Implementation of targeted interventions to decrease antiretroviral-related errors in hospitalized patients

Abstract

Purpose The implementation of targeted interventions aimed at decreasing the frequency of antiretroviral errors in hospitalized patients with human immunodeficiency virus (HIV) is described. Summary A prospective investigation conducted at our institution reported at least one error in the initial antiretroviral regimen in 49 out of 68 patients (72%). Since this analysis, several interventions aimed at decreasing this error rate have been instituted including computer alerts for incorrect doses and drug interactions added to the pharmacy entry system, an educational pocket card distributed among the staff, addition of commercially available combination antiretroviral products to the hospital formulary, computerized physician ordering system updates to include common dosing regimen defaults, involvement of the infectious diseases consult service to evaluate prescribed regimens of newly admitted patients with HIV, and daily review of newly initiated antiretroviral regimens by a clinical pharmacist trained in HIV care. A prospective follow up analysis was conducted after these interventions were in place to evaluate their effectiveness. A total of 78 patients were identified during the study period and were included in the analysis. Twelve (15%) of the patients experienced at least one error in their initial drug regimen compared to 49 (72%) of the control patients from the data collected prior to the interventions (p < 0.001). Conclusion A significant reduction in the frequency of antiretroviral medication errors among hospitalized patients with HIV was observed after the implementation of several interventions. The striking impact of these interventions supports a comprehensive and proactive approach to preventing antiretroviral medication errors in hospitalized patients with HIV.

HIV Pharmacist's Impact on Inpatient Antiretroviral Errors

“…Interventions have ranged from the use of technological innovations (e.g. alert systems and computerized order entry) to medication order review by a pharmacist (staff/infectious diseases/HIV) and have been conducted over a wide range of time intervals (2À24 months) [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Our study took an approach to minimize errors by providing daily review of patient orders on week days by an HIV pharmacist who was also stationed in the out-patient setting where most of the patients (85%) received chronic HIV care.…”

“…Studies at other large hospitals have shown HIV medication error rates ranging from 22 to 86% . These studies have found errors in nearly every aspect of medication management, ranging from ineffective antiretroviral regimens, improper dosages, incorrect frequencies, failure to adjust doses for comorbid disease states, and numerous drug interactions both with medications for separate conditions and with other antiretrovirals .…”

Impact of Pharmacy Technician-Centered Medication Reconciliation on Optimization of Antiretroviral Therapy and Opportunistic Infection Prophylaxis in Hospitalized Patients With HIV/AIDS

“…18 We plan to utilize this data to develop educational pocket-sized cards and a training program, which will highlight important renal dosage adjustments and significant drug-drug interactions involving ART and OI prophylaxis for our pharmacy and medical staff, and to implement a specific process to enhance utilization of ID specialists and clinical pharmacists during the medication reconciliation process for hospitalized HIV-infected patients.…”

Evaluation of human immunodeficiency virus medication errors in a community hospital following the implementation of a pharmacist‐led antiretroviral stewardship program

“…Medication‐related problems that alter ARV concentrations to suboptimal levels (eg, drug interactions) or lead to inadequate virologic suppression (eg, incomplete regimens) have the potential for long‐term implications including drug resistance. The prevalence of medication errors with antiretroviral therapy (ART) in hospitalized PLWH is highly variable and published rates range from 5% to 86% . The high potential for ARV medication errors with transitions of care may develop for a variety of reasons; all of which may influence ARV efficacy or risk medication toxicities.…”

“…ARV medication histories from patients admitted to the hospital are often incomplete with up to 25% of medications not accounted for and more than 60% of patients missing at least one maintenance medication . The most frequent errors reported are incomplete regimens and inappropriate ARV dosing . Most medication errors occur on admission to the hospital and up to 81% of errors have been related to inaccurate information during the medication history…”