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J Clin Outcomes Manage
2004 Oct;11(10):640-646
Reducing adverse drug events involving high-risk medications in acute care
Crea KA, Sherrin TP, Morehead D, Snow R
Abstract: Objective: To utilize a modified version of previously published trigger methodologies to identify opportunities for decreasing adverse drug events (ADEs) and to measure the success of improvement efforts. Methods: To consistently identify a subset of ADEs, we modified the ADE trigger tool utilized by Resar and colleagues. Three high-risk medication classes were chosen for this project: anticoagulants (partial thromboplastin time > 100 sec, international normalized ratio > 5, administration of vitamin K), narcotics and benzodiazepines (administration of flumazenil or naloxone), and insulin (serum glucose < 50 mg/dL or administration of D50W). Eight hospitals reviewed charts to determine the presence of ADEs in the 3 classes of triggers during a 3-month baseline period. Hospital quality improvement professionals met to evaluate the data, identify 1 high-risk class on which their hospital would focus, and explore processes in place that could correlate with variances in ADEs at the hospital level. Each hospital developed and implemented solutions to decrease events such as a restrictive policy on narcotic range orders and pharmacy-based dosing and monitoring services for anticoagulants. Results: Early combined results demonstrate a reduction in ADEs identified through the trigger method from an average of 61.3 per month during the baseline period to an average of 34 per month during the 11-month period from July 2003 through May 2004 (a 45% relative reduction). Conclusion: The use of a modified trigger tool provides a consistent method of identifying patients receiving high-risk medications who have potentially experienced an ADE for further chart review. Providing a stable metric, accountability, and process comparison at OhioHealth facilitated a 45% relative reduction in ADEs within a selected high-risk medication class in 8 Ohio hospitals.
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