Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2021 Dec 1;17(8):e976-e982.
doi: 10.1097/PTS.0000000000000552.

Validating a Trigger Tool for Detecting Adverse Drug Events in Elderly Patients With Multimorbidity (TRIGGER-CHRON)

María Dolores Toscano Guzmán  1 , Mercedes Galván Banqueri  2 , María José Otero  3 , Susana Sánchez Fidalgo  2 , Isabel Font Noguera  4 , María Concepción Pérez Guerrero  5
Affiliations
Observational Study

Validating a Trigger Tool for Detecting Adverse Drug Events in Elderly Patients With Multimorbidity (TRIGGER-CHRON)

María Dolores Toscano Guzmán et al. J Patient Saf. .

Abstract

Purpose: The aims of the study were to evaluate the performance of an initial list developed to detect adverse drug events (ADEs) in elderly patients with multimorbidity in clinical practice, to explore the possibility of shortening the list, and to use this tool to study the incidence and characteristics of the ADEs among this population.

Methods: This observational study was conducted at 12 Spanish hospitals. A random sample of five charts from each hospital was selected weekly for retrospective review for a 12-week period. We included patients aged 65 years and older with multimorbidity, hospitalized more than 48 hours. Adverse drug events were detected using a list of 51 triggers previously selected by an expert panel by means of a modified Delphi method. The number of triggers identified and ADEs detected were recorded. The severity and preventability of the ADEs were evaluated. The positive predictive value (PPV) of each trigger was calculated and used to select the most efficient triggers.

Results: In 720 charts reviewed, 1430 positive triggers were identified that led to detect 215 ADEs in 178 patients (24.7%), of which 13% were serious. One hundred nineteen ADEs (55.3%) were preventable and mainly related to inadequate treatment monitoring and prescribing errors. Triggers with a PPV of 5% or less were eliminated, resulting in a final list of 32 triggers (TRIGGER-CHRON) with a PPV of 22.1%, which accounted for 98.9% of all ADEs detected and 98.6% of the preventable ADEs.

Conclusions: The shorter final validated TRIGGER-CHRON tool is an efficient list for identifying ADEs in elderly patients with multimorbidity, detecting ADEs in one-fourth of hospitalized patients in internal medicine or geriatric units.

PubMed Disclaimer

Conflict of interest statement

The authors disclose no conflict of interest.

References

    1. Medication without harm. In: WHO global patient safety challenge . Geneva, Switzerland: World Health Organization; 2017: Available at: http://apps.who.int/iris/bitstream/10665/255263/1/WHO-HIS-SDS-2017.6-eng... . Accessed April 18, 2018.
    1. Sheikh A, Dhingra-Kumar N, Kelley E, et al. The third global patient safety challenge: tackling medication-related harm. Bull World Health Organ . 2017;795:546–546a.
    1. Harris CM, Sridharan A, Landis R, et al. What happens to the medication regimens of older adults during and after an acute hospitalization? J Patient Saf . 2013;9:150–153.
    1. Avery T, Barber N, Ghaleb M, et al. Investigating the prevalence and causes of prescribing errors in general practice: The PRACtICe Study. A report for the GMC. 2012: Available at: www.gmc-uk.org/about/research/12996.asp . Accessed April 18, 2018.
    1. Saedder EA, Lisby M, Nielsen LP, et al. Number of drugs most frequently found to be independent risk factors for serious adverse reactions: a systematic literature review. Br J Clin Pharmacol . 2015;80:808–817.

Publication types

LinkOut - more resources