Evaluation of Trigger Tool Methodology Related to Adverse Drug Events in Hospitalized Patients

Abstract

Purpose: To determine why an inpatient has had one of the following occurrences in the electronic health record due to an adverse drug event (ADE): international normalized ratio (INR) > 6, plasma blood glucose ≤ 50 mg/dL, or naloxone administration use. Utilizing the Institute for Healthcare Improvement (IHI) Global Trigger Tool, the information gathered will be used to determine how to prevent these events from occurring in the future. Summary: The positive predictive value (PPV) for elevated INR was 35% (confidence interval [CI] 21–53%), hypoglycemia was 70.4% (CI 62–78%), and 53% for naloxone administration (CI 45–60%). Drug interactions were the most common factor that may have contributed to an ele-vated INR, with a mean INR of 7.9. Basal insu-lin monotherapy, recent diet changes, decreases in renal function, and iscontinuation/tapering of corticosteroids were all observed to be contributing factors to hypoglycemia events. The mean trigger glucose level was 42.98 mg/dL. Dose range order sets, high morphine mil-ligram equivalents (MME), and decreased renal func-tion may have contributed to naloxone administra-tion. Polypharmacy was attributed to some of these adverse events, with the average inpatient MME of 100.5 mg. Conclusion: The use of trigger tool methodology was useful for identifying ADEs related to hypoglycemia with insulin, moderately useful for naloxone administration, and least successful for elevated INR with warfarin. The ADEs that were identified revealed a wide variety of contributing factors that can be used as areas of interest when creating new policies and procedures to reduce ADEs in the future.

Keywords

• global, trigger, tool, naloxone, INR, hypoglycemia