Adverse event in psychiatric hospital by Thai HA Psychiatric Trigger Tool

Abstract

Objective To develop a psychiatric trigger tool on identifying adverse event in Thai psychiatric patients and develop risk identifying system using trigger tool.

Materials and methods Trigger tool was developed by the multidisciplinary team based on triggers of Harvard Medical Practice Study (HMPS). Data were collected for 15 trigger indicators from 9 sources. After pilot trial in Suanprung Psychiatric Hospital and harmonization training for multidisciplinary teams from 7 participated psychiatric hospitals, a cross-sectional medical record review was conducted to identify adverse events in medical record of the patients who were discharged from 7 psychiatric hospital during October 2007.

Results Four hundred twenty two medical records were reviewed. The total patients-days were 97,745 days. Three hundred fifty three adverse events were identified with mean rate of 5.1 per 1,000 patients days or 24.6 per 100 patients. The first three triggers that detected most adverse events are; antibiotic receiving trigger, infection in hospital and unplanned readmission with the same diagnosis within 28 days respectively.

Conclusion Psychiatric trigger tool can be used to detect adverse events more effectively in psychiatric patients. However, for efficiency, only the highly sensitive trigger indicators which supported by the convenient retrievable completed data sources should be used.