New Zealand Trigger Tool Adverse Event Subcategories

New Zealand Trigger Tool Adverse Event Subcategories

Adverse Event Sub-Categories / Triggers possibly associated to identified harm / Operational Definition
Clostridium difficile medication associated infection / C-difficile positive stool
Anti-diarrhoeal / A positive C-difficile assay identified and associated to recent antibiotics
IV volume overload/electrolyte imbalance / Other / Fluid overload identified with associated symptoms such as shortness of breath
Diuretic prescribed or IV fluid stopped
Kidney damage due to contrast dye / Raised Urea / Creatinine
(> 2 x baseline) / Acute kidney injury resulting in twice the patient baseline creatinine secondary to recently administered contrast
Medication related cardiac event/arrhythmia / Abrupt medication stop / Bradycardia, tachycardia or other events due to cardiac medications identified
Medication related renal insufficiency / Raised Urea / Creatinine
(> 2 x baseline) / Acute kidney injury resulting in twice the patient baseline creatinine contributed by identified medications, for example, gentamicin
Medication related allergic reaction / Antihistamines) / IV Corticosteroid / Identified allergic reaction due to known or unknown drug allergy
Medication related bleeding / Partial thromboplastin time > 100 secs
INR > 4
Other / Bleeds identified secondary to antiplatelet or anticoagulant therapy
Medication related delirium, confusion, or over-sedation / Naloxone use
Over-sedation/Hypotension / Over –sedation, confusion and/or delirium related to medications
Medication related diarrhoea / Anti-diarrhoeal / Diarrhoea associated with antibiotics or other medications identified
Medication related glycemic events / Hypoglycaemia (< 3 mmol/L) / Hypoglycaemia with associated symptoms due to insulin or oral hypoglycaemic agents
Medication related hypotension / Over-sedation/ Hypotension
Abrupt medication stop / Hypotension identified with associated symptoms secondary to medications such as antihypertensive agents
Medication related nausea and vomiting / Anti-emetics / Ongoing (3 or more episodes within 24 hours) nausea or vomiting identified due to medications
DVT/VTE / Radiological investigation for PE/DVT
Any operative complication / Deep vein thrombosis or pulmonary emboli identified during stay in hospital
Fall with injury / Patient fall / A fall with injury as a result of medications, equipment failure or failure of adequate staffing or care
Skin tear, abrasion, or other breakdown / Any procedure/treatment complication
Other / Identified trauma to the skin from a medical intervention, for example, skin tear secondary to removal of plasters such as Tegaderm.
Stage I or II pressure ulcer / Pressure Ulcer/injury / Pressure injury presenting as intact skin with redness over a localised area or partial thickness loss of dermis without slough.
Stage III or IV pressure ulcer / Pressure Ulcer/injury / Pressure injury presenting as full thickness tissue loss with or without visible bone, tendon or muscle exposure
Catheter associated urinary tract infection / Healthcare associated infection
Positive blood culture / Urinary tract infection identified due to the presence of a catheter
Central line associated blood stream infection / Healthcare associated infection
Positive blood culture / Central line associated septicaemia identified
Peripheral or central line non-blood stream infection / Healthcare associated infection
Positive blood culture / Line Infection secondary to insertion of peripheral or central lines
Respiratory infection (non-ventilator associated) / Healthcare associated infection
Positive blood culture / Hospital acquired pneumonia or respiratory tract infection
Surgical infection / Healthcare associated infection
Positive blood culture / Identified surgical site infections
Ventilator associated pneumonia / Healthcare associated infection
Pneumonia onset / Respiratory infections associated to mechanical ventilation
Abnormal bleeding following surgery or procedure / Decrease of greater than 25% in Hb or Hct
Transfusion/use of blood / Excessive bleeding following surgery that required blood transfusion or return to theatres/ monitoring
Blood clots and other occlusions related to surgery or procedure / Decrease of greater than 25% in Hb or Hct
Radiological investigation for PE/DVT / Haematomas, pulmonary emboli or deep vein thrombosis identified following surgery
Cardiac complications related to surgery or procedure / Post-op troponin level greater than 1.5 ng/ml
Any operative complication / Any cardiac complications, for example, myocardial infarct, identified during surgery or postoperatively
Complications related to peripheral venous or arterial puncture / Any operative complication / Complications such as pseudo-aneurysm or sepsis identified as a result of arterial or venous cannulation
Hypotension/blood loss / Transfusion/use of blood
Decrease of greater than 25% in Hb or Hct / Hypotension with associated symptoms due to blood loss in surgery
Post-op acute renal failure / Acute dialysis
Raised Urea / Creatinine
(> 2 x baseline)
Any operative complication / Acute kidney injury occurred as a result of surgery resulting in creatinine to be more than twice patient baseline
Post-op spinal tap headache / Any operative complication / Headache associated with any procedure which can occur 1 – 5 days after
Premature extubation causing respiratory failure / Intubation/re-intubation/BiPap in PACU
Mechanical ventilation > 24 hours post-op / Respiratory depression as a result of early removal of tube
Prolonged post-op ileus / Any operative complication / Diagnosis of ileus with nil bowel movement for 3 days or more for non-abdominal surgery and 4 days or more for abdominal surgery, with associated symptoms.
Radiation related injury / Any procedure/treatment complication
Any operative complication / Any injury or associated symptoms due to radiation poisoning
Removal retained foreign body / Return to theatre
X-ray intra-op or in PACU / Surgical mishap identified as a result of retained foreign object after surgery
Removal, injury or repair of organ / Injury, repair or removal of organ / Unintended removal, injury or repair of organ identified
Respiratory complications related to surgery or procedure / Intubation/re-intubation/BiPap in PACU
Mechanical ventilation > 24 hours post-op / A complication postoperatively or due to any procedure that resulted in respiratory depression
Other / Other / Any adverse event as a result of medical intervention that cannot be placed in any other subcategory

Health Quality & Safety Commission – Global Trigger Tool Guide Supporting Document Page 1