Describing adverse events in Swiss hospitalized oncology patients using the Global Trigger Tool

Abstract
Background and aims: The occurrence rate of adverse events (AEs) related to care
among hospitalized oncology patients in Switzerland remains unknown. The primary
objective of this study was to describe, for the first time, the occurrence rate, type,
severity of harm, and preventability of AEs related to care, reported in health records of
hospitalized hematological and solid-tumor cancer patients in three Swiss hospitals.
Methods: Using an adapted version of the validated Global Trigger Tool (GTT) from
the Institute for Healthcare Improvement, we conducted a retrospective record
review of patients discharged from oncology units over a 6-week period during
2018. Our convenience sample included all records from adult patients (≥18 years of
age), diagnosed with cancer, and hospitalized (>24 hours). Per the GTT method, two
trained nurses independently assessed patient records to identify AEs using triggers,
and physicians from the included units analyzed the consensus of the two nurses.
Together, they assessed the severity and preventability of each AE.
Results: From the sample of 224 reviewed records, we identified 661 triggers and
169 AEs in 94 of them (42%). Pain related to care was the most frequent AE (n = 29),
followed by constipation (n = 17). AEs rates were 75.4 per 100 admissions and 106.6 per
1000 patient days. Most of the identified AEs (78%) caused temporary harm to the patient
and required an intervention. Among AEs during hospitalization (n = 125), 76 (61%) were
considered not preventable, 28 (22%) preventable, and 21 (17%) undetermined.
Conclusion: About half of the hospitalized oncology patients suffered from at least
one AE related to care during their hospitalization. Pain, constipation, and nosocomial
infections were the most frequent AEs. It is, therefore, essential to identify AEs to
guide future clinical practice initiatives to ensure patient safety.