178. Evaluation of Antiretroviral Medication Errors at a University Hospital with High Prevalence of HIV
Session: Poster Abstract Session: ART Prescribing Errors
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
  • Lucy Cheng HAART IDSA poster.pdf (303.9 kB)
  • Background:

    Highly active antiretroviral therapy (HAART) has markedly reduced morbidity and mortality in persons living with human immunodeficiency virus (HIV) (PLWH). Errors in antiretroviral medications are associated with increased drug resistance, treatment failure, and ultimately death. There is a high prevalence of HIV/AIDS (acquired immune deficiency syndrome) in Newark, New Jersey with a total of 14,051 cumulative cases reported as of 2010. At University Hospital, we treat PLWH on a daily basis and often struggle to reconcile their antiretroviral medications.


    A retrospective review of antiretroviral medications administered during admissions from July 1, 2012 to December 31, 2012 was conducted. Medication errors were categorized as incomplete drug regimen, incorrect dosing, differences from documented home medications, and contraindicated drug-drug interactions (proton pump inhibitors and statins). We also categorized medication errors by specialty (medicine, surgery, neurology, obstetrics/gynecology, and psychiatry).


    A total of 334 admissions of PLWH were reviewed during the study period; 157 admissions (47%) had at least one medication error. Of the total 217 medication errors identified, incorrect dosing (including incorrect renal dosing) was the most common error (87 errors, 40%), followed by incomplete drug regimen (55 errors, 25%). The services with the highest rate of medication errors were surgical services (53%), neurology (50%), and medicine (including all admitting subspecialties, 49%). Of note, patients from 151 admissions were followed by University Hospital’s HIV clinic, and these patients had a substantially lower error rate of 25% (p < 0.0001). Medication errors were significantly reduced after an infectious diseases consultation, from 47% to 33% (p < 0.013).


    HAART error rates are substantially high among hospitalized HIV patients in a highly prevalent area despite frequent practice exposure. A significant number of medication errors are corrected after an infectious diseases consultation. Having a dedicated HIV/AIDS service or HAART consultation service could help prevent and reverse these errors.

    Lucy Cheng, MD1, Jason Zucker, MD2, Shin-Pung Jen, PharmD3 and David Cennimo, MD2, (1)Medicine, New Jersey Medical School, Newark, NJ, (2)Medicine and Pediatrics, New Jersey Medical School, Newark, NJ, (3)University Hospital, Newark, NJ


    L. Cheng, None

    J. Zucker, None

    S. P. Jen, None

    D. Cennimo, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.