Application Of Global Trigger Tools In The Adverse Drug Events Of Elderly Patients

Elderly patients are often at high risk of adverse drug events due to multi-disease coexistence,multi-drug combination,poor drug compliance and weakened ability to respond to drug effects,so it is of great importance to monitor adverse drug events in elderly patients.Therefore,monitoring of adverse drug events in elderly patients is crucial.However,the current voluntary reporting monitoring model is passive and single,and most adverse drug events were reported after the event,and cannot fully reflect the occurrence of adverse events.Compared with the current monitoring methods,the global trigger tool can increase the detection rate of adverse events and predict the occurrence trend of adverse events.In view of the above background,this study mainly aimed at elderly patients,established trigger tools and verified the practicability of triggers.Set up the old ADE trigger.Methods:(1)according to the screening conditions,retrospective analysis was conducted on the elderly adverse reactions collected from the adverse reactions center of sichuan province from November 2016 to November 2017 to understand the occurrence of adverse events in the elderly;(2)literature on ADE trigger tools for elderly patients in PubMed,CNKI and Wanfang databases,and initial trigger items were established in combination with relevant medication guidelines;(3)designed the questionnaires and two rounds of Delphi expert consultation were conducted to consult experts from relevant clinical departments to form the ADE trigger for the elder in this study.Results: a total of 4847 reports were obtained,involving mainly skin and accessory damage,gastrointestinal system damage,central and peripheral nervous system damage.A total of 425 drugs were involved,mainly including anti-infective drugs,traditional Chinese medicine preparations and cardiovascular drugs.There were 19 experts who participated in the survey.The recovery rate of the two-round questionnaire was 100% and 94.74%,the coefficient of opinion variation was 0.16±0.03 and 0.14±0.02,the average coefficient of coordination was 0.428,the coefficient of expert authority was 0.735±0.08,and the average reliability of the questionnaire was 0.773.According to the results of the consultation,36 triggers were sorted out,including 17 laboratory examination indicators,10 treatments,8 clinical manifestations and 1 intervention.Practical verification study of ADE triggers in the elderly.Methods: the elderly inpatients in sichuan provincial people's hospital were selected as the study subjects,and 400 medical records were randomly selected according to the calculation and screening criteria of sample size.The records were reviewed according to the method recommended by the GTT white paper.ADE detected was classified and statistically analyzed according to system-organ involvement,severity,occurrence time and suspected medications.Binary logistic was used for risk factor analysis,and the practicability of the trigger was evaluated by ADE detection rate and positive predictive value.Results: of the 36 triggers,27(75.00%)were positive for trigger,16 were positive for ADE,and the PPV of triggers was 24.17%.44 of the 400 patients had 49 cases of ADE and four of them were not detected by the trigger.In this study,ADE incidence was 11.00% in inpatients,12.25 per 100 admissions,and 13.46 per 1,000 patient days.Severity classification of ADE as follows: 12.25%(6/49)for level 1,83.67%(41/49)for level 2,4.08%(2/49)for level 3,involvement of the systems and organs in the gastrointestinal tract damage(28.30%),metabolism and nutrition disorder(24.53%),involving drugs mainly cardiovascular system drugs(41.37%),and 71.43% of drug ADE occurred in 2 days,binary regression analysis results showed that only kinds has significant effect to occur in elderly ADE.By analyzing the result of medical record review,the trigger was optimized and adjusted,and finally 33 triggers were obtained.This study shows that the established ADE triggers for elderly patients have good practicability(sensitivity and specificity),which is conducive to the monitoring of the occurrence of ADE in elderly patients,the objective reflection of the occurrence of ADE in elderly patients,the improvement of medical staff's ability to recognize ADE in elderly patients,and the improvement of the management level of drug safety in medical institutions.