Institutional members access full text with Ovid®

Share this article on:

Development of a Trigger Tool to Identify Adverse Drug Events in Elderly Patients With Multimorbidity

Toscano Guzmán, María Dolores PharmD*; Galván Banqueri, Mercedes PhD, PharmD; Otero, María José PhD, PharmD; Alfaro Lara, Eva Rocío PhD, PharmD§; Casajus Lagranja, Pilar PharmD; Santos Ramos, Bernardo PharmD

doi: 10.1097/PTS.0000000000000389
Original Article: PDF Only

Purpose Elderly patients with multimorbidity are especially vulnerable to adverse drug events (ADEs) and had high prevalence rates. Identifying ADEs is essential for enabling timely interventions that can mitigate the adverse events detected and for developing targeted strategies to prevent their occurrence as well as to monitor implementation. The aim of this study was to develop a set with appropriate triggers for detecting potential ADEs in elderly patients with multimorbidity.

Methods A modified Delphi methodology was used to reach consensus. Existing triggers for detecting ADEs in adult patients were identified from a literature search in several databases (EMBASE, MEDLINE, Web of Science, Centre for Reviews and Dissemination, and Cochrane Library) and from Institute for Healthcare Improvement published lists. Twelve experts in patient/medication safety or in chronic diseases scored candidate triggers for appropriateness according to 3 criteria (evidence, usefulness for elderly patients, and feasibility of implementation in clinical practice).

Results Seventy-two triggers were initially selected to be evaluated. The final set includes a total of 51 triggers for which the panelists who completed the 2 rounds of evaluation reached agreement. These triggers were organized into 5 modules: 11 as care module triggers, 10 as antidotes/treatment, 11 medication concentrations, 18 abnormal laboratory values, and 1 as emergency department trigger.

Conclusions A set of triggers for detecting ADEs in elderly patients with multimorbidity have been developed, following the consensus of a panel of experts. Subsequent validation in clinical practice is needed to confirm the accuracy and efficiency of these triggers for this population.

From the *UGC de Farmacia del Complejo Hospitalario Universitario de Huelva, Huelva; †UGC de Farmacia del Área Sur de Sevilla, Sevilla; ‡ISMP-Spain. Complejo Asistencial Universitario de Salamanca, Salamanca; §Agencia de Evaluación de Tecnologías Sanitarias de Andalucía, Sevilla; ∥UGC Farmacia. Hospital Universitario Miguel Servet, Zaragoza; and ¶UGC de Farmacia del Área Sur de Sevilla, Sevilla, Spain.

Correspondence: María Dolores Toscano Guzmán, UGC Farmacia del Complejo Hospitalario Universitario de Huelva, Ctra. Sevilla-Huelva, s/n, 21080 Huelva, Spain (e-mail:

The authors disclose no conflict of interest.

Project “PI15/01616”, funded by Instituto de Salud Carlos III, integrated in the national I+D+i 2013-2016 and co-funded by European Union (ERDF/ESF, “Investing in your future”).

Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved