The Development of the Canadian Paediatric Trigger Tool for Identifying Potential Adverse Events

Matlow, Anne; Flintoft, Virginia; Orrbine, Elaine; Brady‐Fryer, Barbara; Cronin, Catherine; Nijssen–Jordan, Cheri; Fleming, Mark T.; Hiltz, Mary-Ann; Lahey, Michele; Zimmerman, Margaret S.; Baker, G. Ross

doi:10.12927/hcq..17671

Cited by 27 publications

(17 citation statements)

References 14 publications

(11 reference statements)

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“…15 Assigning preventability of ADEs identified through trigger tools has been operationalized in various ways. Some have used a binary decision 10, 13, 16 and others have characterized it on a continuum.…”

Section: Discussionmentioning

confidence: 99%

Adverse Drug Event Detection in Pediatric Oncology and Hematology Patients: Using Medication Triggers to Identify Patient Harm in a Specialized Pediatric Patient Population

Call

Burlison

Robertson

et al. 2014

The Journal of Pediatrics

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Objective To investigate the use of a trigger tool for adverse drug event (ADE) detection in a pediatric hospital specializing in oncology, hematology, and other catastrophic diseases. Study design A medication-based trigger tool package analyzed electronic health records from February 2009 to February 2013. Chart review determined whether an ADE precipitated the trigger. Severity was assigned to ADEs, and preventability was assessed. Preventable ADEs were compared with the hospital’s electronic voluntary event reporting system to identify whether these ADEs had been previously identified. The positive predictive values (PPVs) of the entire trigger tool and individual triggers were calculated to assess their accuracy to detect ADEs. Results Trigger occurrences (n=706) were detected in 390 patients from six medication triggers, 33 of which were ADEs (overall PPV = 16%). Hyaluronidase had the highest PPV (60%). Most ADEs were category E harm (temporary harm) per the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) index. One event was category H harm (intervention to sustain life). Naloxone was associated with the most grade 4 ADEs per the Common Terminology Criteria for Adverse Events (CTCAE) v4.03. Twenty-one (64%) ADEs were preventable; 3 of which were submitted via the voluntary reporting system. Conclusion Most of the medication-based triggers yielded low PPVs. Refining the triggers based on patients’ characteristics and medication usage patterns could increase the PPVs and make them more useful for quality improvement. To efficiently detect ADEs, triggers must be revised to reflect specialized pediatric patient populations such as hematology and oncology patients.

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Section: Discussionmentioning

confidence: 99%

Adverse Drug Event Detection in Pediatric Oncology and Hematology Patients: Using Medication Triggers to Identify Patient Harm in a Specialized Pediatric Patient Population

Call

Burlison

Robertson

et al. 2014

The Journal of Pediatrics

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“…The early development stages of the CPTT have been previously reported 27. Briefly, five TTs identified through a detailed literature review and personal communications were adapted to the modular format of the IHI-GTT.…”

Section: Methodsmentioning

confidence: 99%

“…The Patient Safety Collaborative of the Canadian Association of Paediatric Health Centres established a working group to develop a paediatric TT (CPTT) to detect AEs in children hospitalised in Canada 27. The goal was to develop a reliable and robust tool that could be used for both local quality-improvement activities and research into the rate, incidence, and factors contributing to AEs across a large population.…”

Section: Introductionmentioning

confidence: 99%

Description of the development and validation of the Canadian Paediatric Trigger Tool

Matlow

Cronin

Flintoft

et al. 2011

BMJ Quality & Safety

105

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ObjectiveTo describe the process of developing and validating the Canadian Association of Paediatric Health Centres Trigger Tool (CPTT).MethodsFive existing trigger tools were consolidated with duplicate triggers eliminated. After a risk analysis and modified Delphi process, the tool was reduced from 94 to 47 triggers. Feasibility of use was tested, reviewing 40 charts in three hospitals. For validation, charts were randomly selected across four age groups, half medical/half surgical diagnoses, from six paediatric academic health sciences centres. 591 charts were reviewed by six nurses (for triggers and adverse events (AEs)) and three physicians (for AEs only). The incidence of trigger- and AE-positive charts was documented, and the sensitivity and specificity of the tool to identify charts with AEs were determined. Identification of AEs by nurses and physicians was compared. The positive predictive value (PPV) of each trigger was calculated and the ratio of false- to true-positive AE predictors analysed for each trigger.ResultsNurses rated the CPTT easy to use and identified triggers in 61.1% (361/591; 95% CI 57.2 to 65.0) of patient charts; physicians identified AEs in 15.1% (89/ 591, 95% CI 0.23 to 0.43). Over a third of patients with AEs were neonates. The sensitivity and specificity were 0.88 and 0.44, respectively. Nurse and physician AE assessments correlated poorly. The PPV for each trigger ranged from 0 to 88.3%. Triggers with a false/true-positive ratio of >0.7 were eliminated, resulting in the final 35-trigger CPTT.ConclusionsThe CPTT is the first validated, comprehensive trigger tool available to detect AEs in children hospitalised in acute care facilities.

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“…In an effort to bring some standardisation and efficiency to the chart-review process, a two-step method described in 1974 uses, as the first step , a set of screening criteria identifying the presence of certain sentinel words or results in the chart that potentially indicate an adverse event, and therefore warrants further scrutiny 8. This approach, now known by the term “trigger tool,” using either manual or computer-automated methods, has been adapted for a variety of healthcare settings to identify potential adverse events4–7 9 – 12 and has been described in the literature. In the second step the “triggered” charts are reviewed further to determine whether an adverse event occurred and, if so, to obtain additional details such as preventability and severity.…”

mentioning

confidence: 99%

Experience with a trigger tool for identifying adverse drug events among older adults in ambulatory primary care

Singh

McLean-Plunckett

Kee

et al. 2009

Quality and Safety in Health Care

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The Development of the Canadian Paediatric Trigger Tool for Identifying Potential Adverse Events

Cited by 27 publications

References 14 publications

Adverse Drug Event Detection in Pediatric Oncology and Hematology Patients: Using Medication Triggers to Identify Patient Harm in a Specialized Pediatric Patient Population

Adverse Drug Event Detection in Pediatric Oncology and Hematology Patients: Using Medication Triggers to Identify Patient Harm in a Specialized Pediatric Patient Population

Description of the development and validation of the Canadian Paediatric Trigger Tool

Experience with a trigger tool for identifying adverse drug events among older adults in ambulatory primary care

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