全面触发工具在住院患者药物不良事件评估中的应用

The use of global trigger tool for evaluating adverse drug events in hospitalized patients

目的探讨全面触发工具（GTT）在我国住院患者药物不良事件（ADE）评估中的应用。方法根据Institute for Heahhcare Improvement Global Trigger Tool for Measuring Adverse Events及我国具体用药情况，选出14项触发器。自广西医科大学第一附属医院医院信息系统随机抽取2013年1—12月出院病历300份进行审查，筛选触发器阳性病历进行ADE判定、分级以及累及器官和系统分析，计算触发器检出率，并与同年度医院ADE自愿上报率进行比较。结果300份病历涉及300例患者，其中触发器阳性者59例，占19．67％；共检出触发器阳性72例次（检出1项触发器者48例、2项触发器者9例、3项触发器者2例）。对触发器阳性者进行ADE判定，确定ADE共64例次，涉及患者49例，ADE检出率为16．33％（49／300）。64例次ADE中53例次（82．81％）为E级，6例次（9．38％）为F级，5例次（7．81％）为H级。损害器官以胃肠系统最多，共21例次，临床表现为呕吐（20例次）和腹泻（1例次）。同年度医院ADE自愿上报率为0．43％（286／66395），与经触发器检出的ADE发生率16．33％比较，差异有统计学意义（χ2=1479．589，P〈0．001）。结论GTT可较自愿上报系统发现更多的ADE。

Objective To investigate the use of global trigger tool （GTT） for evaluating adverse drug events （ADE） in hospitalized patients. Methods Fourteen triggers were selected according to Institute for Healthcare Improvement Global Trigger Tool for Measuring Adverse Events and situation of medicine administration in China. Three hundred discharged patients＇ medical records, coming from hospital information system of the First Affiliated Hospital of Guangxi Medical University from January to December 2013, were selected randomly and examined. The records with positive triggers were filtered and analyzed on estimation and classification of ADE as well as damage of organ and system. The detection rate of triggers was calculated and compared with the voluntary reporting rate of ADE in the same year. Results A total of 300 patients were involved in the 300 records. Of them, there were 59 patients with positive triggers accounting for 19.67% and 72 cases with positive triggers including 48 patients with only one positive trigger, 9 patients with 2 positive triggers, and 2 patients with 3 positive triggers. The cases with positive triggers were analyzed on estimation of ADE. Sixty-four ADEs were confirmed and these ADEs involved 49 patients. The detection rate of ADE was 16.33% （49/300）. The 64 ADEs contained 53 ADEs （82.81%） of level E, 6 ADEs （9.38%） of level F, and 5 ADEs （7.81%） of level H. The most common damage of organ was gastrointestinal system and a total of 21 cases developed gastrointestinal damages. The clinical manifestations were vomiting （20 cases） and diarrhea （ 1 case）. The voluntary reporting rate of ADE in the same year was 0. 43% （ 286/66 395 ）, compared with the detection rate of triggers （ 16. 33% ）, the difference was statistically significant （ χ2 = 1 479. 589, P 〈 0.001 ）. Conclusion Compared with the voluntary reporting rate, GTT could find more ADE.