Bryony Dean Franklin1, Sylvia Birch, Mike Schachter, Nick Barber. 1. Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust and The School of Pharmacy, University of London Imperial College London, London, UK. Bryony.DeanFranklin@imperial.nhs.uk
Abstract
OBJECTIVES: The aim was to adapt a US adverse drug event (ADE) trigger tool for UK use, and to establish its positive predictive value (PPV) and sensitivity in comparison to retrospective health record review for the identification of preventable ADEs, in a pilot study on one hospital ward. METHODS: An established US trigger tool was adapted for UK use. We applied it retrospectively to 207 patients' health records, following up positive triggers to identify any ADEs (both preventable and non-preventable). We compared the preventable ADEs to those identified using full health record review. KEY FINDINGS: We identified 168 positive triggers in 127 (61%) of 207 patients. Seven ADEs were identified, representing an ADE in 3.4% of patients or 0.7 ADEs per 100 patient days. Five were non-preventable adverse drug reactions and two were due to preventable errors. The prevalence of preventable ADEs was 1.0% of patients, or 0.2 per 100 patient days. The overall PPV was 0.04 for all ADEs, and 0.01 for preventable ADEs. PPVs for individual triggers varied widely. Five preventable ADEs were identified using health record review. The sensitivity of the trigger tool for identifying preventable ADEs was 0.40, when compared to health record review. CONCLUSIONS: Although we identified some ADEs using the trigger tool, more work is needed to further refine the trigger tool to reduce the false positives and increase sensitivity. To comprehensively identify preventable ADEs, retrospective health record review remains the gold standard and we found no efficiency gain in using the trigger tool.
OBJECTIVES: The aim was to adapt a US adverse drug event (ADE) trigger tool for UK use, and to establish its positive predictive value (PPV) and sensitivity in comparison to retrospective health record review for the identification of preventable ADEs, in a pilot study on one hospital ward. METHODS: An established US trigger tool was adapted for UK use. We applied it retrospectively to 207 patients' health records, following up positive triggers to identify any ADEs (both preventable and non-preventable). We compared the preventable ADEs to those identified using full health record review. KEY FINDINGS: We identified 168 positive triggers in 127 (61%) of 207 patients. Seven ADEs were identified, representing an ADE in 3.4% of patients or 0.7 ADEs per 100 patient days. Five were non-preventable adverse drug reactions and two were due to preventable errors. The prevalence of preventable ADEs was 1.0% of patients, or 0.2 per 100 patient days. The overall PPV was 0.04 for all ADEs, and 0.01 for preventable ADEs. PPVs for individual triggers varied widely. Five preventable ADEs were identified using health record review. The sensitivity of the trigger tool for identifying preventable ADEs was 0.40, when compared to health record review. CONCLUSIONS: Although we identified some ADEs using the trigger tool, more work is needed to further refine the trigger tool to reduce the false positives and increase sensitivity. To comprehensively identify preventable ADEs, retrospective health record review remains the gold standard and we found no efficiency gain in using the trigger tool.
Authors: Maria das Dores Graciano Silva; Maria Auxiliadora Parreiras Martins; Luciana de Gouvêa Viana; Luiz Guilherme Passaglia; Renata Rezende de Menezes; João Antonio de Queiroz Oliveira; Jose Luiz Padilha da Silva; Antonio Luiz Pinho Ribeiro Journal: Br J Clin Pharmacol Date: 2018-07-08 Impact factor: 4.335
Authors: Eveline B Boeker; Kim Ram; Joanna E Klopotowska; Monica de Boer; Montse Tuset Creus; Ana L de Andrés; Mio Sakuma; Takeshi Morimoto; Marja A Boermeester; Marcel G W Dijkgraaf Journal: Br J Clin Pharmacol Date: 2015-04 Impact factor: 4.335