Development of trigger tools for detection of adverse drug events in Chinese geriatric inpatients using Delphi method

[Speaker] Qiaozhi Hu:1
[Co-author] Mei Zhan:1, Bin Wu:1, Zhaoyan Chen:2, Ting Xu:1
1:Department of Clinical Pharmacy, West China Hospital of Sichuan University, China, 2:West China Medical School of sichuan university, China

Background: The Global Trigger Tool(GTT)is an efficient and reliable method for possible adverse drug events(ADEs)identification of inpatient hospital records using triggers. The purposes of the study are to develop a trigger tool to detect ADEs for Chinese geriatric inpatients using Delphi method. Methods: Three steps were used to develop the trigger tool. First, the researchers conducted a comprehensive literature review for existing ADEs triggers(adult or elderly)to formed the initial triggers for Delphi process. Second, a group of clinical experts, including physicians, clinical pharmacists and nurses, was established to the triggers selection. Finally, a two phases Delphi method was implemented to evaluate and rate the ADEs triggers. Results: Of the 328 articles were available by retrieval of databases, including 324 English and 5 Chinese. 316 articles which were repetitive studies or not met inclusion criteria were excluded, and finally 12 were included(Table 1). An initial set of 51triggers including five parts(laboratory index, plasma concentration, antidotes, clinical symptoms and intervention)was determined by literature review(Table 2). The expert panel included 18 experts(13 physician, 4 clinical pharmacists and 1 nurses)who were from comprehensive three levels hospitals or major universities. There physicians were from the department of oncology, respiration, gastroenterology, cardiology, endocrinology, nephrology, hematology, urology surgery, thoracic surgery and general surgery. Based on the two phases Delphi process, resulting in 42 triggers were included for ADEs detection in Chinese geriatric inpatients(Table3). Conclusion: Global trigger tool with sensitivity and specificity is a feasible method for ADEs monitoring. By integrating the findings of trigger tool study with a Delphi process, we first developed a specific trigger tool to detect ADEs for Chinese geriatric inpatients who were at high risk of ADEs. This specific trigger tool not only is a feasible method for ADEs monitoring, but also can serves to estimate the incidence of ADEs, and assess the effectiveness of ADE preventive interventions targeting the safety of Chinese geriatric inpatients. In addition, the pilot testing of this 42 triggers tool is the next phase of the work to adjust triggers and identify positive predictive values for each trigger to establish a propagable trigger tools for Chinese geriatric inpatients.

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