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Development of a trigger tool for the detection of adverse drug events in Chinese geriatric inpatients using the Delphi method

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Abstract

Background The global trigger tool is a method of retrospective medical record review that identifies possible harm in hospitalized patients using “triggers”. Elderly patients with multiple co-morbid illnesses are especially vulnerable to adverse drug events (ADEs) that have high prevalence rates. Objective The purpose of this study was to develop an appropriate trigger tool to detect ADEs in Chinese geriatric inpatients by combining a literature review with the Delphi method. Setting Chinese geriatric inpatients. Methods Two steps were used to develop the trigger tool. First, we conducted a comprehensive literature review for existing ADE triggers (adult or elderly) to form the initial triggers for the Delphi process. Second, a group of clinical experts, including physicians, clinical pharmacists and nurses, was established to score candidate triggers for utility according to the usefulness and feasibility of implementing triggers in clinical practice. Main outcome measures The frequency of the full mark, arithmetic mean and coefficient of variation of each trigger. Results An initial set of 51 triggers was selected by literature review for evaluation. The group of experts was composed of 18 clinical experts: 13 physicians, 4 clinical pharmacists, and 1 nurse. Based on the two-phase Delphi process, 42 triggers in five categories (laboratory index, plasma concentration, antidotes, clinical symptoms and intervention) were retained. Conclusion The 42-trigger tool was developed to identify ADEs in Chinese geriatric inpatients. A pilot study that tests the list of triggers to identify ADEs in Chinese geriatric inpatients is the next step for establishing a specific trigger tool for Chinese geriatric inpatients.

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Acknowledgements

The authors thank all of the experts for their participation in the modified Delphi processes. The authors also thank the Preventive Medicine Association of Sichuan (2017KJFW01), which approved the planning, execution and analysis as proposed in the grant application.

Funding

The Preventive Medicine Association of Sichuan supported this study.

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Authors and Affiliations

  1. Department of Pharmacy of West China Hospital, Chengdu, 610041, China

    Qiaozhi Hu, Zhou Qin, Mei Zhan, Bin Wu & Ting Xu

  2. West China Clinical Medical School, Chengdu, China

    Zhaoyan Chen

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  1. Qiaozhi Hu
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Correspondence to Ting Xu.

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Hu, Q., Qin, Z., Zhan, M. et al. Development of a trigger tool for the detection of adverse drug events in Chinese geriatric inpatients using the Delphi method. Int J Clin Pharm 41, 1174–1183 (2019). https://doi.org/10.1007/s11096-019-00871-x

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