Appendix 6: Florida Sub-categories definitions

Florida Hospital Adverse Event/Harm Categories & Sub-Categories / Trigger Description / Operational Definition
Events Related to Medication/Intravenous Fluids
Clostridium difficile medication associated infection / C-difficile positive stool
Anti-diarrhoeal / As per GTT trigger definition (HQSC GTT guide)
IV volume overload/electrolyte imbalance / Check Fluid balance charts & laboratory results to see if harm has occurred.Harm is defined if patient experiences symptoms associated with overload such as shortness of breath. Check if patient requires diuresis, increase in diuretic dose or fluid is stopped.
Kidney damage due to contrast dye / Raised Urea / Creatinine
(> 2 x baseline) / As per GTT trigger definition (HQSC GTT guide)
Medication related cardiac event/arrhythmia / Abrupt medication stop / As per GTT/ADE trigger definition (HQSC GTT guide)
Medication related renal insufficiency / Raised Urea / Creatinine
(> 2 x baseline) / As per GTT trigger definition (HQSC GTT guide)
Medication related allergic reaction / Antihistamines) / IV Corticosteroid / As per GTT trigger definition (HQSC GTT guide)
Medication related bleeding / Partial thromboplastin time > 100 secs
INR > 4
Other / As per GTT trigger definition (HQSC GTT guide)
Medication related delirium, confusion, or over-sedation / Naloxone use
Over-sedation/Hypotension / As per GTT trigger definition (HQSC GTT guide)
Review the physician progress notes, nursing or multidisciplinary notes for evidence of over –sedation, confusion, delirium and lethargy. Review vital signs records or graphics for episodes of hypotension related to the administration of a sedative analgesic or muscle relaxant.
Medication related diarrhoea / Anti-diarrhoeal / Look for diarrhoea associated with antibiotics/ other medications or C. difficile infection caused by antibiotics.
Medication related glycemic events / Hypoglycaemia (< 3 mmol/L) / As per GTT trigger definition (HQSC GTT guide)
Medication related hypotension / Over-sedation/ Hypotension
Abrupt medication stop / As per GTT trigger definition (HQSC GTT guide)
Medication related nausea and vomiting / Anti-emetics / As per GTT trigger definition (HQSC GTT guide)
Medication related constipation / Laxatives / Constipation can be due to medications such as opiates or regularly used antiemetics such as Ondansetron. If laxatives have been prescribed, review notes and bowel chart (if present) to see whether constipation has occurred and whether this is secondary to medication. Bowels not opened for > 3 days is defined as constipation.
Other
Events Related to Patient Care
DVT/VTE / Radiological investigation for PE/DVT
Any operative complication / As per GTT trigger definition (HQSC GTT guide)
This refers to any number of complications, including but not limited to PE, DVT, decubiti, MI renal failure etc.
Fall with injury / Patient fall / A fall in a care setting represents a failure of care and may be the result of medications, equipment failure or failure of adequate staffing. A fall with no injury – no harm. A fall with injury is an AE.A fall which requires treatment due to injury – category F.Falls resulting in higher care (eg cerebral bleed) – Category G/H or above. A mechanical fall in the community is not a harm.
Skin tear, abrasion, or other breakdown / Any procedure/treatment complication
Other / Other than pressure ulcers, any form of 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
Other
Hospital Acquired Infection
Catheter associated urinary tract infection / Healthcare associated infection /
Positive blood culture / As per GTT trigger definition (HQSC GTT guide)
Central line associated blood stream infection / Healthcare associated infection /
Positive blood culture / As per GTT trigger definition (HQSC GTT guide)
Peripheral or central line non-blood stream infection / Healthcare associated infection /
Positive blood culture / As per GTT trigger definition (HQSC GTT guide)
Respiratory infection (non-ventilator associated) / Healthcare associated infection /
Positive blood culture / As per GTT trigger definition (HQSC GTT guide)
Surgical infection / Healthcare associated infection /
Positive blood culture / As per GTT trigger definition (HQSC GTT guide)
Ventilator associated pneumonia / Healthcare associated infection /
Pneumonia onset / As per GTT trigger definition (HQSC GTT guide)
Other
Events Related to Surgery or Other Procedure
Abnormal bleeding following surgery or procedure / Decrease of greater than 25% in Hb or Hct
Transfusion/use of blood / As per GTT trigger definition (HQSC GTT guide)
Blood clots and other occlusions related to surgery or procedure / Decrease of greater than 25% in Hb or Hct
Radiological investigation for PE/DVT / As per GTT trigger definition (HQSC GTT guide)
Cardiac complications related to surgery or procedure / Post-op troponin level greater than 1.5 ng/ml
Any operative complication / As per GTT trigger definition (HQSC GTT guide)
Complications related to peripheral venous or arterial puncture / Any operative complication / As per GTT trigger definition (HQSC GTT guide)
Hypotension/blood loss / Transfusion/use of blood
Decrease of greater than 25% in Hb or Hct / As per GTT trigger definition (HQSC GTT guide)
Post-op acute renal failure / Acute dialysis
Raised Urea / Creatinine
(> 2 x baseline)
Any operative complication / As per GTT trigger definition (HQSC GTT guide)
Post-op spinal tap/ lumbar puncture /epidural 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 / As per GTT trigger definition (HQSC GTT guide)
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 / As per GTT trigger definition (HQSC GTT guide)
Removal retained foreign body / Return to theatre
X-ray intra-op or in PACU / As per GTT trigger definition (HQSC GTT guide)
Removal, injury or repair of organ / Injury, repair or removal of organ / As per GTT trigger definition (HQSC GTT guide)
Respiratory complications related to surgery or procedure / Intubation/re-intubation/BiPap in PACU
Mechanical ventilation > 24 hours post-op / As per GTT trigger definition (HQSC GTT guide)
Other
Events Related to Intensive Care
Catheter associated urinary tract infection / Healthcare associated infection
Positive blood culture / As per GTT trigger definition (HQSC GTT guide)
Central line associated blood stream infection / Healthcare associated infection
Positive blood culture / As per GTT trigger definition (HQSC GTT guide)
Peripheral or central line non-blood stream infection / Healthcare associated infection
Positive blood culture / As per GTT trigger definition (HQSC GTT guide)
Respiratory infection (non-ventilator associated) / Healthcare associated infection
Positive blood culture / As per GTT trigger definition (HQSC GTT guide)
Surgical Infection / Healthcare associated infection
Positive blood culture / As per GTT trigger definition (HQSC GTT guide)
Ventilator associated pneumonia / Healthcare associated infection
Pneumonia onset / As per GTT trigger definition (HQSC GTT guide)
Other