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Developing and Implementing a Standardized Process for Global Trigger Tool Application Across a Large Health System

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Background: To complement voluntary adverse event reporting, which may detect only specific categories of harms and may represent merely a fraction of actual adverse events, the Adventist Health System (AHS) began using the Institute for Healthcare Improvement (IHI) Global Trigger Tool (GTT) to more accurately gauge the number, types, and severity levels of adverse events and developed a centralized process to do so uniformly.

Methods: AHS began using the GTT in 2009 in 25 of its 42 hospitals that used a common electronic medical record (EMR). The common EMR and centralized record review enables AHS to apply the GTT uniformly and provides consistency of data collected. AHS sends quarterly reports to participating facilities to communicate findings and provides case studies illustrating the most egregious harms. Case study recipients are encouraged to further examine patient records, explore events leading to harm, and share the information with process/quality improvement committees, medical executive committees, and boards of directors to identify opportunities for quality improvement. AHS staffing and record review processes have evolved since 2009.

Results: A GTT review of 17,295 patient records indicated that adverse events clustered as medication-related glycemic events; medication-related delirium, confusion, or oversedation related to analgesics, sedatives, and muscle relaxants; pressure ulcers; medication-related bleeding; and medication-related skin/mucosal reaction/itching.

Conclusions: The AHS process demonstrates how a large health system uses the GTT to detect harms. Since 2009 AHS has improved and streamlined its reporting, data entry, and review processes. AHS used major harms findings to initiate systemwide collaborative improvement projects for glycemic management and pressure ulcers.

Document Type: Research Article

Publication date: July 1, 2013

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  • Published monthly, The Joint Commission Journal on Quality and Patient Safety is a peer-reviewed publication dedicated to providing health professionals with the information they need to promote the quality and safety of health care. The Joint Commission Journal on Quality and Patient Safety invites original manuscripts on the development, adaptation, and/or implementation of innovative thinking, strategies, and practices in improving quality and safety in health care. Case studies, program or project reports, reports of new methodologies or new applications of methodologies, research studies on the effectiveness of improvement interventions, and commentaries on issues and practices are all considered.

    Also known as Joint Commission Journal on Quality Improvement and Joint Commission Journal on Quality and Safety
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