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Trigger Tools (To Identify Adverse Drug Events (Ades) ) : T1-T7: From Institute For Healthcare Improvement (Ihi)

This document discusses various trigger tools that can be used to identify adverse drug events. It lists 24 different trigger tools (T1-T24) that can identify issues like hypersensitivity reactions, over-anticoagulation, hypoglycemia, drug-induced liver toxicity, and other potential adverse drug effects. It also includes the Naranjo algorithm, a validated assessment scale used to determine the likelihood that an adverse event is drug-related.

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Arvenaa Subramaniam
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52 views

Trigger Tools (To Identify Adverse Drug Events (Ades) ) : T1-T7: From Institute For Healthcare Improvement (Ihi)

This document discusses various trigger tools that can be used to identify adverse drug events. It lists 24 different trigger tools (T1-T24) that can identify issues like hypersensitivity reactions, over-anticoagulation, hypoglycemia, drug-induced liver toxicity, and other potential adverse drug effects. It also includes the Naranjo algorithm, a validated assessment scale used to determine the likelihood that an adverse event is drug-related.

Uploaded by

Arvenaa Subramaniam
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Trigger Tools (to identify adverse drug events [ADEs])

Tracer drugs
S/No Tracer Drug Process identified
T1 Antihistamines Hypersensitivity reactions or drug effect
T2 Vitamin K (Phytomenadione) Over-anticoagulation with warfarin
T3 Flumazenil (Anexate) Over-sedation with benzodiazepines
T4 Antiemetics Nausea/emesis due to drug use
T5 Naloxone Over-sedation with narcotic
T6 Anti-diarrheals Adverse drug event
T7 Sodium Polysterene Sulfonate Hyperkalemia due to renal impairment or
(Resonium) drug effect
T8 Protamine Over-anticoagulation (unfractionated &
low-molecular weight heparins)
T9 Dantrolene Neuroleptic malignant syndrome
T10 Methylene Blue Drug-induced methaemoglobinaemia
* T1-T7: From Institute for Healthcare Improvement (IHI)

Other Trigger Tools


S/No Trigger Process identified
T11 Glucose <2.8 mmol/L Hypoglycaemia related to insulin and oral
hypoglycemics
T12 Clostridium difficile positive stool Exposure to antibiotics
T13 PTT > 100 sec Over-anticoagulation
T14 INR > 6 Over-anticoagulation with warfarin
T15 WBC count < 3000 Neutropenia related to drug or disease
T16 Platelet count < 50 000 Possible drug-induced thrombocytopenia
T17 Rising serum creatinine Possible drug induced nephrotoxicity
T18 Elevated liver function tests Possible drug-induced hepatotoxicity
T19 Elevated creatinine kinase May indicate rhabdomyolysis
levels
T20 Drug levels Monitor for toxic levels
(aminoglycosides, vancomycin,
theophylline, phenytoin)
T21 Over-sedation, lethargy, falls Related to the use of a sedative,
analgesic or muscle relaxant
T22 Rash Hypersensitivity/ADE
T23 Abrupt medication stop ADE
T24 Transfer to higher level of care Adverse event
PPT= Prothrombin time; INR= International normalised ratio, WBC =white blood cell
* From IHI, with the exception of T18-T19

Compiled by : Jonathan Seah


Sept 2004
Naranjo ADR probability algorithm
Purpose: To provide the rationale for assessing ADRs in several
clinical situations

Question Yes No NA Score

1. Are there previous conclusive reports? +1 0 0


2. Did the adverse event appear after the suspected +2 -1 0
drug was administered?
3. Did the ADR improve when drug was discontinued +1 0 0
or specific antagonist was administered?
4. Was the reaction more severe with increased dose +1 0 0
or less severe with decreased dose?
5. Did the reaction reappear when the drug was re- +2 -1 0
administered?
6. Are there alternative causes (other then the drug) -1 +2 0
that could on their own have caused the reaction?
7. Did the reaction reappear when placebo was given? -1 +1 0
8. Was the drug detected in the blood (or fluids) in toxic +1 0 0
concentrations?
9. Did the patient have a similar reaction with the same +1 0 0
or similar drugs in any previous exposure?
10. Was the adverse event confirmed by any objective +1 0 0
evidence?
Total Score

Score: Definite - Highly Probable (>9); Probable (5-8); Possible (1-4);


Doubtful (< 3).

Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the
probability of adverse drug reactions.
Clin Pharmacol & Ther 1981; 30(2): 239-245

Compiled by : Jonathan Seah


Sept 2004

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