Trigger Tool for Measuring Adverse Drug Events in a Mental Health Setting

Institute for Healthcare Improvement (in collaboration with Noeleen Devaney, Director, Northern Ireland CSCG Support Team)
Cambridge, Massachusetts, USA


The use of “triggers,” or “clues,” to identify adverse drug events (ADEs) is an effective method for measuring the overall level of harm from medications in a health care setting. The Trigger Tool methodology provides instructions for conducting a retrospective review of patient records using triggers to identify possible ADEs. This tool, a customization for psychiatry of the IHI Trigger Tool for Measuring Adverse Drug Events, was developed for use with mental health inpatients and includes a list of known ADE triggers in mental health settings, as well as instructions for collecting the data you need to measure the percentage of admissions with an ADE and the number of ADEs per 1,000 doses.

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.
Adverse drug events present the single greatest risk of harm to patients in hospitals. Traditional efforts to detect ADEs 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 ADEs (harm from medications) and measuring the rate of ADEs over time. Tracking ADEs over time is a useful way to tell if changes the team is making are improving the safety of the medication system. Hundreds of hospitals have used this tool to identify ADEs, to measure the level of harm from each ADE, and to identify areas for improvement in their organizations.
This tool contains: 
  • Background Information 
  • List of ADE Triggers 
  • General Instructions for Identifying and Measuring ADEs 
  • Two Case Scenarios 
  • ADE Patient Record Review Sheet 
  • ADE Monthly Summary Sheet
Note: You can use this tool in conjunction with the Interactive Trigger Tool for Measuring ADEs. Enter your detailed data from all of your ADE Patient Record Review Sheets into the interactive Trigger Tool for Measuring ADEs. The interactive tool will automatically calculate and graph two measures: Percent of Admissions with an ADE and ADEs per 1,000 Doses.

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