Evaluation of Trigger Tool Methodology Related to Adverse Drug Events in Hospitalized Patients


  • Sara Kolc Brown Meijer Pharmacy
  • Jacob Peterson Spectrum Health
  • Shayne Harris Schiedel Meijer Pharmacy
  • Kari Vavra Janes Spectrum Health, Ferris State University




global, trigger, tool, naloxone, INR, hypoglycemia


Purpose: To determine why an inpatient has had one of the following occurrences in the electronic health record due to an adverse drug event (ADE): international normalized ratio (INR) > 6, plasma blood glucose ≤ 50 mg/dL, or naloxone administration use. Utilizing the Institute for Healthcare Improvement (IHI) Global Trigger Tool, the information gathered will be used to determine how to prevent these events from occurring in
the future.

Summary: The positive predictive value (PPV) for elevated INR was 35% (confidence interval [CI] 21–53%), hypoglycemia was 70.4% (CI 62–78%), and 53% for naloxone administration (CI 45–60%). Drug interactions were the most common factor that may have contributed to an ele-vated INR, with a mean INR of 7.9. Basal insu-lin monotherapy, recent diet changes, decreases in renal function, and iscontinuation/tapering of corticosteroids were all observed to be contributing factors to hypoglycemia events. The mean trigger glucose level was 42.98 mg/dL. Dose range order sets, high morphine mil-ligram equivalents (MME), and decreased renal func-tion may have contributed to naloxone administra-tion. Polypharmacy was attributed to some of these adverse events, with the average inpatient MME of 100.5 mg.

Conclusion: The use of trigger tool methodology was useful for identifying ADEs related to hypoglycemia with insulin, moderately useful for naloxone administration, and least successful for elevated INR with warfarin. The ADEs that were identified revealed a wide variety of contributing factors that can be used as areas of interest when creating new policies and procedures to reduce ADEs in the future.

Author Biographies

Sara Kolc Brown, Meijer Pharmacy

Sara Kolc Brown (Sara.Brown@meijer.com) graduated with her Doctor of Pharmacy from the Ferris State University College of Pharmacy in 2018. She completed a postgraduate, community-based pharmacy practice residency with Meijer Pharmacy and Wayne State University in Detroit, Michigan, in 2019. Brown is currently a staff pharmacist with Meijer Outpatient Pharmacy located inside of Spectrum Health Butterworth Hospital in Grand Rapids, Michigan. She is an active member of the Wayne County Pharmacists Association (WCPA), Michigan Pharmacists Association (MPA), MPA Political Action Council Board, American Pharmacists Association, and the Lambda Kappa Sigma (LKS) professional women’s pharmacy fraternity. She serves on the board for WCPA, is the current president of the LKS Alpha Iota alumni chapter, and is on various national LKS committees.

Jacob Peterson, Spectrum Health

Jacob Peterson (Jacob.Peterson@spectrumhealth.org) is a graduate of the Ferris State University College of Pharmacy class of 2018 and recently completed a postgraduate pharmacy practice residency at Spectrum Health. Currently he is a clinical pharmacist at Spectrum Health Butterworth Hospital; his work is involved closely with adult acute care service lines, including general medicine, intensive care, and cardiology, at Butterworth Hospital and the Fred and Lena Meijer Heart Center. Peterson is also a member of the American Society of Health-System Pharmacists and the Western Michigan Society of Health-System Pharmacists.

Shayne Harris Schiedel, Meijer Pharmacy

Shayne Harris Schiedel has been involved in community pharmacy for 10 years. She dual-enrolled at Ferris State University in order to complete her PharmD and a Master of Business Administration in 2018. Schiedel was an active member of the National Community Pharmacists Association and served as secretary of her chapter while in school. She began her pharmacist career as a relief and staff pharmacist with Meijer Pharmacy after graduation, and is currently in a management role as pharmacy team leader with Meijer Pharmacy in Three Rivers, Michigan.

Kari Vavra Janes , Spectrum Health, Ferris State University

Kari Vavra Janes is an associate professor of pharmacy practice at Ferris State University and practices in adult general medicine at Spectrum Health-Grand Rapids. She has held this position for nine years. Janes has completed a pharmacy practice residency and is board certified in pharmacotherapy. Additionally, she has served on numerous local, regional, and state professional organizations. She has an interest in internal medicine, health-system pharmacy, and academia.


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Bottle of pills/medication.



How to Cite

Kolc Brown, S. ., Peterson, J., Harris Schiedel, S., & Vavra Janes , K. . (2019). Evaluation of Trigger Tool Methodology Related to Adverse Drug Events in Hospitalized Patients. Patient Safety, 1(2), 14–23. https://doi.org/10.33940/med/2019.12.2



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