Skip to main content
NCBI home page
Quality & Safety in Health Care logoLink to Quality & Safety in Health Care
. 2003 Dec;12(Suppl 2):ii39–ii45. doi: 10.1136/qhc.12.suppl_2.ii39

Methodology and rationale for the measurement of harm with trigger tools

R Resar, J Rozich, D Classen
PMCID: PMC1765771  PMID: 14645894

Abstract

The growing recognition of harm as an unwelcome and frequently unrecognized byproduct of health care has initiated focused efforts to create highly reliable organizations for safe healthcare delivery. While debate continues over the exact magnitude of harm, there is a general acceptance of the need to improve our ability to deliver care in a safer manner. A major barrier to progress in safety has been the ability to effectively measure harm consistently and thus develop effective and targeted strategies to prevent its occurrence. This has resulted in a shift from initiatives focused exclusively on analysis of errors to those targeting events linked to harm. There is a growing recognition of a distinction between errors and adverse events as they often represent unique concepts fostering different strategies for improvement of safety. Conventional approaches to identifying and quantifying harm such as individual chart audits, incident reports, or voluntary administrative reporting have often been less successful in improving the detection of adverse events. As a result, a new method of measuring harm—the trigger tool—has been developed. It is easily customized and can be readily taught, enabling consistent and accurate measurement of harm. The history, application, and impact of the trigger tool concept in identifying and quantifying harm are discussed.

Full Text

The Full Text of this article is available as a PDF (194.3 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bates D. W., Boyle D. L., Vander Vliet M. B., Schneider J., Leape L. Relationship between medication errors and adverse drug events. J Gen Intern Med. 1995 Apr;10(4):199–205. doi: 10.1007/BF02600255. [DOI] [PubMed] [Google Scholar]
  2. Bates D. W., Cullen D. J., Laird N., Petersen L. A., Small S. D., Servi D., Laffel G., Sweitzer B. J., Shea B. F., Hallisey R. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA. 1995 Jul 5;274(1):29–34. [PubMed] [Google Scholar]
  3. Berwick D. M. Not again! BMJ. 2001 Feb 3;322(7281):247–248. doi: 10.1136/bmj.322.7281.247. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Brennan T. A., Leape L. L., Laird N. M., Hebert L., Localio A. R., Lawthers A. G., Newhouse J. P., Weiler P. C., Hiatt H. H. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med. 1991 Feb 7;324(6):370–376. doi: 10.1056/NEJM199102073240604. [DOI] [PubMed] [Google Scholar]
  5. Classen D. C., Pestotnik S. L., Evans R. S., Burke J. P. Description of a computerized adverse drug event monitor using a hospital information system. Hosp Pharm. 1992 Sep;27(9):774, 776-9, 783. [PubMed] [Google Scholar]
  6. Classen D. C., Pestotnik S. L., Evans R. S., Lloyd J. F., Burke J. P. Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. JAMA. 1997 Jan 22;277(4):301–306. [PubMed] [Google Scholar]
  7. Cullen D. J., Bates D. W., Small S. D., Cooper J. B., Nemeskal A. R., Leape L. L. The incident reporting system does not detect adverse drug events: a problem for quality improvement. Jt Comm J Qual Improv. 1995 Oct;21(10):541–548. doi: 10.1016/s1070-3241(16)30180-8. [DOI] [PubMed] [Google Scholar]
  8. Evans R. S., Pestotnik S. L., Classen D. C., Clemmer T. P., Weaver L. K., Orme J. F., Jr, Lloyd J. F., Burke J. P. A computer-assisted management program for antibiotics and other antiinfective agents. N Engl J Med. 1998 Jan 22;338(4):232–238. doi: 10.1056/NEJM199801223380406. [DOI] [PubMed] [Google Scholar]
  9. Hurwitz N., Wade O. L. Intensive hospital monitoring of adverse reactions to drugs. Br Med J. 1969 Mar 1;1(5643):531–536. doi: 10.1136/bmj.1.5643.531. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Jick H. Drugs--remarkably nontoxic. N Engl J Med. 1974 Oct 17;291(16):824–828. doi: 10.1056/NEJM197410172911605. [DOI] [PubMed] [Google Scholar]
  11. Layde Peter M., Cortes Leslie M., Teret Stephen P., Brasel Karen J., Kuhn Evelyn M., Mercy James A., Hargarten Stephen W., Maas Leslie A. Patient safety efforts should focus on medical injuries. JAMA. 2002 Apr 17;287(15):1993–1997. doi: 10.1001/jama.287.15.1993. [DOI] [PubMed] [Google Scholar]
  12. Leape L. L., Brennan T. A., Laird N., Lawthers A. G., Localio A. R., Barnes B. A., Hebert L., Newhouse J. P., Weiler P. C., Hiatt H. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med. 1991 Feb 7;324(6):377–384. doi: 10.1056/NEJM199102073240605. [DOI] [PubMed] [Google Scholar]
  13. Leape Lucian L., Berwick Donald M., Bates David W. What practices will most improve safety? Evidence-based medicine meets patient safety. JAMA. 2002 Jul 24;288(4):501–507. doi: 10.1001/jama.288.4.501. [DOI] [PubMed] [Google Scholar]
  14. McMullin S. T., Reichley R. M., Kahn M. G., Dunagan W. C., Bailey T. C. Automated system for identifying potential dosage problems at a large university hospital. Am J Health Syst Pharm. 1997 Mar 1;54(5):545–549. doi: 10.1093/ajhp/54.5.545. [DOI] [PubMed] [Google Scholar]
  15. Payne T. H., Savarino J., Marshall R., Hoey C. T. Use of a clinical event monitor to prevent and detect medication errors. Proc AMIA Symp. 2000:640–644. [PMC free article] [PubMed] [Google Scholar]
  16. Reason J. Human error: models and management. BMJ. 2000 Mar 18;320(7237):768–770. doi: 10.1136/bmj.320.7237.768. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Rozich J. D., Haraden C. R., Resar R. K. Adverse drug event trigger tool: a practical methodology for measuring medication related harm. Qual Saf Health Care. 2003 Jun;12(3):194–200. doi: 10.1136/qhc.12.3.194. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Thomas Eric J., Petersen Laura A. Measuring errors and adverse events in health care. J Gen Intern Med. 2003 Jan;18(1):61–67. doi: 10.1046/j.1525-1497.2003.20147.x. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Quality & safety in health care are provided here courtesy of BMJ Publishing Group

RESOURCES