Paediatric Focused Triggering Tool (PFTT) To Assess the Harm and its Utilization to Minimize the Levels of Harm among Children at a Tertiary Care Hospital

Abstract:

Objectives: Very few paediatric trigger tools have been developed to assess harm in children. Hence, a Paediatric-focused trigger tool has been developed, assess its utility to measure the levels of harm, categorize and minimize them further. Methodology: The final 40 trigger tool developed by modifying IHI-GTT adult care, was prospectively tested for structural review of records (n=520) of paediatric population of a tertiary care hospital for incidence of adverse events (AE’s) with associated harm and categorized using modified NCCMERP (National Coordinating Council for Medication Error Reporting and Prevention) index from E-I. Results: Among 292 male and 228 female children, the incidence of AEs was 35%, more in the category of 1-5 years of age with harm assessment events. Out of 182 AEs identified, 107(58.80%) were found to be of E-category, 43(23.62%) were of category F, 22(12.08%) with category G, 9(4.95%) with category H and 1(0.55%) was category I. Two third of the paediatric population of category E and F (82.4%) had temporary harm and remaining (17.6%) were of non- preventable harm, category G-I. One example of AE identified with harm was, decrease in 25% in Haemoglobin or Haematocrit and number of blood transfusions. Further action was taken to strictly monitor and minimize further harm. Conclusion: The present study highlights on the harm assessment among the paediatric population with the help of developed Paediatric-Focused Trigger Tool (PFTT) modified by using IHI-GTT adult trigger tool. This helps paediatric set ups to assess its usefulness and further develop strategies to mitigate the harm.

Key words: Paediatric, Trigger tool, AEs, NCCMERP Index, Harm.