Os Adverse events (AEs) caused by medications pose the highest individual risk of harm to patients in hospitals.
The medication chain involves several sectors of the hospital:
- Standardization
- Receipt
- Distribution
- Unitarization
- Prescription
- Clinical Pharmacology
- Medication administration
- Return of medicines.
In all these steps, it is essential to quality and safety.
According to IHI – Institute for Healthcare Improvement, public health researchers already know that only 10% to 20% of medical errors in hospitals are reported and of those reported errors, 90% to 95% do not cause harm to patients.
History
In the search for changes to reduce errors in the hospital environment, in 2000 IHI formed a Medication System group, made up of physicians, pharmacists, nurses and statisticians, whose goal was to design a safer system. In late 2003, this group developed the first tool to detect a greater number of AEs.
What is Global Trigger Tool (GTT)?
This tool uses a review of random patient records and, through triggers, allows the identification of possible AEs in patients.
This technique increases the detection of AEs approximately 50 times more than traditional audit and voluntary reporting methodologies. It also assesses the level of damage caused by the AE and enables the focus of continuous improvement efforts.
A GTT helps measure losses related to patient hospitalization. Through software, it facilitates the accurate identification of AEs, in addition to measuring the rate of AEs over time. This tool can be connected to the electronic medical record, actively allowing the identification of AEs.
AEs occur in different situations in hospitals' daily routine:
- AEs caused by medications
- AEs in nursing care
- AEs in surgical environment
- AEs in ICU
- AEs caused in the emergency.
Triggers allow you to focus on one type of damage and work on specific improvements for that topic, in addition to monitoring and knowing whether the changes made to avoid errors are effective.
This allows for faster reviews of hospital records and, through a dashboard, makes it possible to monitor and track harm in a specific topic or area in the hospital. For example, when a patient suffered a stroke after being given an anticoagulant. In addition to generating costs and rework, the patient was harmed. Even different types of harm put patient safety at risk.
How to use the GTT tool
The article Adverse drug event trigger tool: A practical methodology for measuring medication related harm, made available by IHI, presents how the tool was tested in four hospitals, with different specialties, in the United States. Its objective was to evaluate the feasibility of training employees to use it.
Some examples of medication-related triggers:
- Requests for certain medications and antidotes
- Abnormal laboratory test values
- Abrupt stop orders
- High serum drug levels
- Leukopenia
- Use of antidiarrheal agents
- Return to hospital after 30 days.
Situations thus identified were sent to the pharmacist, as they required greater attention, and all medical records were reviewed to confirm or deny the AEs.
Based on this training, each hospital established its own team to review medical records, and only a few employees were needed to perform this screening. The method is electronic, which speeds up the process and makes the tool more secure.
Team training must be very well focused and efficient, after all, through this review the trends and causes that determined the variations in damage in organizations are highlighted.
More information about the tool software GTT in the website: www.ihi.org
Conclusion
The tool GTT through triggers, it is possible to identify suspicious cases and generate graphs for administrative and clinical leadership to analyze, which makes it possible to put into practice actions that reduce the risks of AEs and allow the implementation of more effective monitoring of hospital processes.
Even if the hospital you work at does not use the GTT tool, medical record review deserves attention, as it enables evidence-based quality improvements.
An example of a common EA is medication administration schedule or omission of doses. Even though most of the time this does not cause AEs with harm, they deserve attention. After all, at some point, this lack of precision will be responsible for AEs with serious harm. For example, in the case of a patient with pulmonary embolism who missed a dose of anticoagulant and had respiratory arrest and died.
AEs related to the timing of medication administration involve several situations, including the lack of nursing professionals in the sector, which results in an excessive number of patients per employee. This limits and harms the quality of care.
By identifying these flaws, evidence-based decision-making will make it possible to generate improvements that add value and more process safety.
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