From the Institute of Mental Health, Singapore.
J Patient Saf. 2021 Jun 1;17(4):e360-e366. doi: 10.1097/PTS.0000000000000606.
Tools generally used in measuring patient safety incidents in general healthcare settings are not considered suitable for mental health settings. The aim of this study was to develop and evaluate a specialized trigger tool for mental health settings that could detect both traditionally defined adverse events (AEs) and other mental health-related patient safety incidents (MHPSIs).
We first defined and categorized AEs and MHPSIs based on existing literature and then developed a trigger list, initially consisting of 50 items, which was subsequently reduced to 25 items after a pilot study. We then explored the properties of this final 25-item trigger tool, the Mental Health Trigger Tool (MHTT), through a retrospective review of 515 patient records with a two-stage review process similar to Global Trigger Tool methodology. We used findings of an alternative method of review which consisted of page-to-page reviews of patient records in the analysis of properties of MHTT.
Using the MHTT, at least one AE was identified in 98 patient records (19%) and at least one MHPSI was identified in 58 patient records (11%). The MHTT had a sensitivity of 98.6% and its specificity was 100%. The probability of finding an AE/MHPSI when any trigger was detected in a patient record with MHTT was 33.8% and that of individual triggers ranged from 0% to 100%.
The MHTT may offer an effective, practical, and easy-to-use method in identifying and measuring safety incidents in mental health settings.
一般用于衡量一般医疗保健环境中患者安全事件的工具被认为不适合精神卫生环境。本研究旨在开发和评估一种专门用于精神卫生环境的触发工具，该工具既能检测传统定义的不良事件（AE），又能检测其他与精神健康相关的患者安全事件（MHPSI）。
我们首先根据现有文献定义和分类 AE 和 MHPSI，然后开发了一个触发清单，最初包含 50 个项目，在试点研究后减少到 25 个项目。然后，我们通过对 515 份患者记录的回顾性审查，探索了最终的 25 项触发工具，即心理健康触发工具（MHTT）的特性，该审查过程类似于全球触发工具方法，分为两个阶段。我们使用了一种替代审查方法的结果，该方法包括对患者记录逐页审查，以分析 MHTT 的特性。
使用 MHTT，在 98 份患者记录（19%）中至少发现了一个 AE，在 58 份患者记录（11%）中至少发现了一个 MHPSI。MHTT 的灵敏度为 98.6%，特异性为 100%。当使用 MHTT 在患者记录中检测到任何触发时，发现 AE/MHPSI 的概率为 33.8%，而单个触发的概率从 0%到 100%不等。
MHTT 可能为识别和衡量精神卫生环境中的安全事件提供一种有效、实用且易于使用的方法。
