Abstract
Purpose
Adverse drug events (ADE) and medication errors (ME) are common causes of morbidity in patients presenting at emergency departments (ED). Recognition of ADE as being drug related and prevention of ME are key to enhancing pharmacotherapy safety in ED. We assessed the applicability of the Pareto principle (∼80 % of effects result from 20 % of causes) to address locally relevant problems of drug therapy.
Methods
In 752 cases consecutively admitted to the nontraumatic ED of a major regional hospital, ADE, ME, contributing drugs, preventability, and detection rates of ADE by ED staff were investigated. Symptoms, errors, and drugs were sorted by frequency in order to apply the Pareto principle.
Results
In total, 242 ADE were observed, and 148 (61.2 %) were assessed as preventable. ADE contributed to 110 inpatient hospitalizations. The ten most frequent symptoms were causally involved in 88 (80.0 %) inpatient hospitalizations. Only 45 (18.6 %) ADE were recognized as drug-related problems until discharge from the ED. A limited set of 33 drugs accounted for 184 (76.0 %) ADE; ME contributed to 57 ADE. Frequency-based listing of ADE, ME, and drugs involved allowed identification of the most relevant problems and development of easily to implement safety measures, such as wall and pocket charts.
Conclusions
The Pareto principle provides a method for identifying the locally most relevant ADE, ME, and involved drugs. This permits subsequent development of interventions to increase patient safety in the ED admission process that best suit local needs.
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Acknowledgement/conflict of interest
We thank board chairman Peter Krappmann and the business management committee of Fürth Hospital, led by Martin Vitzithum, for supporting the Care Research Project and collaboration in designing the technical infrastructure for study conduct. This study was funded by the German Health Ministry as part of the German Coalition for Patient Safety (www.german-coalition-for-patient-safety.org/) (AZ II A5–2509 ATS 003). Medizinische Medien Informations GmbH (MMI, Neu-Isenburg, Germany) made its drug and drug-interaction databases, Pharmindex Plus ® and OntoDrug® AMTS, available to the study free of charge. Fabian Müller holds shares in Novartis.
Contributions of authors statement
Study conception and design were performed by Müller F, Dormann H, Patapovas A, Bürkle T, and Maas R. All authors made substantial contributions to data acquisition, analysis, or interpretation. Müller and Maas wrote the first draft of the manuscript; all other authors provided significant additions or critical revisions for important intellectual content. All authors approved the final version of the article.
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Fabian Müller and Harald Dormann contributed equally in this article
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Müller, F., Dormann, H., Pfistermeister, B. et al. Application of the Pareto principle to identify and address drug-therapy safety issues. Eur J Clin Pharmacol 70, 727–736 (2014). https://doi.org/10.1007/s00228-014-1665-2
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DOI: https://doi.org/10.1007/s00228-014-1665-2