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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)
slide4
WHO: National Coordinating Council for Medication Error Reporting and Prevention Index for Categorising Error
findings
Findings
  • 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
  • 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
  • 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
  • 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
  • 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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