Piloting a modified trigger tool for identification of patient harm in palliative care patients

Abstract

Abstract Background: Adverse events in the hospitalized palliative population are underexplored, and knowledge of patient safety measures is limited. The distinctive areas of harm relevant to palliative patients are not captured by existing instruments, and a tailored approach could be valuable for palliative care improvements.

Objectives: The aim of the study was to investigate the performance and suitability of a modified version of Global Trigger Tool (GTT) applied to a palliative cohort.

Design: Retrospective journal review was conducted on identical charts by two independent reviewers in 2024 at a palliative ward in a university hospital in Norway. The study was a cohort study that piloted a trigger tool for identifying adverse events in a palliative patient population. The modified trigger tool was based on the generic GTT and primarily adhered to its methodology. A total of 256 patient records was reviewed.

Results: Four hundred and one triggers (1.6 per hospitalization), and 109 cases of harm were identified. The positive predictive value for identifying patient harm was 0.27. Interrater reliability between the two raters for identifying harm was κ = 0.590 (CI 95% [0.461-0.718]). The most frequent triggers were Readmission within 14 days (89 triggers) and Other (60 triggers), while the majority of harm (65 cases) were classified as Overtreatment/Over diagnostics or Disturbed dying/Poor symptom control.

Conclusion: The modified trigger tool identifies patient harm and disturbed dying in palliative care patients. Still, further development is required before routine use.

Keywords: Global Trigger Tool, palliative care, patient safety, patient harm, adverse events