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
Improvement Science Professional Development Program
Tackling Opioid-related Harm
Global Trigger Tool (GTT)
Definition of Harm
Pareto Chart of Harm 2011
New Data Collection Tool
N = 131
Opioids = 114
Harms = 49
Results: Focusing on Constipation
Opioids implicated in Harm
Tackling high rate of opioid-related constipation
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
Change Concepts & Ideas for PDSAs
Phase 1: Bowel monitoring (implemented)
Phase 2: Charting and administration
Phase 3: Patient Experience
Next steps (Project A)
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.
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.
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