Table 3.
Prevalence and positive predictive value (PPV) of triggers and medications involved in the adverse drug events (ADEs) detected
| Trigger | No of ADEs identified with the trigger* | No of triggers found in the charts | PPV (%) | High-alert medications involved in the ADEs detected (n)† | |
| L3 | Serum glucose >110 mg/dL | 38 | 182 | 20.9 | Corticosteroids (36), insulins (2) |
| D7 | Abrupt cessation of medication | 32 | 60 | 53.3 | OAC (8), loop diuretics (7), antiplatelets (5), antipsychotics (4), benzodiazepines (3), β- blockers (2), spironolactone (2), insulins (1) |
| C3 | Oversedation/lethargy | 22 | 71 | 30.9 | Antipsychotics (13), benzodiazepines (5), opioids (4) |
| C4 | Hypotension | 19 | 56 | 33.9 | Loop diuretics (15), β-blockers (3), spironolactone (1) |
| C7 | Adverse reaction recorded | 19 | 38 | 50 | OAC (5), loop diuretics (3), opioids (3), benzodiazepines (2), oral hypoglycaemic (2), spironolactone (2), antiplatelets (1), NSAIDs (1) |
| C6 | Constipation | 18 | 72 | 25 | Opioids (18) |
| L4 | INR >5 | 8 | 25 | 32 | OAC (8) |
| L6 | eGFR <35 mL/min/1.73 m2 | 7 | 99 | 7.1 | Loop diuretics (4), spironolactone (2), immunosuppressants (1) |
| D1 | Vitamin K administration | 6 | 30 | 20 | OAC (6) |
| L8 | K <2.9 mEq/L | 6 | 20 | 30 | Loop diuretics (6) |
| C5 | Transfusion or use of blood products | 5 | 63 | 7.9 | Antiplatelets (3), OAC (2) |
| L7 | K >6.0 mEq/L | 5 | 18 | 27.7 | Loop diuretics (3), spironolactone (2) |
| L14 | HbA1c >6% and glucocorticoid | 5 | 7 | 71.4 | Corticosteroids (5) |
| D5 | Antiemetic administration | 4 | 31 | 12.9 | Opioids (3), digoxin (1) |
| D3 | Flumazenil administration | 3 | 5 | 60 | Benzodiazepines (3) |
| D6 | Haloperidol administration | 3 | 50 | 6 | Antipsychotics (2), opioids (1) |
| L2 | Serum glucose <50 mg/dL | 2 | 16 | 12.5 | Insulins (2) |
| D4 | Naloxone administration | 2 | 4 | 50 | Opioids (2) |
| P1 | Digoxin level >2 ng/mL | 2 | 8 | 25 | Digoxin (2) |
| P2 | Carbamazepine >12 µg/mL | 1 | 1 | 100 | Antiepileptics (1) |
| L5 | Rising BUN or serum creatinine >2 times baseline | 1 | 11 | 9.1 | Loop diuretics (1) |
| L9 | Na <130 mEq/L | 1 | 8 | 12.5 | Spironolactone (1) |
| L10 | ALT >80 U/L and AST >84 U/L | 1 | 8 | 12.5 | Corticosteroids (1) |
| L12 | CPK >269 U/L | 1 | 16 | 6.3 | Corticosteroids (1) |
| E1 | Readmission to ED within 48 hours | 1 | 9 | 11.1 | Loop diuretics (1) |
| Total | 212 | 908 | |||
*In several cases one ADE was identified with more than one trigger.
†In several cases more than one drug was involved in one ADE.
ALP, alkaline phosphatase; ALT, alanine aminotransferase; BUN, blood urea nitrogen; CPK, creatine phosphokinase; GFR, glomerular filtration rate; HbA1c, glycated haemoglobin; INR, International normalised ratio; NSAIDs, non-steroidal anti-inflammatory drugs; OAC, oral anticoagulants.