Resumen de Measuring adverse events using a trigger tool in a paper based patient information system at a teaching hospital in South Africa

María M. Müller, Andries Gous, Natalie Schellack

• The study used the Institute of Healthcare Improvement (IHI) Global Trigger Tool (GTT) as a means of detecting and then monitoring adverse events across the entire population of inpatients in the internal medicine wards at Dr. George Mukhari Academic Hospital (DGMAH). The main focus of a Trigger Tool is to detect adverse events that lead to patient harm caused by medical management, rather than the patient’s underlying condition. To the best of the researcher’s knowledge, no research has been conducted and published that illustrates the use of the IHI GTT in South Africa. This study undertook to determine whether the IHI GTT was effective in measuring and describing adverse events in the internal medicine wards of DGMAH, a teaching hospital in South Africa. This was a quantitative, descriptive and prospective study done over an eight-month period between July 2014 and March 2015 using 160 patient records. It analysed patient records using the IHI GTT with a complete description given on the total adverse events that occurred in patients. Application of the IHI GTT to DGMAH led to the identification of one adverse event per 2.7 admissions in the internal medicine wards. Furthermore, the study identified 126 triggers (0.8 per patient) and 59 adverse events. The rate of 37 adverse events per 100 admissions and 26 adverse events per 1,000 patient-days compared well with similar studies. Twenty-three patients had at least one adverse event during their hospitalisation and 16 patients had more than one adverse event identi􀂿ed. More than 50% of the adverse events were classified as category F (temporary harm to the patient and required initial or prolonged hospitalisation). The death of two patients may have been due to an adverse event and have been reported. The Care Module and Medication Module Triggers that were used noted that none of the adverse events detected were reported as part of the voluntary reporting system currently in use. This is in accordance with what other studies around the world have reported. The IHI GTT was effective in identifying adverse events in the internal medicine wards inpatients at Doctor George Mukhari Academic Hospital