A Modified Trigger Tool for Identification of Patient Harm in Palliative Care Patients. A Pilot Study From Norway

Patient harm in the hospitalized palliative care population is underexplored. The distinctive areas of harm relevant to palliative care patients are not captured by existing instruments developed to identify patient harm in general patient populations. Therefore, a tailored approach could aid in the identification of patient harm and the improvement of patient safety in palliative care.

The aim of the study was to describe the performance and suitability of a modified version of the Global Trigger Tool (GTT) applied to palliative care patients.

Hospital records of 256 consecutive patients at a Norwegian palliative care ward were independently reviewed for triggers and cases of patient harm by 2 reviewers. The modified trigger tool was based on the generic GTT and primarily adhered to its methodology. Some GTT triggers not relevant for palliative care patients were omitted, and new triggers and categories of harm were introduced based on clinical experience and publications on patient harm in palliative care.

Four hundred and one triggers (1.6 per hospitalization), and 109 cases of harm were identified. 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/overdiagnosis or disturbed dying/poor symptom control. The positive predictive value for identifying patient harm was 0.27. Inter-rater reliability for identifying harm was κ=0.590 (95% CI: 0.461-0.718).

The modified trigger tool identifies patient harm and disturbed dying in palliative care patients. However, further development is required before the routine implementation of this tool.