Testing a trigger tool as a method of detecting harm from medication errors in a UK hospital: a pilot study.
OBJECTIVE
The aim was to adapt a US adverse drug event (ADE) trigger tool for UK use, and to establish its positive predictive value (PPV) and sensitivity in comparison to retrospective health record review for the identification of preventable ADEs, in a pilot study on one hospital ward.


METHODS
An established US trigger tool was adapted for UK use. We applied it retrospectively to 207 patients' health records, following up positive triggers to identify any ADEs (both preventable and non-preventable). We compared the preventable ADEs to those identified using full health record review.


RESULTS
We identified 168 positive triggers in 127 (61%) of 207 patients. Seven ADEs were identified, representing an ADE in 3.4% of patients or 0.7 ADEs per 100 patient days. Five were non-preventable adverse drug reactions and two were due to preventable errors. The prevalence of preventable ADEs was 1.0% of patients, or 0.2 per 100 patient days. The overall PPV was 0.04 for all ADEs, and 0.01 for preventable ADEs. PPVs for individual triggers varied widely. Five preventable ADEs were identified using health record review. The sensitivity of the trigger tool for identifying preventable ADEs was 0.40, when compared to health record review.


CONCLUSIONS
Although we identified some ADEs using the trigger tool, more work is needed to further refine the trigger tool to reduce the false positives and increase sensitivity. To comprehensively identify preventable ADEs, retrospective health record review remains the gold standard and we found no efficiency gain in using the trigger tool.
Franklin
Bryony Dean
BD
Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust and The School of Pharmacy, University of London Imperial College London, London, UK. Bryony.DeanFranklin@imperial.nhs.uk
Birch
Sylvia
S
Schachter
Mike
M
Barber
Nick
N
D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology*; D006801:Humans; D008499:Medical Records; D008508:Medication Errors / Q000009:adverse effects*; D010865:Pilot Projects; D006113:United Kingdom / Q000453:epidemiology