title: Measuring adverse drug events on hospital medicine units with the institute for healthcare improvement trigger tool: a chart review.
abstract: BACKGROUND
  An adverse drug event (ADE) is a noxious, unintended response to a drug, occurring at doses used in humans for prophylaxis, diagnosis, or treatment of disease or for modification of physiological function. ADEs account for about one-quarter of all adverse events in Canadian hospitals. Canadian data on specific types of ADEs and commonly implicated drugs are lacking. In particular, there is a paucity of data on ADEs that occur during hospital admissions.
  
  
  OBJECTIVE
  The primary objective was to identify the incidence of ADEs in a sample of adult general medicine inpatients over a 1-year period. The secondary objective was to identify the 5 drugs most frequently responsible for ADEs in this setting.
  
  
  METHODS
  A retrospective chart analysis was conducted for general medicine patients discharged from St Paul's Hospital in Vancouver, British Columbia, from January to December 2011. ADEs were identified using the Institute for Healthcare Improvement (IHI) Trigger Tool for Measuring Adverse Drug Events. The Naranjo criteria were applied to assess causality, and a physician independently authenticated the ADEs for preventability and harm using the categories of harm set out by the US National Coordinating Council for Medication Error Reporting and Prevention.
  
  
  RESULTS
  Of the 204 patient encounters reviewed, 15 involved ADEs, which represented an incidence of 7% over the 1-year study period. The 5 drugs most frequently implicated in ADEs were vancomycin, ciprofloxacin, ceftriaxone, piperacillin-tazobactam, and moxifloxacin.
  
  
  CONCLUSIONS
  The rate of ADEs during hospital admissions was substantial. These events may necessitate additional investigations and interventions and may prolong the hospital stay. The authors do not recommend the IHI Trigger Tool for Measuring Adverse Drug Events for efficient prospective detection of ADEs in manual chart reviews. Possible modifications to improve the utility of this tool might include incorporating it into a compatible electronic health record system with automated trigger detection.
authors.affiliation: BSc(Pharm), ACPR, was, at the time of this study, a pharmacy resident with Lower Mainland Pharmacy Services, Vancouver, British Columbia.
authors.forename: Iris
authors.initials: I
authors.lastname: Lau
authors.affiliation: BSc(Pharm), ACPR, MHA, is with the Pharmacy Department, St Paul's Hospital, Lower Mainland Pharmacy Services, Vancouver, British Columbia.
authors.forename: Allison
authors.initials: A
authors.lastname: Kirkwood
keywords: Institute for Healthcare Improvement; adverse drug events; adverse drug reactions; chart review