impact of clinical pharmacy with cost savings reported from 3112.87$ to 249 844€. Although most studies were non-comparative, they highlighted that clinical pharmacy tend to limit chemotherapy side effects and drug-related problems, improve quality of life and satisfaction of patients and healthcare professional, and a positive economic impact. CONCLUSION Clinical pharmacy can reduce adverse drug events in cancer patients. More robust and economic evaluations are still required to support its development in everyday practice.
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Affiliation(s)
- Claire Lattard
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Amandine Baudouin
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Virginie Larbre
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
- Université Lyon 1- EA 3738, CICLY Centre Pour l'Innovation en Cancérologie de Lyon, 69921, Lyon, Oullins Cedex, France
| | - Chloé Herledan
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
- Université Lyon 1- EA 3738, CICLY Centre Pour l'Innovation en Cancérologie de Lyon, 69921, Lyon, Oullins Cedex, France
| | - Ariane Cerutti
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Marie-Anne Cerfon
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Reine Kimbidima
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Anne-Gaelle Caffin
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Nicolas Vantard
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Vérane Schwiertz
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Florence Ranchon
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
- Université Lyon 1- EA 3738, CICLY Centre Pour l'Innovation en Cancérologie de Lyon, 69921, Lyon, Oullins Cedex, France
| | - Catherine Rioufol
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France.
- Université Lyon 1- EA 3738, CICLY Centre Pour l'Innovation en Cancérologie de Lyon, 69921, Lyon, Oullins Cedex, France.
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Hibbert PD, Molloy CJ, Schultz TJ, Carson-Stevens A, Braithwaite J. Comparing rates of adverse events detected in incident reporting and the Global Trigger Tool: a systematic review. Int J Qual Health Care 2023; 35:mzad056. [PMID: 37440353 PMCID: PMC10367579 DOI: 10.1093/intqhc/mzad056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 06/21/2023] [Accepted: 07/11/2023] [Indexed: 07/15/2023] Open
Abstract
Many hospitals continue to use incident reporting systems (IRSs) as their primary patient safety data source. The information IRSs collect on the frequency of harm to patients [adverse events (AEs)] is generally of poor quality, and some incident types (e.g. diagnostic errors) are under-reported. Other methods of collecting patient safety information using medical record review, such as the Global Trigger Tool (GTT), have been developed. The aim of this study was to undertake a systematic review to empirically quantify the gap between the percentage of AEs detected using the GTT to those that are also detected via IRSs. The review was conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies published in English, which collected AE data using the GTT and IRSs, were included. In total, 14 studies met the inclusion criteria. All studies were undertaken in hospitals and were published between 2006 and 2022. The studies were conducted in six countries, mainly in the USA (nine studies). Studies reviewed 22 589 medical records using the GTT across 107 institutions finding 7166 AEs. The percentage of AEs detected using the GTT that were also detected in corresponding IRSs ranged from 0% to 37.4% with an average of 7.0% (SD 9.1; median 3.9 and IQR 5.2). Twelve of the fourteen studies found <10% of the AEs detected using the GTT were also found in corresponding IRSs. The >10-fold gap between the detection rates of the GTT and IRSs is strong evidence that the rate of AEs collected in IRSs in hospitals should not be used to measure or as a proxy for the level of safety of a hospital. IRSs should be recognized for their strengths which are to detect rare, serious, and new incident types and to enable analysis of contributing and contextual factors to develop preventive and corrective strategies. Health systems should use multiple patient safety data sources to prioritize interventions and promote a cycle of action and improvement based on data rather than merely just collecting and analysing information.
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Affiliation(s)
- Peter D Hibbert
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Macquarie Park, New South Wales 2109, Australia
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, GPO Box 2471, Adelaide, South Australia 5001, Australia
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia 5000, Australia
| | - Charlotte J Molloy
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Macquarie Park, New South Wales 2109, Australia
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, GPO Box 2471, Adelaide, South Australia 5001, Australia
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia 5000, Australia
| | - Timothy J Schultz
- Flinders Health and Medical Research Institute, Flinders University, Sturt Rd, Bedford Park 5042, South Australia, Australia
| | - Andrew Carson-Stevens
- PRIME Centre Wales & Division of Population Medicine, Cardiff University, Heath Park, Cardiff, Wales CF14 4XN, United Kingdom
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Macquarie Park, New South Wales 2109, Australia
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Eggenschwiler LC, Rutjes AWS, Musy SN, Ausserhofer D, Nielen NM, Schwendimann R, Unbeck M, Simon M. Variation in detected adverse events using trigger tools: A systematic review and meta-analysis. PLoS One 2022; 17:e0273800. [PMID: 36048863 PMCID: PMC9436152 DOI: 10.1371/journal.pone.0273800] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 08/15/2022] [Indexed: 11/19/2022] Open
Abstract
Background Adverse event (AE) detection is a major patient safety priority. However, despite extensive research on AEs, reported incidence rates vary widely. Objective This study aimed: (1) to synthesize available evidence on AE incidence in acute care inpatient settings using Trigger Tool methodology; and (2) to explore whether study characteristics and study quality explain variations in reported AE incidence. Design Systematic review and meta-analysis. Methods To identify relevant studies, we queried PubMed, EMBASE, CINAHL, Cochrane Library and three journals in the patient safety field (last update search 25.05.2022). Eligible publications fulfilled the following criteria: adult inpatient samples; acute care hospital settings; Trigger Tool methodology; focus on specialty of internal medicine, surgery or oncology; published in English, French, German, Italian or Spanish. Systematic reviews and studies addressing adverse drug events or exclusively deceased patients were excluded. Risk of bias was assessed using an adapted version of the Quality Assessment Tool for Diagnostic Accuracy Studies 2. Our main outcome of interest was AEs per 100 admissions. We assessed nine study characteristics plus study quality as potential sources of variation using random regression models. We received no funding and did not register this review. Results Screening 6,685 publications yielded 54 eligible studies covering 194,470 admissions. The cumulative AE incidence was 30.0 per 100 admissions (95% CI 23.9–37.5; I2 = 99.7%) and between study heterogeneity was high with a prediction interval of 5.4–164.7. Overall studies’ risk of bias and applicability-related concerns were rated as low. Eight out of nine methodological study characteristics did explain some variation of reported AE rates, such as patient age and type of hospital. Also, study quality did explain variation. Conclusion Estimates of AE studies using trigger tool methodology vary while explaining variation is seriously hampered by the low standards of reporting such as the timeframe of AE detection. Specific reporting guidelines for studies using retrospective medical record review methodology are necessary to strengthen the current evidence base and to help explain between study variation.
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Affiliation(s)
- Luisa C. Eggenschwiler
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Anne W. S. Rutjes
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Sarah N. Musy
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Dietmar Ausserhofer
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
- College of Health Care-Professions Claudiana, Bozen-Bolzano, Italy
| | - Natascha M. Nielen
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - René Schwendimann
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
- Patient Safety Office, University Hospital Basel, Basel, Switzerland
| | - Maria Unbeck
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Michael Simon
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
- * E-mail:
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Zhang N, Pan LY, Chen WY, Ji HH, Peng GQ, Tang ZW, Wang HL, Jia YT, Gong J. A Risk-Factor Model for Antineoplastic Drug-Induced Serious Adverse Events in Cancer Inpatients: A Retrospective Study Based on the Global Trigger Tool and Machine Learning. Front Pharmacol 2022; 13:896104. [PMID: 35847000 PMCID: PMC9277092 DOI: 10.3389/fphar.2022.896104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
The objective of this study was to apply a machine learning method to evaluate the risk factors associated with serious adverse events (SAEs) and predict the occurrence of SAEs in cancer inpatients using antineoplastic drugs. A retrospective review of the medical records of 499 patients diagnosed with cancer admitted between January 1 and December 31, 2017, was performed. First, the Global Trigger Tool (GTT) was used to actively monitor adverse drug events (ADEs) and SAEs caused by antineoplastic drugs and take the number of positive triggers as an intermediate variable. Subsequently, risk factors with statistical significance were selected by univariate analysis and least absolute shrinkage and selection operator (LASSO) analysis. Finally, using the risk factors after the LASSO analysis as covariates, a nomogram based on a logistic model, extreme gradient boosting (XGBoost), categorical boosting (CatBoost), adaptive boosting (AdaBoost), light-gradient-boosting machine (LightGBM), random forest (RF), gradient-boosting decision tree (GBDT), decision tree (DT), and ensemble model based on seven algorithms were used to establish the prediction models. A series of indicators such as the area under the ROC curve (AUROC) and the area under the PR curve (AUPR) was used to evaluate the model performance. A total of 94 SAE patients were identified in our samples. Risk factors of SAEs were the number of triggers, length of stay, age, number of combined drugs, ADEs occurred in previous chemotherapy, and sex. In the test cohort, a nomogram based on the logistic model owns the AUROC of 0.799 and owns the AUPR of 0.527. The GBDT has the best predicting abilities (AUROC = 0.832 and AUPR = 0.557) among the eight machine learning models and was better than the nomogram and was chosen to establish the prediction webpage. This study provides a novel method to accurately predict SAE occurrence in cancer inpatients.
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Affiliation(s)
- Ni Zhang
- National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Department of Pharmacy, Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- School of Pharmacy, Chongqing Medical University, Chongqing, China
| | - Ling-Yun Pan
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing, China
| | - Wan-Yi Chen
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing, China
| | - Huan-Huan Ji
- National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Department of Pharmacy, Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Gui-Qin Peng
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing, China
| | - Zong-Wei Tang
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing, China
| | - Hui-Lai Wang
- Department of Information Center, The University Town Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Yun-Tao Jia, ; Hui-Lai Wang, ; Jun Gong,
| | - Yun-Tao Jia
- National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Department of Pharmacy, Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- School of Pharmacy, Chongqing Medical University, Chongqing, China
- *Correspondence: Yun-Tao Jia, ; Hui-Lai Wang, ; Jun Gong,
| | - Jun Gong
- Department of Information Center, The University Town Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Yun-Tao Jia, ; Hui-Lai Wang, ; Jun Gong,
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Vázquez-Cornejo E, Morales-Ríos O, Hernández-Pliego G, Cicero-Oneto C, Garduño-Espinosa J. Incidence, severity, and preventability of adverse events during the induction of patients with acute lymphoblastic leukemia in a tertiary care pediatric hospital in Mexico. PLoS One 2022; 17:e0265450. [PMID: 35324939 PMCID: PMC8947076 DOI: 10.1371/journal.pone.0265450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/01/2022] [Indexed: 11/18/2022] Open
Abstract
Healthcare-associated adverse events represent a heavy burden of symptoms for pediatric oncology patients. Their description allows knowing the safety and quality of the care processes in countries with limited resources. This study aimed to describe the incidence, types, severity, and preventability of adverse events occurring in pediatric patients with acute lymphoblastic leukemia during the induction phase in a tertiary care pediatric hospital in Mexico. This study analyzed a cohort based on medical records of between 2015 and 2017. Initially, information on patients and adverse events was collected; subsequently, two pediatric oncologist reviewers independently classified adverse events, severity and preventability. Agreement between reviewers was evaluated. Adverse events incidence rates were estimated by type, severity, and preventability. One-hundred and eighty-one pediatric patients pediatric patients with acute lymphoblastic leukemia were studied. An overall adverse events rate of 51.8 per 1000 patient-days was estimated, involving 81.2% of patients during induction. Most adverse events were severe or higher (52.6%). Infectious processes were the most common severe or higher adverse event (30.5%). The presence of adverse events caused 80.2% of hospital readmissions. Of the adverse events, 10.5% were considered preventable and 53.6% could be ameliorable in severity. Improving the safety and quality of the care processes of children with acute lymphoblastic leukemia is possible, and this should contribute to the mitigation and prevention of adverse events associated morbidity and mortality during the remission induction phase.
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Affiliation(s)
- Edmundo Vázquez-Cornejo
- Department of Drug Assessment and Pharmacovigilance, Federico Gómez Children’s Hospital of Mexico, Mexico City, Mexico
- * E-mail:
| | - Olga Morales-Ríos
- Department of Drug Assessment and Pharmacovigilance, Federico Gómez Children’s Hospital of Mexico, Mexico City, Mexico
| | | | - Carlo Cicero-Oneto
- Department of Hemato-oncology, Federico Gómez Children’s Hospital of Mexico, Mexico City, Mexico
| | - Juan Garduño-Espinosa
- Department of Research, Federico Gómez Children’s Hospital of Mexico, Mexico City, Mexico
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Nowak B, Schwendimann R, Lyrer P, Bonati LH, De Marchis GM, Peters N, Zúñiga F, Saar L, Unbeck M, Simon M. Occurrence of No-Harm Incidents and Adverse Events in Hospitalized Patients with Ischemic Stroke or TIA: A Cohort Study Using Trigger Tool Methodology. IJERPH 2022; 19:ijerph19052796. [PMID: 35270487 PMCID: PMC8910044 DOI: 10.3390/ijerph19052796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 12/04/2022]
Abstract
Adverse events (AEs)—healthcare caused events leading to patient harm or even death—are common in healthcare. Although it is a frequently investigated topic, systematic knowledge on this phenomenon in stroke patients is limited. To determine cumulative incidence of no-harm incidents and AEs, including their severity and preventability, a cohort study using trigger tool methodology for retrospective record review was designed. The study was carried out in a stroke center at a university hospital in the German speaking part of Switzerland. Electronic records from 150 randomly selected patient admissions for transient ischemic attack (TIA) or ischemic stroke, with or without acute recanalization therapy, were used. In total, 170 events (108 AEs and 62 no-harm incidents) were identified, affecting 83 patients (55.3%; 95% CI 47 to 63.4), corresponding to an event rate of 113 events/100 admissions or 142 events/1000 patient days. The three most frequent AEs were ischemic strokes (n = 12, 7.1%), urinary tract infections (n = 11, 6.5%) and phlebitis (n = 10, 5.9%). The most frequent no-harm incidents were medication events (n = 37, 21.8%). Preventability ranged from 12.5% for allergic reactions to 100% for medication events and pressure ulcers. Most of the events found (142; 83.5%; 95% CI 76.9 to 88.6) occurred throughout the whole stroke care. The remaining 28 events (16.5%; 95% CI 11.4 to 23.1) were detected during stroke care but were related to care outside the stroke pathway. Trigger tool methodology allows detection of AEs and no-harm incidents, showing a frequent occurrence of both event types in stroke and TIA patients. Further investigations into events’ relationships with organizational systems and processes will be needed, first to achieve a better understanding of these events’ underlying mechanisms and risk factors, then to determine efforts needed to improve patient safety.
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Affiliation(s)
- Bartosch Nowak
- Department Head Organs, Spine- and Neuromedicine, University Hospital Basel, 4031 Basel, Switzerland;
| | - René Schwendimann
- Patient Safety Office, University Hospital Basel, 4031 Basel, Switzerland;
- Institute of Nursing Science, University of Basel, 4031 Basel, Switzerland;
| | - Philippe Lyrer
- Department of Neurology and Stroke Center, University Hospital and University of Basel, 4031 Basel, Switzerland; (P.L.); (L.H.B.); (G.M.D.M.); (N.P.)
| | - Leo H. Bonati
- Department of Neurology and Stroke Center, University Hospital and University of Basel, 4031 Basel, Switzerland; (P.L.); (L.H.B.); (G.M.D.M.); (N.P.)
| | - Gian Marco De Marchis
- Department of Neurology and Stroke Center, University Hospital and University of Basel, 4031 Basel, Switzerland; (P.L.); (L.H.B.); (G.M.D.M.); (N.P.)
| | - Nils Peters
- Department of Neurology and Stroke Center, University Hospital and University of Basel, 4031 Basel, Switzerland; (P.L.); (L.H.B.); (G.M.D.M.); (N.P.)
| | - Franziska Zúñiga
- Institute of Nursing Science, University of Basel, 4031 Basel, Switzerland;
| | - Lili Saar
- Department of Neurology, Universitätsklinik Freiburg, 79106 Freiburg im Breisgau, Germany;
| | - Maria Unbeck
- School of Health and Welfare, Dalarna University, 79131 Falun, Sweden;
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Michael Simon
- Institute of Nursing Science, University of Basel, 4031 Basel, Switzerland;
- Correspondence: ; Tel.: +41-61-207-09-12
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