Adverse events in critical care: Search and active detection through the Trigger Tool

Table 1 Triggers

Trigger	n	%
Skin defects or lacerations	36	14.75
Excitation or drowsiness of the patient	34	13.93
Unscheduled withdrawal of surgical catheter, probes, drains or other devices	34	13.93
Hypotension	33	13.52
Initiation of antibiotics after 48 h of admission	28	11.48
Abrupt fall in hemoglobin or hematocrit by more than 25%	24	9.84
Hypoglycemia	19	7.79
Pneumonia	9	3.69
Reintubation in less than 48 h	6	2.46
Unscheduled surgical reintervention	5	2.05
Chest tube insertion during ICU hospitalization	4	1.64
Initiation of dialysis during ICU hospitalization	4	1.64
Accidental extubation	3	1.23
Adverse drug reaction events	3	1.23
Cardiac arrest	1	0.41
Protamine use	1	0.41
Total	244	100.00

ICU: Intensive care unit.

Table 2 Adverse events

Adverse event	n	(%)
Pressure ulcers	62	17.6
Complications or reactions to medical devices	15	4.3
Lacerations	13	3.7
Drug-induced hypotension	10	2.8
Poor glycemic control	9	2.6
Nosocomial pneumonia	9	2.6
Injury during procedure	8	2.3
Phlebitis	7	2.0
Hemorrhage or hematoma related to surgery or procedure	7	2.0
Acute lung disease or respiratory failure	5	1.4
Operative site infection	5	1.4
Another event	5	1.4
Drug-induced neurological disorders	4	1.1
Sepsis and septic shock	4	1.1
Burns, erosion, bruises and fractures	3	0.9
Pneumothorax	2	0.6
Pruritus, rash or dermal lesions, reactive to drugs or dressings	2	0.6
Adhesion and functional alterations after surgical intervention	1	0.3
Bacteremia associated with device	1	0.3
Error in medication delivery	1	0.3
Events attributable to internal failures in timeliness or continuity of evaluation	1	0.3
Failures attributed to quality	1	0.3
Opportunistic infection by immunosuppressive treatment	1	0.3
Nosocomial urinary tract infection	1	0.3
Delay in diagnosis or treatment	1	0.3
Total	178	100

Table 3 Comparison between the different studies in ICU using the Trigger Tool methodology

Ref.	Patients	No. of ICUs	Sample	Incidence or prevalence of AEs
Resar et al[2]	During ICU stay	62	12074	11.3/100 patient d
Nilsson et al[12]	Those who die in less than 96 h of ICU admission	1	128	32/100 ICU admissions 19.5%
PREVENT[13]	Within 7 d prior to ICU admission	5	280	27.1% (80% related to reason for admission)
UPB (Molina et al)	During ICU stay	1	94	52.1% 3.6 AEs per patient

AEs: Adverse events; ICU: Intensive care unit.

Table 4 Triggers and adverse events among the different studies in ICU using the Trigger Tool methodology

Ref.	Most frequent triggers	Adverse event	Severity	Preventability
Resar et al[2]	1 Proceeding 2 Hemoglobin fall 3 Intubation or reintubation 4 Pneumonia 5 Positive blood cultures	Triggers led to an AE in: 1 17.8% 2 65% 3 54% 4 67% 5 83%	E = 58.2% F = 24.3% G = 2% H = 11.4% Y = 4.1%	Not reported
Nilson et al[12]	Not reported	1 Nosocomial infection (22%) 2 Hypoglycemia (19%) 3 Pressure ulcer (17%) 4 Complication by procedure (15%)	E = 49% F = 10% G = 2.4% H = 4.8% Y = 33.8%	54%
PREVENT[13]	149 triggers. Does not report frequencies	1 Delay/failure in medical management (14.4%) 2 Surgical tissue damage (11.5%) 3 Failure to monitor scales by nursing (96%) 4 Error in medication prescription (8.6%)	E = 5.5% F = 31% G = 32% H = 21% Y = 10.5%	77%
UPB (Molina et al)	248 triggers 1 Skin defects or lacerations (14.7%) 2 Excitation or drowsiness of the patient (13.9%) 3 Hypotension (13.5%) 4 Unscheduled removal of surgery catheter, probes, drains or other devices (13.9%) 5 Initiation of antibiotics after 48 h of admission (11.5%)	1 Pressure ulcers (17.6%) 2 Complications or reactions to medical devices (4.3%) 3 Lacerations (3.7%) 4 Drug-induced hypotension (2.8%) 5 Poor glycemic control (2.6%)	E = 38.4% F = 0.9% G = 0.3% H = 10.8% Y = 0.3%	48.9%