Evaluating iatrogenic prescribing: Development of an oncology-focused trigger tool

Guillaume Hébert (), Florence Netzer, Marie Ferrua, Michel Ducreux, François Lemare and Etienne Minvielle ()
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Guillaume Hébert: IGR - Institut Gustave Roussy, EA MOS - EA Management des Organisations de Santé - EHESP - École des Hautes Études en Santé Publique [EHESP] - PRES Sorbonne Paris Cité
Florence Netzer: Département de pharmacie clinique [Gustave Roussy] - IGR - Institut Gustave Roussy, IGR - Institut Gustave Roussy
Marie Ferrua: IGR - Institut Gustave Roussy, EA MOS - EA Management des Organisations de Santé - EHESP - École des Hautes Études en Santé Publique [EHESP] - PRES Sorbonne Paris Cité
Michel Ducreux: Département d'Oncologie Médicale, IGR - Institut Gustave Roussy
François Lemare: IGR - Institut Gustave Roussy, Département de pharmacie clinique [Gustave Roussy] - IGR - Institut Gustave Roussy
Etienne Minvielle: IGR - Institut Gustave Roussy, EA MOS - EA Management des Organisations de Santé - EHESP - École des Hautes Études en Santé Publique [EHESP] - PRES Sorbonne Paris Cité, EHESP - École des Hautes Études en Santé Publique [EHESP]

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Abstract: Abstract Background: Drug-related iatrogenic effects are common in oncology because chemotherapy is toxic. The evaluation of the application of the guidelines may be a way to understand the occurrence of adverse drug-related event (ADE). There is no specific method for identifying ADEs and measuring harm to patients in oncology. Objective: Our objective was to develop and test an Oncology Trigger Tool (OTT) for ADEs and to describe ADE characteristics and incidence. Methods: A clinical advisory panel identified situations at high risk of ADE occurrence and built 22 triggers with, in each case, an analysis flowchart to confirm or refute occurrence. The OTT was used to review 288 random admissions (Oct. 2010–Sept. 2011) and measure ADE incidence and severity (CTCAE 4.03 – Common Terminology Criteria for Adverse Events). Tool feasibility (time required), inter-rater (IR) reproducibility and positive predictive value (PPV) were measured. Results: Overall, 884 triggers were detected and 122 ADEs, with 42.4 ADEs/100 admissions or 46.0 ADEs/1000 patient-days, and a 31.1% rate of severe ADEs. The most common ADEs were hyperglycaemia (14.5%), unplanned drug-related admission within 30 days (13.7%) and opiate-induced constipation (12.1%). Unplanned drug-related admission was the most serious (82.4% incidence of severe harm). Mean time for OTT implementation was 21.8 min; IR reproducibility was high (j = 0.965 (trigger); j = 0.935 (ADE); j = 0.853 (harm)); PPV 22- trigger version was 20.7%. Conclusions: ADE analysis flowcharts coupled with standardised grading of harm consider- ably reduced IR variability, thus providing a robust oncology-focused trigger tool for use in ADE audits and hospital comparisons. The involvement of a clinical advisory panel in tool development should help drive changes for improving practice. Further research on the OTT is warranted.

Keywords: Medical audit: methods; Medical errors; Medication errors; Adverse effects; Oncology; Anticancer drug; Retrospective studies; Safety management (search for similar items in EconPapers)
Date: 2015
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Published in European Journal of Cancer, 2015, 51 (3), pp.427 - 435. ⟨10.1016/j.ejca.2014.12.002⟩

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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-01446311

DOI: 10.1016/j.ejca.2014.12.002

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