179. Antiretroviral Therapy Prescribing Errors in a Cohort of HIV Clinic Patients Hospitalized at a Tertiary Academic Hospital in Central Massachusetts
Session: Poster Abstract Session: ART Prescribing Errors
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • 179_IDWPOSTER.pdf (452.8 kB)
  • Background: Antiretroviral therapy (ART) prescribing errors in the HIV inpatient setting have been on the rise with potential to cause deleterious health effects including failure to maintain treatment regimen, development of viral resistance, drug-drug interaction, adverse reactions, and patient injury. The novelty of these drugs plus the complexity of the regimens may contribute to errors. To facilitate correcting actions we aim to determine the frequency and type of errors, along with the risk factors that lead to these errors prior to the initiation of computerized physician order entry (CPOE).

    Methods: We performed a retrospective chart review study of all HIV clinic patients admitted to UMASS Memorial Health Center (UMMHC) in Worcester, MA between January 1 and December 31, 2012. UMMHC has two major campuses: A and B. We analyzed ART prescriptions using medication administration records and classified errors by type. Generalized estimating equations (GEE) were used to compute multivariate analyses, with each patient being the clustering unit.

    Results: In 2012, there were 112 admissions among 69 eligible HIV positive individuals with 422 unique ART orders. A total 64% were females, 49% were non-Hispanic Whites, 64% had a CD4 count of >200, 91% had viral load ≤75, and 62% had GFR ≥60. Most patients were admitted to the internal medicine/non-ID service (85%) and to the B campus (59%). The mean length of stay was 5.4 days. A total of 124 (28.3%) ART errors were identified. Errors were classified as incomplete regimen (35%), non-recommended drug-drug combinations (24%), incorrect schedule (22%), and incomplete dosage (19%). Significantly lower errors were seen when prescribing integrase inhibitors (OR=0.30, p-value=0.01). There was a trend for lower ART errors in patients hospitalized at the B campus (OR=0.53, p-value=0.06) or with viral load >75 (OR=0.48, p-value=0.08). A higher trend for ART errors was seen in patients with GFR <60 (OR=1.7, p-value=0.07), but these differences were not significant.

    Conclusion: Errors in prescribing ART in our hospital were common. Understanding the nature of these errors can lead to protocols designed to reduce them, particularly with the impending initiation of CPOE. HIV consultation may be warranted for hospitalized patients on ART due to complexity of medication regimens.

    Adam Brady, MD1, Nisha Kini, MPH2, Bruce Barton, PhD2 and Mireya Wessolossky, MD, MPH3, (1)Department of Medicine, University of Massachusetts Medical School, Worcester, MA, (2)Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, (3)Division of Infectious Disease and Immunology, University of Massachusetts Medical School, Worcester, MA

    Disclosures:

    A. Brady, None

    N. Kini, None

    B. Barton, None

    M. Wessolossky, None

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