title: Application of the Pareto principle to identify and address drug-therapy safety issues.
abstract: OBJECTIVE
  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.
authors.affiliation: Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Fahrstrasse 17, 91054, Erlangen, Germany, fabian.mueller@pharmakologie.med.uni-erlangen.de.
authors.forename: Fabian
authors.initials: F
authors.lastname: Müller
authors.forename: Harald
authors.initials: H
authors.lastname: Dormann
authors.forename: Barbara
authors.initials: B
authors.lastname: Pfistermeister
authors.forename: Anja
authors.initials: A
authors.lastname: Sonst
authors.forename: Andrius
authors.initials: A
authors.lastname: Patapovas
authors.forename: Renate
authors.initials: R
authors.lastname: Vogler
authors.forename: Nina
authors.initials: N
authors.lastname: Hartmann
authors.forename: Bettina
authors.initials: B
authors.lastname: Plank-Kiegele
authors.forename: Melanie
authors.initials: M
authors.lastname: Kirchner
authors.forename: Thomas
authors.initials: T
authors.lastname: Bürkle
authors.forename: Renke
authors.initials: R
authors.lastname: Maas
mesh_terms: D011307:Drug Prescriptions / Q000592:standards / Q000706:statistics & numerical data; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data; D005858:Germany; D006801:Humans; D008508:Medication Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D008962:Models, Theoretical; D010607:Pharmacy Service, Hospital / Q000379:methods / Q000592:standards; D055553:Prescription Drugs / Q000009:adverse effects / Q000145:classification
chemical_list: D055553:Prescription Drugs