IHI Trigger Tool for Measuring Adverse Drug Events

Institute for Healthcare Improvement (in partnership with Premier, Inc., San Diego, California, USA)
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 organization. The Trigger Tool for Measuring Adverse Drug Events provides instructions for conducting a retrospective review of patient records using triggers to identify possible ADEs. This tool includes a list of known ADE triggers and instructions for measuring the number and degree of harmful medication events. The tool provides instructions and forms for collecting the data you need to measure ADEs per 1,000 Doses and Percent of Admissions with an ADE.


Read the related article about using the Trigger Tool:

Rozich JD, Haraden CR, Resar RK. 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.
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.
Related Measures
Adverse Drug Events per 1,000 Doses
Percent of Admissions with an Adverse Drug Event
The Trigger Tool for Measuring Adverse Drug Events contains:
  • Background
  • List of ADE Triggers
  • General Instructions
  • Case Studies
  • ADE Patient Record Review Sheet
  • Pediatric ADE Patient Record Review Sheet
  • ADE Monthly Summary Sheet
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