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Original research
Description of the development and validation of the Canadian Paediatric Trigger Tool
  1. Anne G Matlow1,2,3,
  2. Catherine M G Cronin4,5,
  3. Virginia Flintoft6,
  4. Cheri Nijssen-Jordan7,
  5. Mark Fleming8,
  6. Barbara Brady-Fryer9,
  7. Mary-Ann Hiltz10,
  8. Elaine Orrbine11,
  9. G Ross Baker3,6
  1. 1Department of Paediatrics, Hospital for Sick Children, Toronto, Canada
  2. 2Department of Paediatrics, University of Toronto, Toronto, Canada
  3. 3University of Toronto Centre for Patient Safety, Toronto, Canada
  4. 4Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, Canada
  5. 5Child Health Program, Winnipeg Regional Health Authority, Winnipeg, Canada
  6. 6Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
  7. 7Department of Paediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Canada
  8. 8Department of Psychology, Saint Mary's University, Halifax, Canada
  9. 9Grant MacEwan University, Edmonton, Canada
  10. 10IWK Health Centre, Halifax, Canada
  11. 11Canadian Association of Paediatric Health Centres, Ottawa, Canada
  1. Correspondence to Dr Anne Matlow, Infection Prevention & Control Programme, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada; anne.matlow{at}sickkids.ca

Abstract

Objective To describe the process of developing and validating the Canadian Association of Paediatric Health Centres Trigger Tool (CPTT).

Methods Five existing trigger tools were consolidated with duplicate triggers eliminated. After a risk analysis and modified Delphi process, the tool was reduced from 94 to 47 triggers. Feasibility of use was tested, reviewing 40 charts in three hospitals. For validation, charts were randomly selected across four age groups, half medical/half surgical diagnoses, from six paediatric academic health sciences centres. 591 charts were reviewed by six nurses (for triggers and adverse events (AEs)) and three physicians (for AEs only). The incidence of trigger- and AE-positive charts was documented, and the sensitivity and specificity of the tool to identify charts with AEs were determined. Identification of AEs by nurses and physicians was compared. The positive predictive value (PPV) of each trigger was calculated and the ratio of false- to true-positive AE predictors analysed for each trigger.

Results Nurses rated the CPTT easy to use and identified triggers in 61.1% (361/591; 95% CI 57.2 to 65.0) of patient charts; physicians identified AEs in 15.1% (89/ 591, 95% CI 0.23 to 0.43). Over a third of patients with AEs were neonates. The sensitivity and specificity were 0.88 and 0.44, respectively. Nurse and physician AE assessments correlated poorly. The PPV for each trigger ranged from 0 to 88.3%. Triggers with a false/true-positive ratio of >0.7 were eliminated, resulting in the final 35-trigger CPTT.

Conclusions The CPTT is the first validated, comprehensive trigger tool available to detect AEs in children hospitalised in acute care facilities.

  • Trigger
  • adverse event
  • harm
  • patient safety
  • research

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

https://doi.org/10.1136/bmjqs.2010.041152

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    Footnotes

    • Funding This study was supported by the Canadian Medical Protection Association; Canada's Research Based Pharmaceutical Companies (Rx&D); Department of Paediatrics University of Calgary; Health Canada; Manitoba Institute of Patient Safety (MIPS); Winnipeg Regional Health Authority (WRHA); and Spelman Cronin Consulting (SCC).

    • Competing interests None.

    • Ethics approval Ethics approval was provided by the Hospital for Sick Children, Stollery Children's Hospital, Calgary Children's Hospital, Children's Hospital of Eastern Ontario, Winnipeg Children's Hospital, and IWK Hospital.

    • Provenance and peer review Not commissioned; externally peer reviewed.