Development And Testing Of A Trigger Tool To Identify Adverse Events In Neonatal Ward

ObjectiveTo develop and test a neonatal-ward-focused trigger tool for adverse events(AEs)detection in China.MethodsFirst,three trigger tools were consolidated with duplicate triggers eliminated.After an experts consultation method,the triggers were reduced from 29 to 10;then,the feasibility of use was tested through a two-month retrospective study(2015.07.30-2015.09.30): Inpatients with a minimum 48-hour stay were reviewed in Department of neonatoloy,Children's Hospital of Chongqing Medical University(include neonatal intensive care unit).The incidence of trigger-and adverse events(AEs)-positive(include the severity of adverse events)charts was documented.The entire tool and each trigger was evaluated for positive predictive value(PPV).Reliability and validity was tested through a one-month real-time observational study(2016.05.09-2016.06.09): Charts of those trigger-positive were reviewed.The incidence of trigger-and adverse events(AEs)-positive charts was documented.The entire tool and each trigger was evaluated for positive predictive value(PPV).ResultsDuring the retrospective study,782 medical records revealed 887 triggers(1.13 per patient)and 391 unique AEs(0.50 per patient);78.8% AEs were found by triggers,with a positive predictive value(PPV)0.39(0.45 in neonatal nursery and 0.26 in NICU,P<0.001).Major adverse events were diarrhea(31.2%),electrolyte disorder(12.5%),not appropriate environmental temperature(11.0%),impaired skin integrity(7.9%)and hospital infection(6.6%),There were 83 AEs undetected by trigger tool.29.4% of the adverse events damage grade F and above.During the real-time study,417 triggers and 261 unique AEs were included,total PPV is 0.64,which is higher than that of the retrospective study(0.45).The PPV of triggers about impaired skin integrity(P<0.001)and antibiotic application(P < 0.001)were statistically significant.ConclusionThis tool was a feasible trigger tool in the nursery ward.To enhance the authenticity of the trigger tool,it is necessary to strengthen publicity of the significance of finding AEs among medical workers.