Trigger Tool template This tool provides a sample of questions for a trigger tool

Question Response Identified Issues

Yes/No/ Unsure
Were issues related to patient assessment a factor in
this situation?

E.g. identification/verbal & written communication with other

care providers and/or significant others/diagnosis/risk
assessment

Yes/No/ Unsure
Were staff/staffing issues a factor in this event?

E.g.
Training/Credentialing/Allocation/Scheduling/Escalation/
Handover/Communication/Orientation

Yes/No/ Unsure
Was equipment involved in this event in any way?

E.g. Faulty/Service History/Correct purpose/Training/

Procedures

Yes/No/ Unsure
Was the environment involved in this event in any way?

E.g. Free of distraction/familiar

Trigger tool template V1.0 August 2011 - (Adapted from Veteran Affairs National Centre for Patient Safety (NCPS) USA 1
developed by The Department of Health
 Question Response Identified Issues
Yes/No/ Unsure
Were appropriate rules/policies/procedures -- or the
lack of -- a factor in this event?

E.g. .compliance/understood/ current/ does it exists?

Yes/No/ Unsure
Was the lack of information (or misinterpretation of
information) a factor in this event?

Trigger tool template V1.0 August 2011 - (Adapted from Veteran Affairs National Centre for Patient Safety (NCPS) USA 2
developed by The Department of Health