Application And Optimization Of Global Trigger Tool In The Detection Of Adverse Drug Events In Hospitalized Patients

Objective:The global trigger tool is adopted to establish a trigger for the detection of adverse drug events(ADE)in hospitalized patients;ADE are actively monitored;whether the use of the global trigger tool to detect ADE can improve the detection rate of ADE compared with that of the voluntary reports is investigated;then the global trigger tool is further optimized according to the situation of the hospital,to verify the impact of the optimized global trigger tool on the detection rate of ADE.Methods:1.A retrospective survey analysis method is adopted.According to the recommendation of IHI innovation series white paper,the use of triggers in domestic and foreign,and the medication situation of the Second Affiliated Hospital of Dali University,36 triggers are selected.Randomly extracted cases are tested and trigger-positive cases are further test to identify ADE and to rank the severity of ADE.According to the test results,relevant domestic and foreign literature recommendations and the actual situation of the hospital,the trigger is optimized for the first time,and the original case is tested again after the trigger item is optimized.According to the results of the first optimized test,the trigger entries are analyzed and compared,the more suitable triggers are selected,and the secondary optimized triggers are applied to the 2017 whole-year cases test.2.Sampling:The RAND function in Excel 2010 is used to randomly select the cases of the Second Affiliated Hospital of Dali University during third quarter of2016,50 cases per month,a total of 150;sampling the cases from January 1,2017 toDecember 30,2017,50 cases per month,a total of 600.150 cases in the third quarter of 2016 are used for trigger detection before optimization and trigger test after first optimization;the 600 cases sampled in 2017 are used for trigger test after secondary optimization.3.For the cases content,manual test method is adopted;if a trigger is detected,it is marked as positive;then the cases is thoroughly tested to determine if a ADE has occurred.The severity of ADE was graded using the E-I grade of the US national coordinating council for meditation error redaction and prevention.Apply pre-optimization and/or post-optimization triggers to detect ADE,Compare the detection rate of ADE and a positive predictive-value(PPV).Results:1.Initial exploration of the application of the Global Trigger Tool : Among the150 patients,99 are positive for triggers,accounting for 66%;among the 36 triggers,24 are positive,accounting for 66.7%;a total of 215 cases are detected;the 43 ADEs is determined,involving 30 patients,and the ADE detection rate is 20.0%(30/150);12 triggers are involved,and the overall PPV of 12 triggers is 20.0%;the number of discharged patients in the third quarter is 7,540,and the voluntary reporting rate is0.2%;after comparing the two methods,the Global Trigger Tool has a detection rate100 times that of voluntary reporting.2.Trigger optimization and application for the first time: 90 of 150 cases are trigger-positive,accounting for 60.0%;14 of the 15 triggers are positive,accounting for 93.3%,a total of 159 cases are detected,and 35 ADEs are determined,involving 30 patients,ADE detection rate is 20.0%(30/150),involving 10 triggers,the overall PPV of 15 triggers is 22.0%,compared with the pre-optimization ADE detection rate(20.0%),P>0.05,no statistical difference,the detection rate of ADE dose not decrease.The number of positive triggers after optimization is reduced compared with that before optimization,and the test efficiency is improved.However,when the optimized PPV is compared with that before optimization(23.3%),P>0.05,and there is no statistical difference.3.Triggers secondary optimization and application: Among the 600 patients,277 are positive for triggers,accounting for 46.2%,all of 9 triggers are positive,accounting for 100.0%,a total of 370 cases have been detected,and 106 ADEs have been determined,involving 97 patients,ADE detection rate is 16.2%(97/600);involving 8 triggers,The overall PPV of the nine triggers is 28.6%(106/370),compared with before optimization(20.0%)P>0.05,The difference is not statistically significant.The detection rate of ADE has not decrease,and the detection efficiency is significantly improved(P<0.05).Conclusion:1.The Global Trigger Tool can develop the rate of ADE detection,and fill the deficiency of the voluntary reporting system.It is applicable to the detection of adverse events in the Second Affiliated Hospital of Dali University.2.Although the first optimized deleted the triggers ADE detection rate is not reduced,but the detection efficiency was not significantly improved.The trigger optimization is not reasonable enough,so the trigger is further optimized.3.The secondary optimization does not reduce the ADE detection rate and improving the ADE detection efficiency.the trigger optimization is reasonable and suitable for the detection of ADE in the Second Affiliated Hospital of Dali University.