Introduction to Trigger Tools for Identifying Adverse Events
The use of "triggers" (clues) to identify adverse events is an effective method for measuring the overall level of harm from medical care in a health care organization.
- What a Trigger Tool is and how it's used
- How to select and use the appropriate Trigger Tool
- Related content and additional resources
What Is a Trigger Tool?
A Trigger Tool is an easy-to-use method for accurately identifying adverse events (harm) and measuring the rate of adverse events over time. Tracking adverse events over time is a useful way to tell if changes being made are improving the safety of the care processes.
The use of "triggers," or clues, to identify adverse events (AEs) is an effective method for measuring the overall level of harm from medical care in a health care organization. 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.
Choosing a Trigger Tool
There are two approaches to using the harm measures from the Trigger Tools:
- To monitor an overall level of harm as a "dashboard" item
- To track harm in a specific topic or area
The IHI Global Trigger Tool for Measuring Adverse Events is designed specifically for the first approach. This is the tool to use for an organization-wide measure that can be reported to leadership. It is designed for use with the records of adult inpatients in acute care.
Improvement efforts to reduce harm require focused efforts in specific topics and areas. It is helpful to track harm measures related to the area of focus. This can be accomplished in two ways: either using a Trigger Tool specific to that area or using one module from the IHI Global Trigger Tool.
For example, if focusing on harm from medications (or adverse drug events, ADEs), use the Trigger Tool for Measuring Adverse Drug Events. This tool can be used to collect data on that type of harm only and is helpful when working on improvements to medication systems. Another option is to use only the Medication Module from the IHI Global Trigger Tool (which is based on the ADE Trigger Tool).
In both cases, data on medication harm can be collected from the same medical records that are used for the IHI Global Trigger Tool harm measure (i.e., there is no need to obtain a second set of records). The only reason to obtain additional records would be if you are focusing on a specific population for targeted improvement (e.g., the pulmonary nursing unit), in which case records obtained should be selected from that population only.
Both the IHI Global Trigger Tool and the Trigger Tool for Measuring ADEs are designed for use with the adult population.
With all Trigger Tools, data should always be tracked over time and categorized for review, such as in a histogram. This may identify further focus areas for work. Intensive review using a subset of triggers can be very helpful, such as anticoagulant-related harm in medications, and may be used for very focused improvement efforts.
- Training Record Set for IHI Global Trigger Tool, to be used when training new reviewers how to use the tool.
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