The CAPHC Paediatric Trigger

Tool

Implementation for Patient Safety and Quality Implementation for Patient Safety and Quality Improvement Improvement

Webinar Pilot – May 29, 2009Webinar Pilot – May 29, 2009

Purpose of the WEBINAR

To launch the CAPHC Paediatric Trigger Tool

(CPTT) for use in quality improvement activities

directed towards improved patient safety for

infants, children and youth

Assumptions

Webinar participants:

Agree that adverse events (AEs) and the associated harm

and disability are an issue for hospitalized paediatric

patients

Are considering use of the CPTT as a component of an

overall patient safety strategy for their organization

Webinar Outline

1. Development of the CPTT

2. Uses of the CPTT for Improving Patient Safety

3. System Capabilities of the CPTT

4. Resource Requirements at Health Centres

5. Getting started using the CPTT

What is the CPTT?

An electronic tool intended to assist healthcare providers to:

Identify adverse events (AEs) and associated harm in

hospitalized paediatric patients (DETECT)

Develop a database for measurement of patient safety outcomes

Create metrics to estimate the incidence of AEs in an

organization (QUANTIFY)

Monitor the incidence of AEs over time (TRACK)

Measure the effectiveness of hospital safety programs

Target key areas for improvement

Development of the CPTT

Trigger tool methodology:

What is a trigger ?

How do triggers work to identify adverse events ?

What triggers were chosen for the CPTT and why ?

Development of the CPTT

What is the capacity of the CPTT for detecting AEs in

hospitalized paediatric patients ?

Validity and reliability

Sensitivity

Specificity

Uses of the CPTT

To create a systematic process for collection and storage

of patient safety data

To identify specific areas for improvement and those that

are in most need of improvement

To measure the effectiveness of initiatives taken to

improve patient safety

Using the CPTT to support Patient Safety

• Random routine chart audit conducted on a regular schedule• Review of discrete populations or healthcare processes –

e.g. NICU, Pediatric Cardiac Surgery, etc• Special Situations – n of 1 chart reviews, RCA, etc.• Concurrent review in high risk areas• Establish a baseline and ongoing monitoring of AE rates• Evaluate compliance with incident reporting• An as a component of the M& M review process

Capacity/Capabilities of the CPTT

Data entry and on site storage

Privacy and security

Data analysis and reporting

Benchmarking

Education

Resource Requirements

Chart selection

The review process

The two-stage process

Who should conduct the reviews

What training/qualifications are required to do the chart reviews

Time required to conduct the chart reviews

Tips and strategies

Getting started using the CPTT

How to acquire/download the CPTT

System requirements

Embedded instructions on use of the software

Where to find help

Recommended Reading

Resar, R. K., Rozich, J. D., & Classen, D. (2003).

Methodology and rationale for the measurement of harm

with trigger tools. Qual. Saf. Health Care, 12, ii39-45.

Adler, L. et al (2008). Global Trigger Tool: Implementation

Basics. J Patient Saf, 4, 245 – 249.

Griffin, F. A. & Resar, R. K. (2009). IHI Trigger Tool for

Measuring Adverse Events (2nd ed.). IHI Innovation Series

white paper. Cambridge, Massachusetts: Institute for

healthcare Improvement. (available on www.IHI.org).