Table 2.

Results, ranked by final rating, for Rounds 1-3 assessing 19 outpatient ADE triggers for utility of patient interventions

Outpatient ADE Trigger Information				Utility of Patient Intervention (1=High, 9=Low)
Name	Rule	Goal	Description	Round 1		Round 2		Round 3
				N	Median (Range)	N	Median (Range)	N	Median (Range)
Warfarin	[Started on warfarin within 14 days AND (International Normalized Ratio (INR)>3.0 AND INR increased by 1 within 2 days) AND no repeat INR within 2 days] OR (Started in warfarin longer than 14 days prior AND INR>4 AND no repeat INR within 2 weeks) OR (INR>6 AND no repeat INR within 2 days)	Detect rapid or excessive anticoagulation to prevent bleed	Look for over anticoagulation and no evidence of rechecking within reasonable window	8	1.0 (1-5)	7	1.0 (1-2)	6	1.0 (1-2)
Potassium- high	[(K+>5.5 and up by >10% since last measurement) OR (K+>6.0)] AND (Potassium (K) raiser active OR Potassium reducer discontinued 1 day to 4 weeks days prior) AND No new potassium reducer OR Decrease in potassium raiser within 5 days of triggering result	Detect hyperkalemia to prevent further increase and arrhythmia	Look for rising potassium and no evidence of change	7	1.0 (1-6)	6	1.0 (1-2)	5	1.0 (1-3)
Potassium- low	Use of potassium (K) reducer AND [K <3.0 OR (K < 3.5 AND K decreased by >15%) versus previous measurement] AND (No new potassium raiser OR decreased potassium reducer) within 5 days of triggering potassium result	Detect hypokalemia to prevent further decline and arrhythmia	Look for dropping potassium and no evidence of change	7	2.0 (1-7)	6	2.0 (1-3)	5	2.0 (1-3)
Delirium	Active prescription of sedative hypnotic including anticholinergic AND Subsequent new diagnosis of (dementia, fall, delirium)	Detect impairment in consciousness and cognition to improve quality of life	Look for psychotropic with subsequent decline in consciousness or cognition	7	2.0 (1-7)	6	2.0 (1-3)	5	2.0 (1-3)
Bone Marrow Toxin	(On bone-marrow-toxic drug with a course more than 2 weeks AND No chemotherapy within 2 weeks) AND [(white blood cell count (WBCs)<2,500 AND decrease from before course by more than 2,000) OR (WBCs<2,000 AND decrease from before course by more than 1,000) OR (Platelets<50k AND decrease by 75k within 1 week)] AND (no repeat complete blood count OR no decrease in drug) within 5 days of triggering result	Detect early signs of myelo-suppression to prevent more severe cases	Look for decrease in cells after non-cancer drug and no evidence of recognition	7	1.0 (1-3)	6	1.0 (1-2)	5	2.0 (1-4)
Hepato- toxic	Active prescription for hepatotoxic drug AND aspartate aminotransferase (AST) or alanine aminotransferase (ALT) levels >150	Detect potential hepatotoxicity to prevent serious liver damage	Look for development of hepatotoxicity while on drug that can cause hepatotoxicity	7	2.0 (1-3)	6	2.0 (1-3)	5	2.0 (1-4)
Thyroid	Abnormal thyroid-stimulating hormone (TSH) test on thyroid replacement and no repeat test or new prescription of thyroid replacement within 2 months of triggering value.	Detect out of range thyroid to prevent related problems	Look for out-of-range TSH without evidence of follow up	8	2.5 (1-7)	7	3.0 (1-4)	6	3.0 (2-4)
Antibiotic	Trough levels of antibiotic more than double the recommended maximum AND at least two days left in the course AND no reduction in dose of the antibiotic.	Prevent antibiotic toxicity (hearing and renal function)	Look for dangerously high trough levels	8	2.0 (1-3)	7	2.0 (1-3)	6	3.0 (2-4)
Steroid	Long-term prescription of oral glucocorticoid (written for 3-months supply or for 6 months of refills or renewed after 3 months) AND at 6 weeks after steroid started no bisphosphonate prescribed	Detect long-term steroid course with inappropriate monitoring/ treatment for prevention of related problems	Look for long term course of steroid and no bisphosphonate or no glucose check	8	3.0 (1-6)	7	3.0 (2-6)	6	3.0 (3-6)
Blood Pressure	Diagnosis code for (fall, dizziness, orthostatic hypotension) AND antihypertensive started within 3 months AND systolic BP below 140 AND no reduction in or new prescription for any antihypertensive medication	Detect symptomatic low BP to prevent further problems	Look for problem associated with relatively low BP and no evidence of addressing the problem	7	4.0 (1-9)	6	3.0 (1-8)	6	3.0 (1-6)
Anti– Platelet	Receiving antiplatelet agent AND platelets < 50,000/m3 AND no repeat complete blood count within 2 weeks	Detect platelet impairment with thrombocytopenia to prevent bleed	Look for low platelets in a patient receiving an antiplatelet agent	7	3.0 (1-9)	6	3.0 (1-8)	6	3.0 (2-9)
Creatinine	[New order or increase in (direct GFR reducer OR volume reducer OR nephrotoxin) within (1-5 days OR 1 day to last creatinine measure) AND (No new trimethoprim within 5 days)] AND (No decrease in any meds above since the last creatinine measure OR no repeat order for creatinine) AND (>25% reduction in creatinine clearance since initiation or increase of above med AND resulting creatinine clearance < 50)	Detect decreased renal function to prevent reactions from other drugs that are renally cleared	Soon after starting a drug that might decrease creatinine, look for a decrease in creatinine clearance to a concerning level and make sure that the new drug has not been decreased.	7	3.0 (1-9)	5	3.0 (2-9)	6	3.5 (2-7)
Calcium Channel Blocker	Weight increased >6 pounds between 2 weeks and 3 months of starting dihydropyridine calcium-channel blocker (CCB) AND no diagnosis of congestive heart failure AND (no discontinuation of CCB OR no new antihypertensive other than a diuretic)	Detect edema to mitigate it	Look for rapid weight gain soon after starting CCB that may induce LE edema and no evidence of recognition	7	3.0 (2-9)	6	3.5 (2-6)	6	4.5 (3-8)
Theo- phylline	Theophylline level >20 μg/ml OR Theophylline given for >12 months with no level measured	Detect potential or actual dangerous theophylline level to prevent dangerous adverse reactions	Look for high theophylline level or inadequate monitoring	7	4.0 (2-8)	6	4.5 (3-8)	5	5.0 (4-8)
Parkin- sonism	Change from (typical to atypical antipsychotic OR from any antipsychotic to quetiapine) within 4 weeks of starting therapy OR [prescription of dopaminergic medication OR new diagnosis of (akathisia OR parkinsonism OR tremor)] within 3 months of starting	Detect drug induced parkinsonism	Look for early change to less toxic antipsychotic or new diagnosis of common adverse effects of antipsychotic medication	7	5.0 (2-9)	6	5.0 (3-9)	5	5.0 (3-8)
ACE Inhibitor	New order for Angiotensin II Receptor Blockers (ARB) within 3 months of starting Angiotensin Converting Enzyme Inhibitor (ACEI)	Detect cough from ACE inhibitor	Look for switch from ACE inhibitor to ARB.	7	5.0 (2-9)	6	5.0 (4-9)	6	5.0 (4-9)
C-Diff	Prescription of (oral vancomycin or metronidazole OR Order for Clostridium Difficile culture or toxin OR ICD9 code for C. diff colitis or similar codes) within (1 day after start AND before 4 weeks after the completion) of an antibiotic course OR Prescription of antidiarrheal within (1 day after start AND before 3 weeks after the completion) of an antibiotic course	Detect antibiotic- associated diarrhea	Look for evidence of clinical suspicion of C. difficile colitis or regular antibiotic-associated diarrhea	8	6.0 (1-9)	7	6.0 (1-9)	6	6.0 (3-7)
Fungal	Prescription of an oral or vaginal antifungal between 3 days after start of antibiotic and 10 days after end of course.	Detect antibiotic- associated fungal infection	Look for treatment of mucosal fungal infection	8	7.0 (3-9)	7	7.0 (3-9)	6	7.0 (3-9)
Anti- depressant	Within a time frame of 1 day to 6 weeks after the prescription of an antidepressant, prescription of a different antidepressant.	Detect any adverse event from an antidepressant	Look for new antidepressant within a time frame that is more suggestive of replacing a prior antidepressant than augmentation therapy.	7	7.0 (3-9)	6	7.5 (3-9)	6	7.5 (3-8)

ADE=Adverse drug event

N= number of participants who rated the trigger

Highlighted cells indicate triggers that met consensus criteria in Round 2and were selected for testing with patient-level data