**This version of the IHI Global Trigger Tool has been adapted to reflect the local UK context.**

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

UK Version REVISED September 2008

The UK version of the IHI Global Trigger was revised in September 2008 as part of IHI's continuing work in the UK with the Safer Patients Initiative, NHS Institute for Innovation and Improvement, and other related initatives. The revisions are as follows:

1. The following triggers have been added back into the tool:
   • G7 – Complication of procedure or treatment
   • G8 – Transfer to higher level of care
   • M5 – Abrupt medication stop
2. The supporting explanation for G7 and G8 from the 2005 UK version of the IHI Global Trigger Tool has been retained.
3. A paragraph has been provided for M5 as the 2005 text was not precisely what is being taught in the UK.

Related Information

• 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.

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.

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

See also the following related information: 

• Training Record Set for IHI Global Trigger Tool, to be used when training new reviewers how to use the tool.
• Random Number Generator Tool, to generate a random sample of patient records for review.