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Trigger Tool for Measuring Adverse Drug Events in a Mental Health Setting
12/9/2008 3:32:22 PM
User Comments on Trigger Tool for Measuring Adverse Drug Events in a Mental Health Setting
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Re: Trigger Tool for Measuring Adverse Drug Events in a Mental Health Setting
1/30/2009 2:56:33 PM
While respecting that this is going to be useful for site without IT resources and dependent upon manual chart review, I have to share our experience with these triggers back around 2000-2001 when Premier called them the MECPI tool, as I recall. We used it at our six hospitals and uncovered many unreported events, which did give us a far better idea of the prevalence of events than our voluntary (under)reporting system. So it gave us a rate.
However, NCCMERP in 2002 stated well why we should not get hung up on rates. We should be more qualitative in our assessments. We found this methodology was not sustainable, as evidenced by its dependence upon random sampling. It's retro, so offers no real-time opportunity to prevent or ammeliorate harm. Being mono triggers, many are inherently low yield, e.g., we found that only 1/50 benadryl cases was related to an ADE.
I'm glad you disengaged NCCMERP's ADE scale from the element of preventability, as we have found this very useful across our system since about 2002, and which we wish NCCMERP would do.
I have to wonder if a facility that lacks adequate IT investment to automate 100% real-time screening for higher yield composite lab/drug triggers would be any more likely to invest in the manpower to use this tool. No EMR or CPOE is needed to accomplish this. Our Lab IT folks found a way to filter their INR and other reports by administration of drug, e.g., warfarin, to exclude reporting high INRs in non-warfarin liver patients, among other examples. Most non-clinician administrative bean counters will more reluctantly invest in people than in technology (tech is easier/cleaner to "fire" if/when no longer wanted/needed).
Thanks for providing this, which is uesful as far as it goes. We could really use your clout to convince the Cerner Milleniums of the world to provide truly sophisticated real-time, high yield surveillance and meaningful alerts to clinicians of patients with one foot on a banana peel. Please help us with that, because that is where we are all truly investing. Thanks.
Edit by: Albert Rizos on 1/30/2009 2:58:13 PM
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Total Posts: 243
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Re: Trigger Tool for Measuring Adverse Drug Events in a Mental Health Setting
2/3/2009 1:34:37 PM
Albert - thanks for your thoughtful comments and observations.
The first IHI ADE Trigger Tool was developed in 1999. I am not familiar with the Premier MECPI tool you mention so not sure how they may have used the triggers and if the methodology was same as ours.
It was never the intended design of the Trigger Tool to provide real-time data that could be used to prevent or mitigate harm. It was specifically designed as a retrospective review tool to collect a standard measurement that could be monitored over time. In this regard, we believe rates ARE important - it is only by measuring them over time that one can determine whether improvement is occurring.
Some hospitals are also using automated systems to identify triggers in real time for the purpose of intervening in patient care. This was the work Classen did at LDS and was the basis of our Trigger Tool thinking. However this is generally not done in place of the Trigger Tool chart review as each serves a different purpose. If despite doing real-time intervention, one saw that the rate of harm as measured retrospectively was not decreasing that would indicate other factors that need to be addressed.
Edit by: Fran Griffin on 2/3/2009 1:35:04 PM
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