Evaluation of Performance of IHI Global Trigger Tool in Identification of Adverse Drug Events: A Prospective Observational Study

Aims: The study aims to evaluate the performance of the Institute for Healthcare Improvement (IHI) global trigger tool in the identification of adverse drug events.

Study design: Prospective observational study.

Place and duration of study: The study was conducted in a General Medicine department of a secondary care referral hospital located in rural, resource-limited settings of Bathalapalli, Anantapur district, Andhra Pradesh, India. The study was conducted for a period of six months, from June 2019 to November 2019.

Methodology: A pre-designed data collection form was used to collect the data from the study participants. The required data was obtained from the patient case sheet, lab reports, treatment charts, daily nursing notes, daily physician notes, and direct patient interviews. The global trigger tool developed by IHI was used for the rapid review of inpatient medical records and to generate clues for the identification of ADEs. Descriptive statistics were used to represent the findings of demographics, clinical characteristics, ADE profiles, IHI triggers, and clinical alterations. ADE incidence was shown in a measure of ADE per 1000 patient days. IHI global trigger tool performance in detecting ADE was measured by sensitivity, specificity, positive predictive value, and negative predictive value.

Results: A total of 192 patients were enrolled in the study. Among them, 225 triggers and 123 ADEs were detected. The incidence of ADEs in the inpatients estimated by the IHI method was estimated as; 20.2 ADEs per 1000 patient days,64.0ADEs per 100 admissions, 56.2percent of admissions with ADE. Majority of ADEs are shown possible relationship with drug (60; 48.7%), level-2 severity (49; 39.8%), and not preventable (52; 42.2%). Most IHI global triggers showed high sensitivity, specificity, positive predictive value, and negative predictive value for detecting ADEs.

Conclusion: The study shows that most of the triggers in the IHI Trigger tool have shown good accuracy in identifying ADEs. Thus, using the IHI Trigger Tool to identify ADEs can help to improve patient safety. Therefore, the study recommends incorporating IHI global trigger tool in routine, conventional ADE screening techniques to improve the detection rate and promote drug safety.