5PSQ-139 Adverse events associated with high-alert medications detected by trigger methodology in patients with chronic illnesses

Background The WHO´s third global patient safety challenge ‘Medication Without Harm’ recommends implementing measures to reduce adverse drugs events (ADEs) in patients with polypharmacy who are receiving treatment with high-alert drugs. In Spain, we have access to a list of high-alert medications for patients with chronic diseases (HAMC list) developed by ISMP-Spain and the Ministry of Health, and, recently, a panel of experts had selected a set of triggers specifically for detecting ADEs in elderly patients with multi-morbidity (Trigger-CHRON). Purpose To evaluate the effectiveness of the Trigger-CHRON for identifying ADEs that are caused by drugs included in the HAMC list, in chronic, multi-morbidity elderly patients. Material and methods Observational, retrospective and multicentre study carried out in 12 Spanish hospitals. Chronic patients with multi-morbidity over 65 years, with a length of stay of more than 48 hours in internal medicine or geriatric hospital units, were randomly selected to have their clinical records reviewed. Each hospital looked at five patients weekly over a period of 12 weeks. The Trigger-CHRON was used to guide the medical record review, in order to identify ADEs. This tool includes the following triggers: 11 care module, 10 antidotes/treatment, 11 medication concentrations, 18 abnormal laboratory values, and one Emergency Department. ADEs were analysed, and the medications involved were registered. ADEs caused by drugs included in the HAMC list were recorded. Results Seven hundred and twenty patients were included and 215 ADEs were detected, of which164 (76%) were caused by at least one drug included in the HAMC list. Drugs involved in ADEs were: corticosteroids (38), loop diuretics (30), opioids (26), oral anticoagulants (20), antipsychotics (15), spironolactone/eplerenone (nine), antiplatelets (seven), benzodiazepines (seven), insulins (five), s- adrenergic blockers (three), oral hypoglycemic (two), digoxin (one), immunosuppressants (one) and non-steroidal anti-inflammatories drugs (one). Conclusion The Trigger-CHRON has permitted the detection of a large number of ADEs in which more than 75% were caused by a drug included on the HAMC list. This indicates the usefulness of this tool for determining ADEs at institutions, and to monitor the impact of future interventions carried out within the framework of the WHO global patient safety challenge. References and/or Acknowledgements Grupo CRONOS y de seguridad de la SEFH. No conflict of interest