Describing adverse events in Swiss hospitalized oncology patients using the Global Trigger Tool

Abstract

Background and aimsThe occurrence rate of adverse events (AEs) related to care among hospitalized oncology patients in Switzerland remains unknown. The primary objective of this study was to describe, for the first time, the occurrence rate, type, severity of harm, and preventability of AEs related to care, reported in health records of hospitalized hematological and solid‐tumor cancer patients in three Swiss hospitals.MethodsUsing an adapted version of the validated Global Trigger Tool (GTT) from the Institute for Healthcare Improvement, we conducted a retrospective record review of patients discharged from oncology units over a 6‐week period during 2018. Our convenience sample included all records from adult patients (≥18 years of age), diagnosed with cancer, and hospitalized (>24 hours). Per the GTT method, two trained nurses independently assessed patient records to identify AEs using triggers, and physicians from the included units analyzed the consensus of the two nurses. Together, they assessed the severity and preventability of each AE.ResultsFrom the sample of 224 reviewed records, we identified 661 triggers and 169 AEs in 94 of them (42%). Pain related to care was the most frequent AE (n = 29), followed by constipation (n = 17). AEs rates were 75.4 per 100 admissions and 106.6 per 1000 patient days. Most of the identified AEs (78%) caused temporary harm to the patient and required an intervention. Among AEs during hospitalization (n = 125), 76 (61%) were considered not preventable, 28 (22%) preventable, and 21 (17%) undetermined.ConclusionAbout half of the hospitalized oncology patients suffered from at least one AE related to care during their hospitalization. Pain, constipation, and nosocomial infections were the most frequent AEs. It is, therefore, essential to identify AEs to guide future clinical practice initiatives to ensure patient safety.

Variation in detected adverse events using trigger tools: A systematic review and meta-analysis

“…And in the 48 studies whose data allowed us to calculate percentages of admissions with one or more AEs, these ranged from 7% to 69%. AE preventability percentages, which 37 studies (69%) reported, ranged from 7% to 93%; however, four of these studies provided no relevant raw data [ 21 , 45 , 55 , 56 ].…”

“…Some researchers use all six of these [ 17 , 18 ] while most use only those relevant to their setting [ 19 , 20 ]. Yet others either create additional modules (e.g., Oncology Module [ 21 , 22 ]) or develop modified versions tailored specifically to their patient and care settings [ 3 , 23 ]. While former versions diverge too importantly from the original GTT to label it as GTT, they are still considered as trigger tools (TTs).…”

Incidence, severity, and preventability of adverse events during the induction of patients with acute lymphoblastic leukemia in a tertiary care pediatric hospital in Mexico

“…There were 132 (33.1%) moderate, 128 (32.1%) severe, 64 (16.0%) life-threatening, 57 (14.3%) mild and 18 (4.5%) fatal AEs (Table 5). The incidence rate by severity grade is shown in [6][7][8][9][10][11][12][13][14] days). Of these readmissions, 58.6% were caused by infections as febrile neutropenia (42.7%) and sepsis (8.7%), while the main non-infectious causes of readmission were mucositis (8.7%), stroke (5.3%), vomiting (4.7%) and paralytic ileus (3.3%) (S5 Table ).…”

“…An epidemiological description of AEs occurring in pediatric oncology care processes should include adverse drug events (ADEs), which are a common cause of hospitalization in children with neoplasms [9], as well as AEs related to medical procedures [2]. Moreover, an essential aspect is the determination of AEs preventability, as this informs about opportunities to improve patient safety in medical care processes [10,11]. Preventability implies that the methods to avoid harm are known or that the harm is related to errors in medical care [12], so not all adverse events are preventable [4,13].…”

Occurrence of No-Harm Incidents and Adverse Events in Hospitalized Patients with Ischemic Stroke or TIA: A Cohort Study Using Trigger Tool Methodology

“…In some studies, all of these modules are used [ 16 , 17 ], while most researchers use only those modules relevant to their clinical setting [ 18 , 19 ]. However, other users of the GTT methodology design additional modules (e.g., oncology module [ 20 , 21 ]) or create modified versions, tailored specifically to their clinical context [ 8 , 15 , 22 ]. While some versions diverge too much from the original GTT to label it as GTT, they are still considered as trigger tools (TTs).…”