Utility of an Adverse Drug Event Trigger Tool in Veterans Affairs Nursing Facilities
DESIGN: Retrospective chart review.
SETTING/PATIENTS: Veterans residing in three VA nursing facilities between September 29, 2010, and October 29, 2010.
MEASUREMENT: We used the Institute for Healthcare Improvement-endorsed nursing facility ADE trigger tool, modified to enhance its clinical relevance to detect potential ADEs. Electronic medical records were screened to identify residents with one or more abnormal laboratory values specified in the trigger tool.
MAIN OUTCOME MEASURES: A potential ADE was defined as the concurrent administration of medication that could cause the abnormal laboratory value. An overall PPV, or proportion of residents with an abnormal laboratory value who had a potential ADE, and average time required to complete each trigger tool assessment, were calculated.
RESULTS: Among 321 veterans, 50.5% (n = 162) had at least one abnormal laboratory value contained in the trigger tool. Ninety-nine potential ADEs involving 146 medications were detected in 65 veterans. The overall PPV of the ADE trigger tool was 40.1% (65/162), and the average time to complete resident assessments was 8.8 (standard deviation ± 5.7) minutes. The most common potential ADEs were acute kidney injury (n = 30 residents), hypokalemia (n = 18), hypoglycemia (n = 13), and hyperkalemia (n = 10).
CONCLUSIONS: The modified nursing facility trigger tool was shown to be an effective and efficient method for detecting potential ADEs.
Keywords: ACE = Angiotensin converting enzyme; ADE = Adverse drug event; AKI = Acute kidney injury; ALP = Alkaline phosphatase; ALT = Alanine aminotransferase; ARB = Angiotensin II receptor blocker; AST = Aspartate aminotransferase; Adverse drug event; CPK = Creatine phosphokinase; CPRS = Computerized patient record system; Elderly; F = Free; Hgb = Hemoglobin; IHI = Institute for Healthcare Improvement; INR = International normalized ratio; IOM = Institute of Medicine; MDS = Minimum Data Set; MRR = Medication regimen review; NAPA = N-acetylprocainamide; NNA = Number needed to alert; Nursing facility; P = Peak; PPV = Positive predictive value; R = Random; RAP = Resident Assessment Protocol; RIFLE = Risk; injury; and failure; and loss; and end-stage kidney disease; SD = Standard deviation; SSRI = Selective serotonin reuptake inhibitor; T = Total; T. bili = Total bilirubin; T4 = Thyroxine; TSH = Thyroid-stimulating hormone; Tr = Trough; Trigger tool; ULN = Upper limit of normal; VA = Veterans Affairs; aPTT = Activated partial thromboplastin time
Document Type: Research Article
Publication date: 2013-02-01
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