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Utility of an Adverse Drug Event Trigger Tool in Veterans Affairs Nursing Facilities

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OBJECTIVE: To determine the utility (i.e., positive predictive value [PPV] and time requirement) of an adverse drug event (ADE) trigger tool in Veterans Affairs (VA) nursing facilities and to describe the most common types of potential ADEs detected with the trigger tool.

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.
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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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  • The Consultant Pharmacist® is the official peer-reviewed journal of the American Society of Consultant Pharmacists. It is dedicated exclusively to the medication needs of the elderly in all settings, including adult day care, ambulatory care, assisted living, community, hospice, and nursing facilities. This award-winning journal is a member benefit of ASCP. Individuals who are not members and wish to receive The Consultant Pharmacist® will want to consider joining ASCP.
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