title: Performance of the adverse drug event trigger tool and the global trigger tool for identifying adverse drug events: experience in a Belgian hospital.
abstract: BACKGROUND
  Medication-related harm can be detected using the adverse drug event (ADE) trigger tool and the medication module of the Global Trigger Tool (GTT) developed by the Institute for Healthcare Improvement (IHI). In recent years, there has been some controversy on the performance of this method. In addition, there are limited data on the performance of the medication module of the GTT as compared with the ADE trigger tool.
  
  
  OBJECTIVE
  To evaluate the performance of the ADE trigger tool and of the medication module of the GTT for identifying ADEs.
  
  
  METHODS
  The methodology of the IHI was used. A random sample of 20 adult admissions per month was selected over a 12-month period in a teaching hospital in Belgium. The ADE trigger tool was adapted to the Belgian setting and included 20 triggers. The positive predictive value (PPV) of each trigger was calculated, as well as the proportion of ADEs that would have been identified with the medication module of the GTT as compared with the ADE trigger tool.
  
  
  RESULTS
  A total of 200 triggers and 62 ADEs were found, representing 26 ADEs/100 admissions. Nineteen ADEs (31%) were found spontaneously without the presence of a trigger. Three triggers never occurred. The PPVs of other triggers varied from 0 to 0.67, with half of them having PPVs less than 0.20. If we had used the medication triggers included in the GTT (n = 11), we would have identified 77% of total ADEs and 67% of preventable ADEs.
  
  
  CONCLUSIONS
  Applying the trigger tool method proposed by the IHI to a Belgian hospital led to the identification of one ADE out of 4 admissions. To increase performance, refining the list of triggers in the ADE trigger tool and in the medication module of the GTT would be needed. Recording nontriggered events should be encouraged.
authors.affiliation: Université catholique de Louvain, CHU Mont-Godinne Dinant, Yvoir, Belgium.
authors.forename: Lise
authors.initials: L
authors.lastname: Carnevali
authors.forename: Bruno
authors.initials: B
authors.lastname: Krug
authors.forename: Fabienne
authors.initials: F
authors.lastname: Amant
authors.forename: Dominique
authors.initials: D
authors.lastname: Van Pee
authors.forename: Véronique
authors.initials: V
authors.lastname: Gérard
authors.forename: Xavier
authors.initials: X
authors.lastname: de Béthune
authors.forename: Anne
authors.initials: A
authors.lastname: Spinewine
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems / Q000592:standards* / Q000706:statistics & numerical data; D001530:Belgium; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D006745:Hospital Bed Capacity, 300 to 499; D006784:Hospitals, Teaching; D006801:Humans; D008499:Medical Records; D008508:Medication Errors / Q000706:statistics & numerical data; D011237:Predictive Value of Tests
keywords: Belgium; adverse drug reactions reporting systems; medication errors; safety management; trigger tool