Development and Implementation of an e-Trigger Tool for Adverse Drug Events in a Swiss University Hospital

ObjectivesTimely recognition of medication misuse and dependence is crucial to avoid both adverse drug events and increasing health expenditure. Yet the detection of these disorders in older people remains challenging due to the paucity of evidence on characteristics of patients at risk. This study investigates sociodemographic, pharmacological and clinical characteristics and factors associated with prolonged medication use, misuse and dependence in hospitalised older patients, focusing on three commonly prescribed central nervous system depressants (CNSDs): opioid analgesics, benzodiazepines and z-hypnotics.DesignA prospective, cross-sectional study complying with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines.SettingSomatic departments of the Akershus University Hospital, Norway.Participants246 patients aged 65–90 were included.Outcome measuresProlonged use was defined as using CNSDs for ≥4 weeks. Misuse and dependence were assessed with the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria for substance abuse and dependence. We used descriptive statistics to report patients’ characteristics and logistic regression to demonstrate factors associated with prolonged use, and misuse or dependence.ResultsForty per cent of participants reported using CNSDs for ≥4 weeks. The odds of prolonged use were higher for patients aged 75–84 (OR=2.32, 95% CI 1.16 to 4.65) and ≥85 (OR=3.33, 95% CI 1.25 to 8.87) vs <75 years, for pain intensity (OR=1.02, 95% CI 1.01 to 1.04), and polypharmacy versus no polypharmacy (OR=5.16, 95% CI 2.13 to 12.55). The odds were lower for patients who completed secondary education (OR=0.33, 95% CI 0.13 to 0.83) compared with those with only basic education. Factors associated with misuse or dependence were pain intensity (OR=1.02, 95% CI 1.01 to 1.04) and concurrent use of ≥2 CNSDs (OR=3.99, 95% CI 1.34 to 11.88).ConclusionCNSD overuse is prevalent among hospitalised older patients, despite clear guidelines and recommendations. Our findings underline a need for stronger focus on responsible prescribing, timely detection and prevention of this issue, with special attention towards older patients, those with enhanced pain, polypharmacy and/or concurrent use of several CNSDs.Trial registration numberNCT03162081.

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Validating a Trigger Tool for Detecting Adverse Drug Events in Elderly Patients With Multimorbidity (TRIGGER-CHRON)

Journal of Patient Safety ◽

10.1097/pts.0000000000000552 ◽

2018 ◽

Vol Publish Ahead of Print ◽

Cited By ~ 2

Author(s):

María Dolores Toscano Guzmán ◽

Mercedes Galván Banqueri ◽

María José Otero ◽

Susana Sánchez Fidalgo ◽

Isabel Font Noguera ◽

...

Keyword(s):

Elderly Patients ◽

Adverse Drug Events ◽

Trigger Tool

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

BMC Pediatrics ◽

10.1186/s12887-020-02354-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Yi Liu ◽

Junfeng Yan ◽

Yunfei Xie ◽

Yuan Bian

Keyword(s):

Cohort Study ◽

Retrospective Review ◽

Retrospective Cohort ◽

Literature Search ◽

Adverse Drug Events ◽

Trigger Tool ◽

Trigger Rate ◽

Global Trigger Tool ◽

Pediatric Inpatient ◽

Grade 3

Abstract 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.

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

Journal of Clinical Nursing ◽

10.1111/jocn.12714 ◽

2014 ◽

Vol 24 (3-4) ◽

pp. 582-591 ◽

Cited By ~ 19

Author(s):

Marja Härkänen ◽

Marjo Kervinen ◽

Jouni Ahonen ◽

Ari Voutilainen ◽

Hannele Turunen ◽

...

Keyword(s):

Risk Factors ◽

Adverse Drug Events ◽

Patient Specific ◽

Trigger Tool ◽

Specific Risk ◽

Global Trigger Tool

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Characterisations of adverse events detected in a university hospital: a 4-year study using the Global Trigger Tool method

BMJ Open ◽

10.1136/bmjopen-2014-004879 ◽

2014 ◽

Vol 4 (5) ◽

pp. e004879 ◽

Cited By ~ 34

Author(s):

Hans Rutberg ◽

Madeleine Borgstedt Risberg ◽

Rune Sjödahl ◽

Pernilla Nordqvist ◽

Lars Valter ◽

...

Keyword(s):

Adverse Events ◽

University Hospital ◽

Trigger Tool ◽

Global Trigger Tool

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Adverse drug events in children during hospitalization and after discharge in a Norwegian University Hospital

Acta Paediatrica ◽

10.1111/j.1651-2227.2002.tb01647.x ◽

2007 ◽

Vol 91 (1) ◽

pp. 88-94 ◽

Cited By ~ 32

Author(s):

I Buajordet ◽

F Wesenberg ◽

O Brørs ◽

A Langslet

Keyword(s):

Adverse Drug Events ◽

University Hospital

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A Web-Based Clinical System for Cohort Surveillance of Specific Clinical Effectiveness and Safety Outcomes: A Cohort Study of Non–Vitamin K Antagonist Oral Anticoagulants and Warfarin

JMIR Medical Informatics ◽

10.2196/13329 ◽

2019 ◽

Vol 7 (3) ◽

pp. e13329 ◽

Cited By ~ 1

Author(s):

Fong-Ci Lin ◽

Shih-Tsung Huang ◽

Rung Ji Shang ◽

Chi-Chuan Wang ◽

Fei-Yuan Hsiao ◽

...

Keyword(s):

Ischemic Stroke ◽

Surveillance System ◽

Adverse Drug Events ◽

Medical Center ◽

Oral Anticoagulants ◽

Critical Role ◽

Clinical Effectiveness ◽

University Hospital ◽

Drug Surveillance ◽

Web Based

Background Conventional systems of drug surveillance lack a seamless workflow, which makes it crucial to have an active drug surveillance system that proactively assesses adverse drug events. Objective The aim of this study was to develop a seamless, Web-based workflow for comparing the safety and effectiveness of drugs in a database of electronic medical records. Methods We proposed a comprehensive integration process for cohort surveillance using the National Taiwan University Hospital Clinical Surveillance System (NCSS). We studied a practical application of the NCSS that evaluates the drug safety and effectiveness of novel oral anticoagulants (NOACs) and warfarin by cohort tree analysis in an efficient and interoperable platform. Results We demonstrated a practical example of investigating the differences in effectiveness and safety between NOACs and warfarin in patients with nonvalvular atrial fibrillation (AF) using the NCSS. We efficiently identified 2357 patients with nonvalvular AF with newly prescribed oral anticoagulants between 2010 and 2015 and further developed 1 main cohort and 2 subcohorts for separately measuring ischemic stroke as the clinical effectiveness outcome and intracranial hemorrhage (ICH) as the safety outcome. In the subcohort of ischemic stroke, NOAC users exhibited a significantly lower risk of ischemic stroke than warfarin users after adjusting for age, sex, comorbidity, and comedication in an intention-to-treat (ITT) analysis (P=.01) but did not exhibit a significantly distinct risk in an as-treated (AT) analysis (P=.12) after the 2-year follow-up. In the subcohort of ICH, NOAC users did not exhibit a different risk of ICH both in ITT (P=.68) and AT analyses (P=.15). Conclusions With a seamless and Web-based workflow, the NCSS can serve the critical role of forming associations between evidence and the real world at a medical center in Taiwan.

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‘Start smart’: using front-line ownership to improve the quality of empiric antibiotic prescribing in a paediatric hospital

BMJ Open Quality ◽

10.1136/bmjoq-2018-000445 ◽

2019 ◽

Vol 8 (3) ◽

pp. e000445

Author(s):

Robert Cunney ◽

Michelle Kirrane-Scott ◽

Aisling Rafferty ◽

Patrick Stapleton ◽

Ikechukwu Okafor ◽

...

Keyword(s):

Adverse Drug Events ◽

Point Of Care ◽

University Hospital ◽

Antibiotic Prescribing ◽

Front Line ◽

Improvement Project ◽

Paediatric Hospital ◽

Prescribing Quality ◽

Data Feedback ◽

Empiric Antibiotic

Infection is the most frequent indication for non-scheduled admission to paediatric hospitals, leading to high levels of empiric antibiotic prescribing. Antibiotic prescribing in line with local guidelines, improves patient outcomes, reduces adverse drug events and helps to reduce the emergence of antimicrobial resistance. We undertook an improvement project at Temple Street Children’s University Hospital targeting documentation of indication and compliance with empiric antibiotic prescribing guidelines among medical admissions via the emergency department (ED). Results of weekly audits of empiric antibiotic prescribing were fed back to prescribers. Front-line ownership techniques were used to empower prescribers to generate ideas for change, such as regular discussion of antibiotic prescribing issues at weekly clinical meetings, antibiotic ‘spot quiz’, updates to prescribing guidelines, improved access and promotion of a prescribing app, laminated guideline summary cards, and reminders and guideline summaries at a point of prescribing in ED. Documentation of indication and guideline compliance increased from a median of 30% in December 2014 to 100% in March 2015, and was sustained at 100% to September 2016, then 90% to December 2017. The intervention was associated with improvements in non-targeted indicators of prescribing quality, an overall reduction in antimicrobial consumption in the hospital, and a €105 000 reduction in annual antimicrobial acquisition costs. We found that a simple, paper-based, data collection system was effective, provided opportunities for a point-of-care interaction with prescribers, and facilitated weekly data feedback. We also found that using a pre-existing weekly clinical meeting to foster prescriber ownership of the data, allowing prescribers to identify possible tests of change, and exploiting the competitive nature of doctors, led to a rapid and sustained improvement in prescribing quality. Awareness of local prescribing processes and culture are essential to delivering improvements in antimicrobial stewardship.

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The patterns and burden of multimorbidity in geriatric patients with prolonged use of addictive medications

Aging Clinical and Experimental Research ◽

10.1007/s40520-021-01791-5 ◽

2021 ◽

Author(s):

Socheat Cheng ◽

Tahreem Ghazal Siddiqui ◽

Michael Gossop ◽

Torgeir Bruun Wyller ◽

Espen Saxhaug Kristoffersen ◽

...

Keyword(s):

Older Patients ◽

Geriatric Patients ◽

Adverse Drug Events ◽

Rating Scale ◽

Cross Sectional Study ◽

University Hospital ◽

Cross Sectional ◽

Multiple Substance ◽

The Relationship ◽

Addictive Drug

Abstract Background Multimorbidity and prolonged use of addictive medications are prevalent among older patients, and known to increase the risk of adverse drug events. Yet, the relationship between these two entities has remained understudied. Aims This study explored the association between multimorbidity burden and prolonged use of addictive medications in geriatric patients, adjusted for clinically important covariates. Furthermore, we identified comorbidity patterns in prolonged users. Methods We conducted a cross-sectional study on a consecutive sample of 246 patients, aged 65–90 years, admitted to a large public university hospital in Norway. We defined prolonged use of addictive medications as using benzodiazepines, opioids and/or z-hypnotics beyond the duration recommended by clinical guidelines (≥ 4 weeks). Multimorbidity was assessed with the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), based on diagnoses made by independent physicians. Results Compared to non-prolonged use, prolonged use was significantly more common among patients who had psychiatric (19/27, 70%), liver (19/22, 86%), upper gastrointestinal tract (21/32, 66%), musculoskeletal (52/96, 54%), or nervous system disorders (46/92, 50%). Patients with prolonged use had a higher multimorbidity burden than those without such use (CIRS-G score, mean = 7.7, SD = 2.7 versus mean = 4.6, SD = 2.2, p < 0.001). Multivariable logistic regression indicated a significant association between multimorbidity burden and prolonged addictive medication use (OR = 1.72, 95% CI 1.42–2.08). Predictive margins postestimation showed a systematic increase in the predicted CIRS-G scores when the number of addictive drug used increases. Conclusions Multimorbidity is strongly associated with prolonged use of addictive medications. Multiple substance use may aggravate disease burden of older patients.

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