title: Utility of an adverse drug event trigger tool in Veterans Affairs nursing facilities.
abstract: OBJECTIVE
  To determine the utility (i.e., positive predictive value [PPV] and time requirement) of an adverse drug event (ADE) trigger tool in Veterans Affairs (VA) nursing facilities and to describe the most common types of potential ADEs detected with the trigger tool.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Veterans residing in three VA nursing facilities between September 29, 2010, and October 29, 2010.
  
  
  METHODS
  We used the Institute for Healthcare Improvement-endorsed nursing facility ADE trigger tool, modified to enhance its clinical relevance to detect potential ADEs. Electronic medical records were screened to identify residents with one or more abnormal laboratory values specified in the trigger tool.
  
  
  METHODS
  A potential ADE was defined as the concurrent administration of medication that could cause the abnormal laboratory value. An overall PPV, or proportion of residents with an abnormal laboratory value who had a potential ADE, and average time required to complete each trigger tool assessment, were calculated.
  
  
  RESULTS
  Among 321 veterans, 50.5% (n = 162) had at least one abnormal laboratory value contained in the trigger tool. Ninety-nine potential ADEs involving 146 medications were detected in 65 veterans. The overall PPV of the ADE trigger tool was 40.1% (65/162), and the average time to complete resident assessments was 8.8 (standard deviation ± 5.7) minutes. The most common potential ADEs were acute kidney injury (n = 30 residents), hypokalemia (n = 18), hypoglycemia (n = 13), and hyperkalemia (n = 10).
  
  
  CONCLUSIONS
  The modified nursing facility trigger tool was shown to be an effective and efficient method for detecting potential ADEs.
authors: Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. zam12@pitt.edu
authors: Zachary A
authors: ZA
authors: Marcum
authors: Kelly L
authors: KL
authors: Arbogast
authors: Michael C
authors: MC
authors: Behrens
authors: Michael W
authors: MW
authors: Logsdon
authors: Susan Dove
authors: SD
authors: Francis
authors: Sean M
authors: SM
authors: Jeffery
authors: Sherrie L
authors: SL
authors: Aspinall
authors: Joseph T
authors: JT
authors: Hanlon
authors: Steven M
authors: SM
authors: Handler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis* / Q000453:epidemiology; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
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