PMID- 34951611
OWN - NLM
STAT- MEDLINE
DCOM- 20220223
LR  - 20230928
IS  - 1549-8425 (Electronic)
IS  - 1549-8417 (Linking)
VI  - 18
IP  - 1
DP  - 2022 Jan 1
TI  - Development of a Trigger Tool to Identify Adverse Events and Harm in a 
      Neuropsychiatry Setting.
PG  - e343-e350
LID - 10.1097/PTS.0000000000000784 [doi]
AB  - BACKGROUND OBJECTIVES: Adverse drug events (ADEs) present the greatest risk of 
      harm to patients in hospitals, especially those receiving neuropsychiatric 
      treatment. The objective of the present record-based study was to test the 
      appropriateness of the neuropsychiatry trigger tool (NPTT) to identify and 
      measure harm due to adverse events (AEs). METHODS: A total of 1324 clinical case 
      notes of discharged patients from 2017 to 2018 with a hospital stay >24 hours to 
      <70 days were examined. RESULTS: One hundred forty-four (10.88%) patients 
      experienced 166 AEs. A total of 854 triggers (range, 1-12 triggers per patient) 
      were identified in 296 (22.36%) and 39 (2.94%) patients presented with triggers 
      at admission. The overall AE rate per 1000 patient days was 12.73 (intensive care 
      unit, 21; inpatient department, 11.54). Triggers at admission were altered 
      sensorium and abnormal behavior followed by headache, ataxia, and aspiration 
      pneumonia. A small number of triggers accounted for most AEs (laxative, rising 
      liver function test (LFT), hypokalemia, hyponatremia, health care-associated 
      infections, intubation, abnormal behavior/sensorium, hepatic encephalopathy, 
      antiemetics), although type of AE reported differed by level of care. Most AEs 
      caused minor harm, and relatively fewer patients experienced temporary harm 
      requiring intervention (110; 8.29%), permanent harm (45; 3.39%), harm requiring 
      initial/prolonged hospitalization (10; 0.75%), interventions to sustain life (24; 
      1.81%), and death (109; 8%). The higher the number of AEs, the longer was the 
      length of stay (average increased from 9.32 to 17.33 days). The NPTT identified 
      30 times more AEs compared with 5 AEs reported by voluntary method. 
      Medication-related ADEs were found in 130 (90%) of 144 patients who experienced 
      AEs. Antitubercular drugs caused most ameliorable AEs (visual disturbance, 
      drug-induced vomiting, deranged LFT, constipation). Care is needed in attributing 
      harm because some triggers (abnormal sensorium/behavior, intubation, 
      headache/dizziness, laxatives) may overlap with neurological illnesses 
      (cerebrovascular accident [CVA]/meningitis/stroke). If the triggers are 
      identified early, harm/discomfort to the patients can be reduced. The NPTT can be 
      used in patient safety improvement projects. Harm occurred in 296 (22.28%) 
      patients (temporary, 120 [9%]; permanent, 178 [13%]). Adverse events prolonged 
      hospital stay (14.29 days) compared with 9.32 days in patients without AEs. 
      CONCLUSIONS: A higher number of triggers per patient (>/=5), trigger nature 
      (intubation, cardiac arrest/shock), or the presenting illness 
      (CVA/neuroinfections/status epilepticus/prolonged seizures) were correlated with 
      the highest harm, that is, death. Because some triggers (abnormal 
      sensorium/behavior, headache/dizziness, laxatives, intubation) may overlap with 
      neurological illness (CVA/meningitis/stroke), care is needed in attributing harm. 
      The NPTT identified 30 times more AEs compared with 5 AEs reported by voluntary 
      method. Antitubercular drugs caused ameliorable AEs (visual disturbance, 
      drug-induced vomiting, deranged LFT, constipation) and, if identified early, can 
      reduce harm/discomfort to the patients.
CI  - Copyright (c) 2020 Wolters Kluwer Health, Inc. All rights reserved.
FAU - Sharma, Sangeeta
AU  - Sharma S
AD  - From the Departments of Neuropsychopharmacology.
FAU - Kapoor, Kaveri
AU  - Kapoor K
AD  - From the Departments of Neuropsychopharmacology.
FAU - Nasare, Namita
AU  - Nasare N
AD  - From the Departments of Neuropsychopharmacology.
FAU - Bhardhwaj, Ankit
AU  - Bhardhwaj A
AD  - From the Departments of Neuropsychopharmacology.
FAU - Kushwaha, Suman
AU  - Kushwaha S
AD  - Neurology, Institute of Human Behaviour and Allied Sciences, Delhi, India.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Patient Saf
JT  - Journal of patient safety
JID - 101233393
SB  - IM
MH  - *Drug-Related Side Effects and Adverse Reactions/epidemiology
MH  - Hospitalization
MH  - Humans
MH  - *Neuropsychiatry
MH  - Patient Safety
MH  - Retrospective Studies
COIS- The authors disclose no conflict of interest.
EDAT- 2021/12/25 06:00
MHDA- 2022/02/24 06:00
CRDT- 2021/12/24 12:08
PHST- 2021/12/24 12:08 [entrez]
PHST- 2021/12/25 06:00 [pubmed]
PHST- 2022/02/24 06:00 [medline]
AID - 01209203-202201000-00055 [pii]
AID - 10.1097/PTS.0000000000000784 [doi]
PST - ppublish
SO  - J Patient Saf. 2022 Jan 1;18(1):e343-e350. doi: 10.1097/PTS.0000000000000784.