Utilização do método Trigger Tool para identificação de reações adversas a medicamentos em um hospital privado de Cascavel - PR

A farmacovigilância é uma das responsabilidades do farmacêutico clínico, sendo que a implantação do método de identificação de gatilhos é uma maneira de evitar riscos à saúde do paciente e custos desnecessários ao sistema. Neste sentido, o presente trabalho tem como objetivo analisar a eficiência da farmacovigilância por meio do método Trigger Tool, implantado em um hospital privado de Cascavel, analisando ocorrência das principais reações adversas à medicamentos. A metodologia adotada para a elaboração deste material foi o estudo transversal retrospectivo, com coleta de dados por meio de relatórios manuais e também gerados pelo software Tasy. Ao final do estudo, foram identificadas 39 suspeitas de RAM, no qual a população estudada fora classificada como adultos com idade média 50,7 anos, com predominância do sexo feminino. O principal gatilho identificado foi o Metronidazol (16), seguido de Prometazina (13) e Hidrocortisona (10). Concluiu-se que o uso dos rastreadores se mostrou útil para a investigação, notificação e registro nos prontuários dos pacientes, ficando acessível para consultas e possíveis internamentos posteriores. Embora não possibilite a identificação da causa das RAM por conta da alta complexibilidade da farmacoterapia dos pacientes estudados.

Extemporaneous Compounding: A Possible Trigger Tool to Detect potentially health incidents

Background: Extemporaneous compounding (EC) involves preparation of a therapeutic product to a specific-patient need. However, there is a potential relation between this procedure and the occurrence of health incidents (HI). The use of triggers tool increases HI identification. Objective: This study assessed the performance of EC as trigger to detect potentially health incidents arising from this procedure. Method: A one-month observational and cross-sectional study was performed in internal medicine ward and intensive care unit of medium-sized hospital. Data collection was carried out in 5 stages: all triggered patients with dysphagia or enteral feeding tube with prescription of EC were included; it was observed all EC executed in standardized drugs prescribed; the procedure was compared with the hospital guide and scientific literature; HI monitoring and their evaluation using WHO and NCC MERP algorithms; a search for pharmaceutical alternatives (PA) that would avoid the observed EC. Results: 197 patients were recruited. Almost half of them were triggered by EC from 84 standardized drugs. 48 patients met inclusion criteria. It was identified 28 adverse drug reactions, 01 therapeutic ineffectiveness and 29 medication errors. EC as trigger tool showed a PPV value of 0.38. Finally, only 24 drugs have PA available in the market, that could avoid one third of all observed EC. Conclusion: It was possible to detect potentially HI in one of two patients with enteral feeding tube using EC as trigger tool. The use of EC as a trigger tool contributes to identify potentially HI arising from drugs, which have not gotten pharmaceutical alternatives to be administered via enteral feeding tube.

Adverse events in women giving birth in a labor ward: a retrospective record review study

Background Childbirth could negatively affect the woman’s health through adverse events. To prevent adverse events and increase patient safety it is important to detect and learn from them. The aim of the study was to describe adverse events, including the preventability and severity of harm during planned vaginal births, in women giving birth in the labor ward. Methods The study had a descriptive design with a retrospective birth record review to assess the preventability of adverse events using the Swedish version of the Global Trigger Tool. The setting was a labor ward in Sweden with low-risk and risk childbirths. Descriptive statistics, Pearson’s Chi-square test and Student’s t-test were used. Results A total of 38 adverse events (12.2%) were identified in 311 reviewed birth records. Of these, 28 (73.7%) were assessed as preventable. Third- or fourth-degree lacerations and distended urinary bladder were most prevalent together with anesthesia-related adverse events. The majority of the adverse events were classified into the harm categories of ‘prolonged hospital care’ (63.2%) and ‘temporary harm’ (31.6%). No permanent harm were identified, but over two-thirds of the adverse events were assessed as preventable. Conclusions This first study using Global Trigger Tool in a labor ward in Sweden identified a higher incidence of adverse events than previous studies in obstetric care. No permanent patient harm was found, but over two-thirds of the adverse events were assessed as preventable. The results draw particular attention to 3rd-or 4th-degree lacerations, distended urinary bladder and anesthesia-related adverse events. The feedback on identified adverse events should be used for systematic quality improvement and clinical recommendations how to prevent adverse events must be implemented.

Development and Validation of a Trigger Tool for Identifying Drug-Related Emergency Department Visits

There are various trigger tools for detecting adverse drug events (ADEs), however, a drug-related emergency department (ED) visit trigger tool (DrEDTT) has not yet been developed. We aimed to develop and validate a DrEDTT with a multi-center cohort. In this cross-sectional study, we developed the DrEDTT consisting of 28 triggers through a comprehensive literature review and three phase expert group discussion. Next, we evaluated the performance of the DrEDTT by applying it to relevant medical records retrieved from four hospitals from January 2016 to June 2016. Two experts performed an in-depth chart review of a 25% of random sample of trigger flagged and unflagged ED visits and a true ADE was determined through causality assessment. Among 66,564 patients who visited the ED for reasons other than traffic accident and trauma during the study period, at least one trigger was found in 21,268 (32.0%) patients. A total of 959 true ADE cases (5.8%) were identified from a randomly selected 25% of ED visit cases. The overall positive predictive value was 14.0% (range: 8.3–66.7%). Sensitivity and specificity of DrEDTT were 77.7% and 70.4%, respectively. In conclusion, this newly developed trigger tool might be helpful to detect ADE-related ED visits.

Evaluation of Performance of IHI Global Trigger Tool in Identification of Adverse Drug Events: A Prospective Observational Study

Aims: The study aims to evaluate the performance of the Institute for Healthcare Improvement (IHI) global trigger tool in the identification of adverse drug events. Study design: Prospective observational study. Place and duration of study: The study was conducted in a General Medicine department of a secondary care referral hospital located in rural, resource-limited settings of Bathalapalli, Anantapur district, Andhra Pradesh, India. The study was conducted for a period of six months, from June 2019 to November 2019. Methodology: A pre-designed data collection form was used to collect the data from the study participants. The required data was obtained from the patient case sheet, lab reports, treatment charts, daily nursing notes, daily physician notes, and direct patient interviews. The global trigger tool developed by IHI was used for the rapid review of inpatient medical records and to generate clues for the identification of ADEs. Descriptive statistics were used to represent the findings of demographics, clinical characteristics, ADE profiles, IHI triggers, and clinical alterations. ADE incidence was shown in a measure of ADE per 1000 patient days. IHI global trigger tool performance in detecting ADE was measured by sensitivity, specificity, positive predictive value, and negative predictive value. Results: A total of 192 patients were enrolled in the study. Among them, 225 triggers and 123 ADEs were detected. The incidence of ADEs in the inpatients estimated by the IHI method was estimated as; 20.2 ADEs per 1000 patient days,64.0ADEs per 100 admissions, 56.2percent of admissions with ADE. Majority of ADEs are shown possible relationship with drug (60; 48.7%), level-2 severity (49; 39.8%), and not preventable (52; 42.2%). Most IHI global triggers showed high sensitivity, specificity, positive predictive value, and negative predictive value for detecting ADEs. Conclusion: The study shows that most of the triggers in the IHI Trigger tool have shown good accuracy in identifying ADEs. Thus, using the IHI Trigger Tool to identify ADEs can help to improve patient safety. Therefore, the study recommends incorporating IHI global trigger tool in routine, conventional ADE screening techniques to improve the detection rate and promote drug safety.