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Primary Care Trigger Tool. Manaia Health PHO . Linda Holman Quality Leader. Background. Few studies on trigger tool use in primary care Primary care trigger tools have been used in Scotland and England NHS

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Primary care trigger tool

Primary Care Trigger Tool

Manaia Health PHO

Linda Holman

Quality Leader


Background
Background

  • Few studies on trigger tool use in primary care

  • Primary care trigger tools have been used in Scotland and England NHS

  • Sensitivity and specificity of primary care trigger tool in identifying harm not known


Method
Method

  • 37 triggers used initially

  • 170 patients in one large general practice identified

  • 50% of cohort Māori

  • Included children

  • Record for one year reviewed looking for presence of triggers and associated harm

  • Record also reviewed for harm without any trigger

  • 2 review teams (GP + nurse/pharmacist)


WHO: National Coordinating Council for Medication Error Reporting and Prevention Index for Categorising Error


Findings
Findings Reporting and Prevention Index for Categorising Error

  • 1034 triggers initially identified

  • 40 030 days of follow-up

  • 637 consultations

  • Harm found in 63 of these triggers + 1 outside of the defined triggers(corresponding to 45 individual events)

  • Harm categories: E = 48, F = 11, G = 3, H = 0, I = 1


Rates of harm
Rates of Harm Reporting and Prevention Index for Categorising Error

  • Rate of harm: 0.07 (95% CI 0.05-0.09)

  • Rate of harm per 100 patient years = 41 (95% CI 29-55)

  • Rate of harm between Māori and non-Māori

    no difference (adjusting for age and sex)

  • Rate of harm if male 0.53 (95% CI 0.29-0.98) adjusting for age and ethnicity


Triggers refined reduced to 8
Triggers refined & reduced to 8 Reporting and Prevention Index for Categorising Error

  • Adverse reaction documented in PMS

  • ≥ consultations with a GP in 1 week

  • Cessation of medication

  • Reduction in medication dose

  • ≥6 medications prescribed

  • Seen in ED/A+M within 2 weeks of seeing GP

  • eGFR < 35

  • Death


Efficacy of refined tool
Efficacy of Refined Tool Reporting and Prevention Index for Categorising Error

  • Odds ratio of harm occurring is refined trigger tool used (adjusting for age, sex and ethnicity) 6.3 (95% CI 2.7-14.8)

  • Sensitivity of refined trigger tool 0.88

  • Specificity of refined trigger tool 0.48


Discussion
Discussion Reporting and Prevention Index for Categorising Error

  • Rates of harm comparable to published literature in primary care

  • Predominant cause of harm from medication

  • Small number of harms that could be linked to an actual error

  • Value in pharmacist being involved

  • Qualitative information gained during process valuable


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