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Primary Care Trigger Tool

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

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  1. Primary Care Trigger Tool Manaia Health PHO Linda Holman Quality Leader

  2. 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

  3. 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)

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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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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