Application of the Pareto principle to identify and address drug-therapy safety issues

Abstract

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.

Data Requirements for the Correct Identification of Medication Errors and Adverse Drug Events in Patients Presenting at an Emergency Department

“…The analysis focused on the possible causal involvement of each individual administered drug or drug combination in the clinical condition of the patient. [1,5,10,28]. In the first study phase a refined classification system for medication errors and adverse drug events was established [7] to facilitate the classification of medication errors and adverse drug events and risk patterns [1].…”

“…In study phase II checklists and teaching sessions were used according to the "Pareto principle" to address the most common and relevant issues identified in the first study phase [10], in study phase III these measures were complemented by electronic tools [29]. The detailed methodology including the event adjudication and the false negative rate has been previously described [1,5,10]. In brief, in a first step all records were assessed for ADE or ME by an interdisciplinary panel of at least one physician and one pharmacist.…”

“…Frequency and clinical severity /relevance of the ADE and ME identified by a certain type of data may also influence the selection of data sources primarily adapted for use with a CDSS. Previously we could demonstrate that a limited number of drugs and clinical conditions accounted for a large proportion of ADE and ME [10]. Therefore, the "Pareto" principle (80/20 rule) may be applicable when prioritization is necessary.…”

“…This resembles the recently revised definition of the European Medicines Agency (EMA) for an adverse drug reaction (ADR) as "a response to a medicinal product which is noxious and unintended". In this respect it has previously been noted that absolute numbers reported in the literature regarding the prevalence of ADE and ME vary to a degree that cannot be explained by the clinical setting alone (ADE prevalence ranging from 0.17% to 65% depending on patient group and study setting [8][9][10][11]). Varying definitions aside, incomplete/insufficient consideration of all available patient data has been identified as a major source of bias and underreporting of ADE and ME [12,13].…”

Exposure to potential drug-antimicrobial agent interactions in primary health care

“…More specific, Spriet et al 11 gave overview of significant CYP450-mediated interactions involving antiinfective agents and drugs frequently received in the Intensive Care Unit (ICU) and Becker 12,13 described adverse interactions of antibiotics commonly used in dental practice while Tey et al 14 reported on drug interactions with often prescribed antimicrobials in dermatological practice. However, differences in morbidity structure or complexity of healthcare contribute to specificity of study findings 15 . Hence, as intention to improve the safety of pharmacotherapy in the Health Center, the primary aim of this study was to identify the frequency and type of clinically significant potential drug-antimicrobial agent interactions among outpatients and to define recommendations for their control subsequently based on these local reports.…”