An efficient and reliable process for measuring harm due to medical care is needed to advance pediatric patient safety. Several pediatric studies have assessed the use of trigger tools in varying inpatient environments. Using the Institute for Healthcare Improvement’s adult-focused Global Trigger Tool as a model, we developed and pilot tested a trigger tool that would identify the most common causes of harm in pediatric inpatient environments.
After formal training, 6 academic children’s hospitals used this novel pediatric trigger tool to review 100 randomly selected inpatient records per site from patients discharged during the month of February 2012.
From the 600 patient charts evaluated, 240 harmful events (“harms”) were identified, resulting in a rate of 40 harms per 100 patients admitted and 54.9 harms per 1000 patient days across the 6 hospitals. At least 1 harm was identified in 146 patients (24.3% of patients). Of the 240 total events, 108 (45.0%) were assessed to have been potentially or definitely preventable. The most common patient harms were intravenous catheter infiltrations/burns, respiratory distress, constipation, pain, and surgical complications.
Consistent with earlier rates of all-cause harm in adult hospitals, harm occurs at high rates in hospitalized children. Availability and use of an all-cause harm identification tool will establish the epidemiology of harm and will provide a consistent approach to assessing the effect of interventions on harms in hospitalized children.
Comments
Trigger Tool for Non-Hospital Settings
While hospitals account for a large portion of preventable medical errors, many occur at or as a consequence of a doctor's office visit. In October 2007, my 13-year-old daughter was the victim of a preventable medical error. She is now permanently disabled. Her adverse event was the result of a neurologist prescribing the wrong drug. One which was not recommended for a child her age, and for a condition she did not have. While many adverse events occur at hospitals, I imagine just as many may occur in non-hospital care settings. Not only did the neurologist give her a drug that caused a stroke, but he is most likely the reason why the emergency room staff failed to diagnose my daughter in a timely fashion - she was not diagnosed with a stroke until at least eight to ten hours later. Today, Robyn is a thriving college student after many years of physically and mentally hard work and rehabilitation. We were both pleased to read in your article "A Trigger Tool to Detect Harm in Pediatric Inpatient Settings" that researchers are taking pediatric adverse events seriously. It is our hope that the Pediatric Trigger Tool quickly expands into non-hospital settings
Conflict of Interest:
I am a Patient Safety Activist with Consumers Union Safe Patient Project.