The Global Trigger Tool in Psychiatry: A National Trigger Panel

Recent research increasingly addresses the safety issues of psychopharmacotherapy, particularly in connection with the need for long-term medication use in the treatment of mental disorders. In this context, the Global Trigger Tool (GTT) method serves as an effective instrument for monitoring adverse events, however, its application in psychiatry requires adaptation considering the specifics of this medical field and the organizational features of psychiatric care in Russia. This systematic review includes an analysis of 7 key studies conducted in Sweden, Norway, Singapore, the USA, and Russia, identified in PubMed, Google Scholar, and Elibrary databases (up to March 2025). The included articles describe both the application of the original methodology in psychiatry and attempts to modify it for this medical domain. Of particular interest are studies that attempted to adapt the GTT to the legal and cultural characteristics of national healthcare systems. All included studies demonstrated the value of this methodology for monitoring the safety of pharmacotherapy in psychiatric practice. Based on the obtained results and considering international experience, while taking into account the specifics of Russian psychiatric practice, the authors developed a specialized trigger panel during a dialogue conference. This panel enables the creation of a unified system for monitoring psychopharmacotherapy safety, which is especially relevant for Russian medical institutions. The implementation of this methodology can not only standardize the safety monitoring process but also significantly enhance the safety level of pharmacotherapy in the treatment of mental disorders in the Russian Federation.

1. Slawomirski L, Auraaen A, Klazinga N. The economics of patient safety: strengthening a value-based approach to reducing patient harm at national level. OECD; 2017. Available at: https://www.oecd.org/health/health-systems/The-Economics-of-Patient-Safety-March-2017.pdf.

2. Hodkinson A, Tyler N, Ashcroft DM, Keers RN, Khan K, Phipps D et al. Preventable medication harm across health care settings: a systematic review and meta-analysis. BMC Med. 2020;18(1):313. https://doi.org/10.1186/s12916-020-01774-9.

3. Carmona-Huerta J, Castiello-De Obeso S, Ramírez-Palomino J, Duran-Gutiérrez R, Cardona-Muller D, Grover-Paez F et al. Polypharmacy in a hospitalized psychiatric population: risk estimation and damage quantification. BMC Psychiatry. 2019;19(1):78. https://doi.org/10.1186/s12888-019-2058-y.

4. Мосолов СН. Биологические методы терапии психических расстройств (доказательная медицина – клинической практике). М.: Социальнополитическая мысль; 2012. 1073 с.

5. Kukreja S, Kalra G, Shah N, Shrivastava A. Polypharmacy in psychiatry: a review. Mens Sana Monogr. 2013;11:82–99. https://doi.org/10.4103/0973-1229.104497.

6. Mosolov S, Malin D, Ryvkin P, Sychev D. Psychotropic drugs interaction. Current Therapy of Mental Disorders. 2019;(S1):2–33. (In Russ.) https://doi.org/10.21265/PSYPH.2019.50.40828.

7. Taub S, Krivoy A, Whiskey E, Shergill SS. New approaches to antipsychotic medication adherence – safety, tolerability and acceptability. Expert Opin Drug Saf. 2022;21(4):517–524. https://doi.org/10.1080/14740338.2021.1983540.

8. Famenka AG. Methods for identifying and assessing medical errors and adverse events in health care. Meditsinskie Novosti. 2012;(4):41–47. (In Russ.) Режим доступа: https://cyberleninka.ru/article/n/metody-vyyavleniyaanaliza-i-otsenki-oshibok-i-neblagopriyatnyh-sobytiy-voznikayuschih-priokazanii-meditsinskoy-pomoschi

9. Thomas EJ, Petersen LA. Measuring errors and adverse events in health care. J Gen Intern Med. 2003;18(1):61–67. https://doi.org/10.1046/j.1525-1497.2003.20147.x.

10. Classen DC, Lloyd RC, Provost L, Griffin FA, Resar R. Development and evaluation of the Institute for Healthcare Improvement Global Trigger Tool. J Patient Saf. 2008;4(3):169–177. https://doi.org/10.1097/PTS.0b013e318183a475.

11. Resar RK, Rozich JD, Classen D. Methodology and rationale for the measurement of harm with trigger tools. Qual Saf Health Care. 2006;15(Suppl. 1):i39–i45. https://doi.org/10.1136/qshc.2005.016543.

12. Griffin FA, Classen DC. Detection of adverse events in surgical patients using the Trigger Tool approach. Qual Saf Health Care. 2008;17(4):253–258. https://doi.org/10.1136/qshc.2007.025080.

13. Garry DA, McKechnie SR, Culliford DJ, Ezra M, Garry PS, Loveland RC et al. A prospective multicentre observational study of adverse iatrogenic events and substandard care preceding intensive care unit admission (PREVENT). Anaesthesia. 2014;69(2):137–142. https://doi.org/10.1111/anae.12494.

14. Hibbert PD, Molloy CJ, Schultz TJ, Carson-Stevens A, Braithwaite J. Comparing rates of adverse events detected in incident reporting and the Global Trigger Tool: a systematic review. Int J Qual Health Care. 2023;35(3):mzad056. https://doi.org/10.1093/intqhc/mzad056.

15. Ivashchenko DV, Buromskaya NI, Savchenko LM, Shevchenko YS, Sychev DA. Global trigger tool value for revealing of unwanted events related to medical care in pediatrics. Meditsinskiy Sovet. 2018;(17):56–65. (In Russ.) https://doi.org/10.21518/2079-701X-2018-17-56-65.

16. Ivashchenko DV, Buromskaya NI, Malakhova AD, Tsarkova NA, Savchenko LM, Shevchenko YS, Sychev DA. Off-label antipsychotics prescription to adolescents with acute psychotic episodes does not cause adverse drug reactions. Neurology, Neuropsychiatry, Psychosomatics. 2021;13(3):19–26. (In Russ.) https://doi.org/10.14412/2074-2711-2021-3-19-26.

17. Ivashchenko D, Buromskaya N, Savchenko L, Shevchenko Y, Sychev D. Global trigger tool in child psychiatry: Treatment safety evaluation in adolescents with an acute psychotic episode. Int J Risk Saf Med. 2020;31(1):25–35. https://doi.org/10.3233/JRS-195030.

18. Hibbert PD, Molloy CJ, Hooper TD, Wiles LK, Runciman WB, Lachman P et al. The application of the Global Trigger Tool: a systematic review. Int J Qual Health Care. 2016;28(6):640–649. https://doi.org/10.1093/intqhc/mzw115.

19. Füredi J, Mohr P, Swingler D, Bitter I, Gheorghe MD, Hotujac L et al. Psychiatry in selected countries of Central and Eastern Europe: an overview of the current situation. Acta Psychiatr Scand. 2006;114(4):223–231. https://doi.org/10.1111/j.1600-0447.2006.00804.x.

20. Nilsson L, Borgstedt-Risberg M, Soop M, Nylén U, Ålenius C, Rutberg H. Incidence of adverse events in Sweden during 2013–2016: a cohort study describing the implementation of a national trigger tool. BMJ Open. 2018;8(3):e019966. https://doi.org/10.1136/bmjopen-2017-019966.

21. Deilkås ET, Bukholm G, Lindstrøm JC. Monitoring adverse events in Norwegian hospitals from 2010 to 2013. BMJ Open. 2015;5(9):e008576. https://doi.org/10.1136/bmjopen-2015-008576.

22. Nilsson L, Borgstedt-Risberg M, Brunner C, Nyberg U, Nylén U, Ålenius C et al. Adverse events in psychiatry: a national cohort study in Sweden with a unique psychiatric trigger tool. BMC Psychiatry. 2020;20(1):44. https://doi.org/10.1186/s12888-020-2463-2.

23. Kirilochev OO, Umerova AR. Triggers of adverse drug events as a tool to augment the safety of pharmacotherapy in psychiatry. Ural Medical Journal. 2019;12(180):172–180. (In Russ.) https://doi.org/10.25694/URMJ.2019.12.35.

24. Okkenhaug A, Tritter JQ, Myklebust TÅ, Deilkås ET, Meirik K, Landstad BJ et al. Mitigating risk in Norwegian psychiatric care: identifying triggers of adverse events through Global Trigger Tool for psychiatric care. Int J Risk Saf Med. 2019;30(4):203–216. https://doi.org/10.3233/JRS-195063.

25. Sajith GS, Fung DS, Chua HC. The Mental Health Trigger Tool: development and testing of a specialized trigger tool for mental health settings. J Patient Saf. 2019;15(1):42–49. https://doi.org/10.1097/PTS.0000000000000523.

26. Reilly CA, Cullen SW, Watts BV, Mills PD, Paull DE, Marcus SC. How well do incident reporting systems work on inpatient psychiatric units? Jt Comm J Qual Patient Saf. 2019;45(1):63–69. https://doi.org/10.1016/j.jcjq.2018.06.001.

27. Okkenhaug A, Tritter JQ, Landstad BJ. Developing a research tool to detect iatrogenic adverse events in psychiatric health care by involving service users and health professionals. J Psychiatr Ment Health Nurs. 2024;31(3):405–416. https://doi.org/10.1111/jpm.12994.

28. Marcus N, Stergiopoulos V. Re-examining mental health crisis intervention: A rapid review comparing outcomes across police, co-responder and nonpolice models. Health Soc Care Community. 2022;30(5):1665–1679. https://doi.org/10.1111/hsc.13731.

29. Kirilochev OO, Umerova AR. Perspectives on using tools to control polypharmacy in psychiatric patients. Caspian Journal of Medicine and Pharmacy. 2021;2(4):6–12. (In Russ.) Available at: https://elibrary.ru/fybfvm.

30. Dos Santos SLF, Gondim APS. Trackers for adverse events in child mental health: descriptive analysis using the global trigger tool. Braz J Pharm Sci. 2023;59:e20837. https://doi.org/10.1590/s2175-97902023e20837.

31. Noorda NMF, Sallevelt BTGM, Langendijk WL, Egberts TCG, van Puijenbroek EP, Wilting I, Knol W. Performance of a trigger tool for detecting adverse drug reactions in patients with polypharmacy acutely admitted to the geriatric ward. Eur Geriatr Med. 2022;13(4):837–847. https://doi.org/10.1007/s41999-022-00649-x.

32. Yu N, Wu L, Yin Q, Du S, Liu X, Wu S et al. Adverse drug events in Chinese elder inpatients: a retrospective review for evaluating the efficiency of the Global Trigger Tool. Front Med. 2023;10:1232334. https://doi.org/10.3389/fmed.2023.1232334.

33. Valkonen V, Haatainen K, Saano S, Tiihonen M. Evaluation of Global trigger tool as a medication safety tool for adverse drug event detection-a crosssectional study in a tertiary hospital. Eur J Clin Pharmacol. 2023;79(5):617–625. https://doi.org/10.1007/s00228-023-03469-5.

34. Mosolov SN. Ethical-deontological problems of therapy of mental disorders. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2023;123(9):7–14. (In Russ.) https://doi.org/10.17116/jnevro20231230917

35. Daumit GL, McGinty EE, Pronovost P, Dixon LB, Guallar E, Ford DE et al. Patient Safety Events and Harms During Medical and Surgical Hospitalizations for Persons With Serious Mental Illness. Psychiatr Serv. 2016;67(10):1068–1075. https://doi.org/10.1176/appi.ps.201500415.