Use of Trigger Tool for Detection of Adverse Drug Reactions among Hospitalized Patients in a Nigerian University Teaching Hospital

Objectives: To determine the incidence and severity of adverse drug reactions among hospitalized patients in a Nigerian teaching hospital using the trigger tool method.

Study Design: Descriptive cross-sectional study.

Setting: The study was conducted in Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria from July to December, 2012.

Participants: Medication charts of discharged patients were reviewed by a healthcare team consisting of one pharmacist, a nurse and a physician.

Intervention and Method: Randomly selected patients medication charts were reviewed using the procedure described in the Institute of Health Improvements (IHI) global trigger tool for measuring adverse events. Twenty minutes were allocated for review of each patient record. Treatment charts with positive trigger(s) were reviewed further by the doctor in the review team to ascertain if adverse reaction(s) did occur. Detected adverse reactions were then categorized and statistically analysed.

Results and Main Outcome Measure(s): From the 120 patients charts randomly selected and reviewed, there were 2173 patient-days. About 473 triggers were identified of which 175 were confirmed to be adverse drug reactions by the review panel. The incidence measures calculated were 145.8 adverse drug reactions per 100 admissions and 80.5 ADRs per 1000 patient-days. A total of 97 patients had at least one ADR during their hospitalization and the proportion of patients’ admissions with an adverse event was 80.8%.

Conclusions: This study identified high incidence of adverse drugs reactions among the hospitalized patients in the teaching hospital. Further research is required to develop strategies towards the incorporation of this technique in the routine healthcare process. This would possibly improve case detection of adverse drug reactions and promote patients safety.