IHI Global Trigger Tool for Measuring Adverse Events
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Institute for Healthcare Improvement
Cambridge,
Massachusetts,
USA
**June 2007 UPDATE**
In Appendix C on page 35, the calculation for the measure "Percent of admissions with an adverse event" was missing the denominator (Total records reviewed). The calculation has now been updated in the paper, to read: "Number of records with at least 1 event/Total records reviewed x 100=Percent of admissions with an adverse event."
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The use of "triggers," or clues, to identify adverse events (AEs) is an effective method for measuring the overall level of harm in a health care organization. The IHI Global Trigger Tool for Measuring AEs provides instructions for training reviewers in this methodology and conducting a retrospective review of patient records using triggers to identify possible AEs. This tool includes a list of known AE triggers as well as instructions for selecting records, training information, and appendices with references and common questions. The tool provides instructions and forms for collecting the data you need to track three measures:
- Adverse Events per 1,000 Patient Days
- Adverse Events per 100 Admissions
- Percent of Admissions with an Adverse Event
Read the related article about using the Trigger Tool for Measuring Adverse Drug Events (ADEs):
Adverse drug event trigger tool: A practical methodology for measuring medication related harm. Quality and Safety in Health Care. 2003;12:194-200.
For more general information on Trigger Tools and how to select the appropriate one, see the Introduction to Trigger Tools page.
Background
The Institute for Healthcare Improvement formed the Idealized Design of the Medication System (IDMS) Group in May 2000. The group of 30 physicians, pharmacists, nurses, and statisticians established an aim to design a medication system that is safer by a factor of 10 and more cost-effective than systems currently in use. The Trigger Tool for Measuring Adverse Drug Events was initially developed by this group and provided the basis for development of other subsequent Trigger Tools.
Traditional efforts to detect AEs have focused on voluntary reporting and tracking of errors. However, public health researchers have established that only 10 to 20 percent of errors are ever reported and, of those, 90 to 95 percent cause no harm to patients. Hospitals need a more effective way to identify events that do cause harm to patients, in order to select and test changes to reduce harm.
This tool provides an easy-to-use method for accurately identifying AEs (harm) and measuring the rate of AEs over time. Tracking AEs over time is a useful way to tell if changes being made are improving the safety of the care processes. Many hospitals have used this tool to identify AEs, to measure the level of harm from each AE, and to identify areas for improvement in their organizations.
Directions
Download the tool for detailed information.
The IHI Global Trigger Tool for Measuring AEs contains:
- Background on Development and Methodology
- Rules and Methods for Use
- Triggers and Definitions
- Training Instructions
- Stories from Experienced Organizations
- References and Resources
Related Information:
Questions
For specific questions regarding the IHI Global Trigger Tool, please contact Fran Griffin, IHI Director, at fgriffin@ihi.org.
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