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Ashika Maharaj/Gill Robb. Improvement Science Professional Development Program Tackling Opioid-related Harm. Global Trigger Tool (GTT). Systematic methodology for quantifying patient harm using a targeted chart review process Adverse Drug Event Trigger Tool (ADE TT) subset of GTT

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Ashika Maharaj/Gill Robb

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Ashika Maharaj/Gill Robb

Improvement Science Professional Development Program

Tackling Opioid-related Harm


Global Trigger Tool (GTT)

  • Systematic methodology for quantifying patient harm using a targeted chart review process

  • Adverse Drug Event Trigger Tool (ADE TT) subset of GTT

  • Developed by IHI 2003


Definition of Harm

  • ‘Unintended physical injury resulting from or contributed to by medical care that requires additional monitoring, treatment or hospitalisation or that results in death’

  • Reference: White Paper: IHI Global Trigger Tool for Measuring Adverse Events 2009


Harm Category


Background

  • Revelations from 2011 ADE data:

    • 30% of medication-harm related to Opioids

    • 23% of this was Constipation

    • Risk highest on surgical wards

  • Forum to discuss findings (mid 2012)

  • Retrospective detailed analysis of a surgical ward requested


Pareto Chart of Harm 2011


New Data Collection Tool


Baseline Data

N = 131

Opioids = 114

Harms = 49


Results: Focusing on Constipation


Opioids implicated in Harm


Projects identified

Project A

Tackling high rate of opioid-related constipation

Project B

Tackling opioid-related oversedation


Aim (Project A)

To reduce Opioid related constipation on Ward 10 (combined surgical ward) from 30% to 15% by 1 July 2013


Driver Diagram


Change Concepts & Ideas for PDSAs


Measures


Team established

Phase 1: Bowel monitoring (implemented)

Phase 2: Charting and administration

Phase 3: Patient Experience

Retrospective analysis

Next steps (Project A)


Examples

89 year old patient was admitted due to R) femur fracture following a fall. His bowels did not open for seven days whilst on the ward secondary to regular oxycodone, fentanyl, and morphine. He required several interventions including laxatives and fleet enema.


Examples

35 year old was admitted to orthopaedics after developing lower back pain in medical ward. Cause was not identified, however, patients bowel had not moved for five days. She was on regular morphine for pain. It was only after she complained that laxatives and enemas were offered and her bowels opened.


Examples

Other DHB(worst case scenario): Patient passed away suddenly and unexpectedly shortly after admission to the Surgical Unit. The cause of death was ascertained by the coroner to be due to bowel ischaemia (from constipation) and that morphine could not be excluded as a contributing factor. Patient had also been on clozapine.


By Gill Robb


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