175. Customized Order Entry Sets Reduce Antiretroviral Prescribing Errors in an Urban Academic Medical Center:  Another Opportunity for Antimicrobial Stewardship
Session: Poster Abstract Session: ART Prescribing Errors
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • HIV Error (2).pdf (441.3 kB)
  • Background: Antiretroviral medication (ARV) prescribing errors are common among hospitalized HIV-infected patients because of inpatient prescriber unfamiliarity with the complexities of ARV regimens. Educational reference materials, diligent in-servicing of staff, and dedicated HIV pharmacists can help reduce such errors but may not always be available.  We designed customized order entry sets (COES) to assist in ARV prescribing. This system displays dosing recommendations, identifies significant drug interactions, and reminds the prescriber to avoid ordering incomplete regimens.  This study reviews the impact of COES on ARV errors.

    Methods: Orders for ARVs were reviewed for patients hospitalized in a 6 month period before the implementation of the order sets and for patients hospitalized in a 6 month period after the intervention 

    Results: Overall the percentage of errors decreased by 35% (38.0% to 24.8%, p<0.01) primarily due to a reduction in protease inhibitor (PI)-prescribing errors (see table). The majority of errors involved the PI class, although error frequency decreased for both PI-based and non-PI-based regimens.  A shift in predominant drug class errors was observed between study periods as there was a trend towards increased usage of non-PI regimens post intervention.

     

    Pre-COES

    N (%)

    Post-COES

    N (%)

    P-value

    Admitted patients on ARV

    723 (48.7)

    661 (50.2)

    0.55

    Types of regimen

         PI-based

         Non-PI-based

         Combination formulation

    .

    493 (68.2)

    137 (19.0)

    93 (12.9)

    .

    428 (64.8)

    156 (23.6)

    77 (11.7)

    0.10

    Admissions with any errors

    275 (38.0)

    164 (24.8)

    <0.01

    Error types

         Incomplete regimen

         Incorrect ARV agent

         Wrong dose

         Wrong frequency

         Not renally dosed         

         Drug interactions

    .

    50 (6.9)

    13 (1.8)

    100 (13.8)

    55 (7.6)

    68 (9.4)

    74 (10.2)

    .

    23 (3.5)

    8 (1.2)

    46 (7.0)

    40 (6.1)

    35 (5.3)

    38 (5.8)

    .

    <0.01

    0.39

    <0.01

    0.29

    <0.01

    <0.01

    Total number of errors

    380

    198

     

    Errors by ARV class

         NRTI

         NNRTI

         PI

    .

    129 (33.9)

    18 (4.7)

    158 (41.6)

    .

    90 (45.4)

    7 (3.5)

    57 (28.8)

     

     

    Conclusion: Detailed COES improved ARV prescribing habits and reduced the potential for the dispensing and administration of incorrect ARV regimens to patients. Where HIV-specific medication reconciliation is unavailable, such order sets may prove to be a safe, efficient, and cost-effective means of minimizing ARV medication errors.

    Caryn Weiss, ANP1, Keith Veltri, PharmD1, Yi Guo, PharmD2, Philip Chung, PharmD, MS2 and Grace Minamoto, MD1, (1)Montefiore Medical Center, Bronx, NY, (2)Pharmacy, Montefiore Medical Center, Bronx, NY

    Disclosures:

    C. Weiss, None

    K. Veltri, None

    Y. Guo, None

    P. Chung, None

    G. Minamoto, None

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