176. Antiretroviral Medication Errors in Hospitalized Patients with HIV
Session: Poster Abstract Session: ART Prescribing Errors
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Background: Regimens of highly active antiretroviral therapy (HAART) are often complex in nature and prone to medication errors.  This study evaluated the effect of interventions targeted to reduce HAART- or opportunistic infection (OI)-related medication errors and determine the rate of resolution of these errors.

Methods: Retrospective observational before-after study of patients admitted and prescribed antiretroviral therapy, pre-intervention (pre) 1/1/11 to 10/31/11 and post-intervention (post) 7/1/12 to 12/31/12.  Targeted interventions included pharmacy education, modification of electronic medication drug files, collaboration with the Infectious Diseases (ID) department, and daily medication profile review by ID clinical pharmacy specialist.  Patients treated with lamivudine or tenofovir monotherapy for hepatitis B were excluded.

Results: Pre-intervention 162 admissions; post-intervention 110 admissions.   Rate of medication errors per admission were significantly reduced, 81/162 (50%) pre vs. 37/110 (34%) post (p<0.001).  124 errors occurred in pre group (mean 1.5 per patient) and 43 errors in post group (mean 1.2 per patient).  Most common error types were major drug interactions 26% and dosing 20% in pre group and renal dosing (28%) and OI-related (21%) in post group. A significantly higher error resolution rate was observed in post group (36% vs. 74% p<0.001).  The median time to resolution of errors between the groups was significantly different (180 hrs pre;95% CI: 73.5-258.6 vs 23 hrs post; 95% CI: 5.7-39.3; p<0.001).  After adjustment for potential confounders with logistic regression, the post group was independently associated with fewer medication error occurrence (OR 0.4; 95% CI 0.24-0.80; p=0.006).  Overall, presence of an ID consult demonstrated a significantly higher rate of error resolution compared to no ID consult (32% vs 68% p=0.002).

Conclusion: Multifaceted, multidisciplinary stewardship efforts reduced rate of HAART- or OI-related medication errors and increased overall resolution of errors.  We plan to continue monitoring and enhance these efforts to further reduce the error rate.

Jamie Sanders, PharmD1, Andrea Pallotta, PharmD1, Seth Bauer, PharmD1, Jennifer Sekeres, PharmD1, Ramona Davis, PharmD1, Alan J. Taege, MD2 and Elizabeth A. Neuner, PharmD1, (1)Pharmacy, Cleveland Clinic, Cleveland, OH, (2)Infectious Diseases, Cleveland Clinic, Cleveland, OH

Disclosures:

J. Sanders, None

A. Pallotta, None

S. Bauer, None

J. Sekeres, None

R. Davis, None

A. J. Taege, None

E. A. Neuner, None

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