Institute for Healthcare Improvement (in partnership with Premier, Inc., San Diego, California, USA)
Cambridge, Massachusetts, USA
One copy of this one-page form registers information obtained from one individual pediatric patient record during a review for adverse drug events. Everyone on the review team should use the same standard form. Aggregate the data monthly, using the Pediatric ADE Monthly Summary Sheet.
This review tool was developed as part of the Trigger Tool for Measuring Adverse Drug Events and was modified for the pediatric population (patients under 18 years of age). When reviewing pediatric patient records (also called charts) for ADEs, use a copy of this form to register information for each patient record reviewed.
With your team, look at the list of triggers on the form and, if necessary, add or remove triggers to make the list appropriate for your patient record review process. Distribute the final form to all team members, either electronically or on paper. Each patient record in the review requires its own copy of the form, whether or not the record turns out to contain triggers and ADEs.
After you have completed the Pediatric ADE Patient Record Review Sheet for a sample of patient records, summarize your findings in the ADE Monthly Summary Sheet. For each patient record reviewed, document the following: whether an ADE occurred; the number of ADEs; and, if you have collected the data, the total number of medication doses received. The sheet provides the data you need to measure ADEs per 1,000 Doses and Percent of Admissions with an ADE.