Table 2.
Outcome of respective trigger in relation to the adverse event sorted by positive predictive value
| Original triggers N = 88 | n (%) of patients with ≥ 1 of the respective trigger | n of triggers detected by RNs | n of triggers related to AE | PPV, % | Revised triggers N = 29 a |
|---|---|---|---|---|---|
| Infiltration/extravasation of intravenous injection/ infusion | 40 (6.7) | 60 | 71 | 100.0 | Blood vessel, skin and/or tissue harm |
| Pressure ulcers | 9 (1.5) | 14 | 18 | 100.0 | Blood vessel, skin and/or tissue harm |
| Urinary retention | 9 (1.5) | 10 | 10 | 100.0 | Urinary retention |
| Positive culture from central line catheter or insertion site | 9 (1.5) | 10 | 10 | 100,0 | Positive culture |
| Clostridium difficile positive stool | 5 (0.8) | 5 | 5 | 100.0 | Hospital-acquired infection |
| Neurological harm | 4 (0.7) | 5 | 6 | 100.0 | Neurological impairment/harm |
| Anesthesia related harm | 4 (0.7) | 4 | 4 | 100.0 | Anesthesia-related impairment/harm |
| Anaphylactic reaction | 2 (0.3) | 2 | 3 | 100,0 | Anaphylactic reaction |
| Ventilator-associated pneumonia | 2 (0.3) | 2 | 2 | 100.0 | Ventilator-associated pneumonia |
| Hallucinations/delirium/ICU syndrome | 1 (0.2) | 1 | 1 | 100.0 | Other |
| Occurrence of any postoperative complication | 17 (2.8) | 20 | 19 | 95.0 | Postoperative impairment/harm |
| Abnormal body temperature | 16 (2.7) | 19 | 17 | 89.5 | Abnormal body temperature |
| Post-operative infection | 11 (1.8) | 14 | 12 | 85.7 | Hospital-acquired infection |
| Other side-effect of drug | 34 (5.7) | 36 | 27 | 75.0 | ADE/ADR |
| Readmission to the Intensive Care Unit | 4 (0.7) | 4 | 3 | 75.0 | Unplanned transfer to higher level of care |
| Skin- and blood vessel harm, thrombophlebitis | 100 (16.7) | 242 | 168 | 69.4 | Blood vessel, skin and/or tissue harm |
| Positive blood culture | 30 (5.0) | 40 | 27 | 67.5 | Positive culture |
| Unplanned drug withdrawal | 4 (0.7) | 3 | 2 | 66.7 | ADE/ADR |
| Change in procedure or technique | 7 (1.2) | 7 | 4 | 57.1 | Change in procedure/organ harm |
| Intubation/reintubation/tracheotomy/ coniotomy | 25 (4.2) | 36 | 20 | 55.6 | Intubation, tracheotomy, or coniotomy |
| Dissatisfaction with care | 14 (2.3) | 13 | 7 | 53.8 | Documentation of mistake or dissatisfaction with care |
| Occurrence of mistake | 77 (12.8) | 94 | 50 | 53.2 | Documentation of mistake or dissatisfaction with care |
| Fungal infection | 27 (4.5) | 30 | 15 | 50.0 | Hospital-acquired infection |
| Reoperation | 12 (2.0) | 18 | 9 | 50.0 | Reoperation |
| Instrumental delivery | 16 (2.7) | 14 | 7 | 50.0 | Other |
| Unplanned removal of and/or harm of an organ during surgery or other invasive action | 5 (0.8) | 6 | 3 | 50.0 | Change in procedure/organ harm |
| Unplanned mechanical ventilation greater than 24 h post-operatively | 2 (0.3) | 2 | 1 | 50.0 | Cardiac arrest or failures in vital signs |
| Naloxone administration | 2 (0.3) | 2 | 1 | 50.0 | ADE/ADR |
| Wound rupture | 2 (0.3) | 2 | 1 | 50.0 | Blood vessel, skin and/or tissue harm |
| Rising serum creatinine | 6 (1.0) | 10 | 4 | 40.0 | Renal impairment/harm |
| Readmission to the ED within 48 hours | 4 (0.7) | 3 | 1 | 33.3 | Unplanned readmission within 30 days |
| Unplanned dialysis | 2 (0.3) | 3 | 1 | 33.3 | Renal impairment/harm |
| Other infection | 79 (13.2) | 117 | 38 | 32.5 | Hospital-acquired infection |
| Aspiration | 14 (2.3) | 11 | 3 | 27.3 | Cardiac arrest or failures in vital signs |
| Pain | 127 (21.2) | 234 | 62 | 26.5 | Pain |
| Unplanned intubation/reintubation/ delayed extubation/CPAP/BiPaP | 7 (1.2) | 8 | 2 | 25.0 | Cardiac arrest or failures in vital signs |
| Apgar < 7 | 17 (2.8) | 17 | 4 | 23.5 | Decreased vitality in infant |
| Pneumonia | 17 (2.8) | 17 | 4 | 23.5 | Hospital-acquired infection |
| Readmission within 30 days | 81 (13.5) | 92 | 21 | 22.8 | Unplanned readmission within 30 days |
| Necrotizing enterocolitis | 7 (1.2) | 9 | 2 | 22.2 | Necrotizing enterocolitis |
| Antidote administration | 8 (1.3) | 14 | 3 | 21.4 | ADE/ADR |
| Care: other | 71 (11.8) | 114 | 24 | 21.1 | Other |
| Transfer to higher level of care | 28 (4.7) | 34 | 7 | 20.6 | Unplanned transfer to higher level of care |
| Operative time greater than 6 h | 5 (0.8) | 5 | 1 | 20.0 | Other |
| Antibiotic treated urinary tract infection | 16 (2.7) | 16 | 3 | 18.8 | Hospital-acquired infection |
| Pathological blood gas from umbilical cord blood | 12 (2.0) | 12 | 2 | 16.7 | Decreased vitality in infant |
| Time in ED greater than 6 hours | 6 (1.0) | 6 | 1 | 16.7 | Other |
| Post-operative admission to intensive care unit | 6 (1.0) | 6 | 1 | 16.7 | Unplanned transfer to higher level of care |
| Ultrasound guided drainage | 4 (0.7) | 6 | 1 | 16.7 | Hospital-acquired infection |
| Partial Thromboplastin Time (PTT) greater than 100 seconds | 2 (0.3) | 7 | 1 | 14.3 | ADE/ADR |
| Any codes or arrest | 34 (5.7) | 96 | 13 | 13.5 | Cardiac arrest or failures in vital signs |
| C-reactive protein > 200 mg/liter | 25 (4.2) | 62 | 7 | 11.3 | Hospital-acquired infection |
| Viral gastroenteritis | 32 (5.3) | 53 | 6 | 11.3 | Hospital-acquired infection |
| Abnormal liver enzymes | 23 (3.8) | 45 | 4 | 8.9 | ADE/ADR |
| Abnormal potassium value | 18 (3.0) | 48 | 4 | 8.3 | ADE/ADR |
| Glucose < than 3 mmol/liter or administration of 300 mg/ml or 500 mg/ml glucose | 54 (9.0) | 154 | 12 | 7.8 | Hypoglycemia |
| Vitamin K administration (excluding newborns) | 15 (2.5) | 44 | 3 | 6.8 | ADE/ADR |
| Neutropenia and antibiotic treatment | 13 (2.2) | 65 | 4 | 6.2 | Hospital-acquired infection |
| Abnormal sodium value | 17 (2.8) | 36 | 2 | 5.6 | ADE/ADR |
| Too high or too low drug concentration | 14 (2.3) | 40 | 2 | 5,0 | ADE/ADR |
| Transfusion | 72 (12.0) | 400 | 18 | 4.5 | Cardiac arrest or failures in vital signs |
| Failures in cardiovascular, respiratory or neurological function | 114 (19.0) | 778 | 32 | 4.1 | Cardiac arrest or failures in vital signs |
| Induced delivery | 88 (14.7) | 90 | 3 | 3.3 | Other |
| Abrupt drop in hemoglobin | 46 (7.7) | 111 | 3 | 2.7 | Cardiac arrest or failures in vital signs |
| Thrombocytes < 50 x109/liter | 20 (3.3) | 87 | 2 | 2.3 | ADE/ADR |
| 11 triggers not related to an AEb | 28 (4.7) | 33 | 0 | 0.0 | |
| Total | 429 (71.5) | 3598 | 824 | 22.9 |
RN, registered nurse; AE, adverse events; PPV, positive predictive value; ICU, intensive care unit; ADE, adverse drug event; ADR, adverse drug reaction.
aThe revised trigger column includes the triggers in the final trigger list. For the removed triggers an example of a trigger in the final trigger list suitable for the detection of corresponding AEs is given.
None of the triggers Deep vein thrombosis or embolism, Positive culture from cerebrospinal fluid, Intra- or postoperative death, Post-operative increase in troponin levels, Wrong site/wrong procedure/wrong patient, Flumazenil administration, Sodium polystyrene administration, Interactions, Transfer of mother/child, Terbutaline administration, or 3rd- or 4th-degree lacerations were identified in this study.
bNone of the triggers: International Normalized Ratio (INR) greater > 5, Glucose > 20 mmol/liter, Activation of dose range checking, Intensive care unit procedure, Ultrasound of the brain > week 32 - < 3 months, In-hospital stroke, Falls, Intra-operative administration of administration of inotropes/antidotes, Abnormal pathology report, Unplanned insertion of arterial or central venous line during surgery, Post-operative pleural fluid were associated with an AE in Review Stage 2.