Adverse drug event detection in pediatric oncology and hematology patients: using medication triggers to identify patient harm in a specialized pediatric patient population.
OBJECTIVE
To investigate the use of a trigger tool for the detection of adverse drug events (ADE) in a pediatric hospital specializing in oncology, hematology, and other catastrophic diseases.


METHODS
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 6 medication triggers, 33 of which were ADEs (overall PPV = 16%). Hyaluronidase had the greatest PPV (60%). Most ADEs were category E harm (temporary harm) per the National Coordinating Council for Medication Error Reporting and Prevention 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 v4.03. Twenty-one (64%) ADEs were preventable, 3 of which were submitted via the voluntary reporting system.


CONCLUSIONS
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.
Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN.
Rosemary J
RJ
Call
Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN.
Jonathan D
JD
Burlison
Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN.
Jennifer J
JJ
Robertson
Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN.
Jeffrey R
JR
Scott
Department of Information Sciences, St. Jude Children's Research Hospital, Memphis, TN.
Donald K
DK
Baker
Department of Anesthesiology, St. Jude Children's Research Hospital, Memphis, TN.
Michael G
MG
Rossi
Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN.
Scott C
SC
Howard
Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN. Electronic address: james.hoffman@stjude.org.
James M
JM
Hoffman
D016907:Adverse Drug Reaction Reporting Systems; D002648:Child; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006402:Hematologic Diseases / Q000188:drug therapy*; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000188:drug therapy*; D064406:Patient Harm / Q000517:prevention & control*