A Trigger Tool to Detect Harm in Pediatric Inpatient Settings

Abstract

OBJECTIVES: An efficient and reliable process for measuring harm due to medical care is needed to advance pediatric patient safety. Several pediatric studies have assessed the use of trigger tools in varying inpatient environments. Using the Institute for Healthcare Improvement’s adult-focused Global Trigger Tool as a model, we developed and pilot tested a trigger tool that would identify the most common causes of harm in pediatric inpatient environments. METHODS: After formal training, 6 academic children’s hospitals used this novel pediatric trigger tool to review 100 randomly selected inpatient records per site from patients discharged during the month of February 2012. RESULTS: From the 600 patient charts evaluated, 240 harmful events (“harms”) were identified, resulting in a rate of 40 harms per 100 patients admitted and 54.9 harms per 1000 patient days across the 6 hospitals. At least 1 harm was identified in 146 patients (24.3% of patients). Of the 240 total events, 108 (45.0%) were assessed to have been potentially or definitely preventable. The most common patient harms were intravenous catheter infiltrations/burns, respiratory distress, constipation, pain, and surgical complications. CONCLUSIONS: Consistent with earlier rates of all-cause harm in adult hospitals, harm occurs at high rates in hospitalized children. Availability and use of an all-cause harm identification tool will establish the epidemiology of harm and will provide a consistent approach to assessing the effect of interventions on harms in hospitalized children.

Performance of the Global Assessment of Pediatric Patient Safety (GAPPS) Tool

“…23 Our work builds on the IHI GTT as well as multiple pediatric trigger tools. [7][8][9][10] To our knowledge, no previous adult or pediatric study has conducted the detailed trigger-by-trigger analysis we conducted, leading to a robustly scrutinized set of manual and automatable triggers. This process and the resulting components of GAPPS may be informative in future efforts to refine adult, as well as pediatric, tools.…”

“…[8][9][10][11][12][13][14] In addition, we spoke with trigger developers, including those who developed PACHMT and the IHI GTT, to identify any additional triggers and inform GAPPS development. 7 From our review, we compiled a list of 78 candidate triggers for possible inclusion in GAPPS; this list of candidate triggers was compiled by the GAPPS team with input from the developers of PACHMT.…”

“…7 The final draft of the GAPPS tool tested in the National Field Test included 54 triggers (Table 1).…”

“…The most recent has been the Pediatric All-Cause Harm Measurement Tool (PACHMT), which found that children, like adults, experience high rates of AEs due to medical care. 7 Building on previous efforts, including PACHMT, our objective was to further develop and rigorously test the performance of a refined pediatric global trigger tool: Global Assessment of Pediatric Patient Safety (GAPPS).…”

Patient Safety Incidents Involving Sick Children in Primary Care in England and Wales: A Mixed Methods Analysis

“…To our knowledge, no systematic approach has been taken to studying the burden of iatrogenic harm in children [4,5,13,14]. Methods that have been used include analysis of vital statistics and case note reviews (some guided by trigger tools) [13–17].…”