Using a Trigger Tool to Assess Adverse Drug Events in a Children's Rehabilitation Hospital

Some of the most common actions after an adverse drug event (ADE) have been carefully listed, studied, and described as "triggers." Trigger-based tools for finding and evaluating ADEs have been validated in varied patient populations. A recent article described the frequency and severity of ADEs in hospitalized children in tertiary care children's hospitals. Our objective was to discover whether children in a pediatric rehabilitation setting are at higher risk for ADEs because of polypharmacy, or at a lower risk because of relative overall clinical stability. A pediatric inpatient trigger tool was used in 3 groups of children hospitalized in a pediatric rehabilitation setting. ADE frequencies and patient characteristics were compared with values from a multicenter study using the same tools in pediatric tertiary care hospitals. Changes in ADE frequency over time were assessed (2005, n=20; 2006, n=20; 2008, n=19). No serious ADEs were newly discovered using the trigger tool. Nearly all of the ADEs (16 of 17) discovered by the trigger tool had not been voluntarily reported to the hospital's event reporting program. ADE frequencies expressed per patient were higher than those seen in tertiary care children's hospitals. Longer lengths of stay resulted in lower ADE frequencies when expressed per day. ADE frequency increased in the institution over time, reflecting increases in the acuity and complexity of patients cared for at this facility. Many ADEs affected bowel frequency. Systematic chart review using a trigger tool discovered ADEs that had not been voluntarily reported or evaluated. ADEs in pediatric rehabilitation patients occurred less often than those in tertiary pediatric care when expressed as rates per day, but were more frequent when expressed per patient or per medication. Types and severity of ADEs in pediatric rehabilitation can guide monitoring and attention to specific areas of care.