Evaluation of antiretroviral-related errors and interventions by the clinical pharmacist in hospitalized HIV-infected patients

Abstract

ObjectivesThe aim of the study was to identify antiretroviral-related errors in the prescribing of medication to HIV-infected inpatients and to ascertain the degree of acceptance of the pharmacist's interventions. MethodsAn observational, prospective, 1-year study was conducted in a 750-bed tertiary-care teaching hospital by a pharmacist trained in HIV pharmacotherapy. Interactions with antiretrovirals were checked for contraindicated combinations. Inpatient antiretroviral prescriptions were compared with outpatient dispensing records for reconciliation. Renal and hepatic function was monitored to determine the need for dose adjustments. ResultsThe prescriptions for 247 admissions (189 patients) were reviewed. Sixty antiretroviral-related problems were identified in 41 patients (21.7%). The most common problem was contraindicated combinations (n 5 20; 33.3%), followed by incorrect dose (n 5 10; 16.7%), dose omission (n 5 9; 15%), lack of dosage reduction in patients with renal or hepatic impairment (n 5 6; 10% and n 5 1; 1.7%, respectively), omission of an antiretroviral (n 5 6; 10%), addition of an alternative antiretroviral (n 5 5; 8.3%) and incorrect schedule according to outpatient treatment (n 5 3; 5%). Fifteen out of 20 errors were made during admission. A multivariate analysis showed that factors associated with an increased risk of antiretroviral-related problems included renal impairment [odds ratio (OR) 3.95; 95% confidence interval (CI) 1.39-11.23], treatment with atazanavir (OR 3.53; 95% CI 1.61-7.76) and admission to a unit other than an infectious diseases unit (OR 2.50; 95% CI 1.28-4.88). Use of a nonnucleoside reverse transcriptase inhibitor was a protective factor (OR 0.33; 95% CI 0.13-0.81). Ninety-two per cent of the pharmacist's interventions were accepted. ConclusionAntiretroviral-related errors affected more than one-in-five patients. The most common causes of error were contraindicated or not recommended drug-drug combinations and dose-related errors. A clinical pharmacist trained in HIV pharmacotherapy could help to detect errors and reduce the duration of their effect.

Role of the Pharmacist in Caring for Patients with HIV/AIDS: Clinical Practice Guidelines

“…145 Furthermore, when clinical pharmacists were actively involved in or leading the medication evaluation of HIV-positive patients being admitted to hospital, medication errors were prevented, error rates were further reduced, and the duration of uncorrected errors was significantly shorter. 8,149,157,158 Pharmacists can also be useful resources for residents and physicians, especially those with limited experience in HIV, who may be more prone to antiretroviral prescribing errors. 159,160 Pharmacists can provide advice regarding dosage adjustments to address drug interactions or organ insufficiencies, can suggest alternatives if current therapies or formulations are unsuitable or contraindicated, and can ensure that complete regimens are prescribed, including comedications, problems that a computerized physician order entry system is unlikely to be able to identify or help resolve.…”

Irrational Anti-Retroviral Therapy Prescription among Children Under 15 Years in Eastern Uganda

“…substantially lower than in research done for HAART [29,[35][36][37]. It should be noted that the studies that were done for HAART comprised both adult and child participants.…”

Antiretroviral changes during the first year of therapy

“…18,25 These differences may be justified by factors such as ARV classes (NRTI, NNRTI and PI), adherence, toxicity, adverse reactions, incorrect drug combinations in coinfections, and pharmacogenetics of patients. 4,6,10,15,26 In our study, EFZ was the drug most often switched in the initial regimens. This is possibly due to the significant prevalence of CNS-related adverse events associated with this drug.…”

“…Due to the increasing number of PLWHA using HAART, treatment monitoring for the rational adherence of patients to therapy has become a priority, with improved clinical parameters and less risk of failure, hospitalization, costs, morbidity and mortality, longer survival and positive prevention with the adoption of healthy lifestyle habits. [8][9][10] In this context, we aimed to describe the profile of HIV+ patients seen at a reference center in Fortaleza/Ceará, who had their initial antiretroviral regimen modified in the first year of treatment, and the factors involved in the modifications of HAART during this period.…”