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Use the 'trigger tool' to accurately track medication errors

Nurse Manager Weekly, January 23, 2003

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Adverse event data exists in patient records, but few organizations are eager to hire the full-time staff it would take to pore through all of the paperwork.

With this problem in mind, the Institute for Healthcare Improvement's (IHI) Frances A. Griffin, RRT, MPA, and colleagues set out three years ago to develop a tool to quickly zero in on medical errors that cause harm.

Facilities who use this tool report success. About a year and a half ago, patients at Illinois-based OSF HealthCare experienced an average of 3.8 adverse drug events (ADEs) per 1,000 doses. Today, that number has shrunk to around 1.4 ADEs per 1,000 doses.

Tool development

Using various pieces of existing work, Griffin, the co-director of the Safety Domain for the IHI's IMPACT program, and the rest of the IHI's Idealized Design of the Medication System group, compiled a list of 24 medical-chart red flags into an ADE chart-review tool. They call it the "trigger tool," for short.

The triggers on this list often signify the occurrence of an ADE, and allow chart reviewers to skip over the bulk of a patient's charts.

Using the tool: the nitty-gritty

So how does the tool work? Start by having a multidisciplinary team do a monthly retrospective review of charts. Griffin recommends the team include at least a nurse, a pharmacist, and a physician-and that the members be kept consistent.

The team should review at least 20 charts per month. After a short while, "most people get to where they can do one in 15 minutes," said Griffin. Members should concentrate only on the part of the chart that will tell them about ADEs. "You don't want to read the whole chart. That could take hours," she noted.

If team members don't find any triggers in a chart, they should move on. However, the appearance of a trigger merits further investigation, because it may reveal that an ADE occurred. For instance, if Benadryl was prescribed, find out why. Was it an allergic reaction to a medication? Did staff know about the allergy ahead of time?

Decide whether harm resulted from the error, and then classify it according to the National Coordinating Council for Medication Error Reporting and Prevention Index, www.nccmerp.org/.

Adapted from: Briefings on Patient Safety, www.hcmarketplace.com/Prod.cfm?id=234&ENMW.

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