Quality Improvement of Antiretroviral Therapy Errors at University Hospital
University Hospital has more than 600 admissions of people living with Human Immunodeficiency Virus (PLWH) yearly. In an earlier study of antiretroviral therapy (ART) error, nearly half of PLWH admissions had at least one medication error, which could lead to increased drug resistance and treatment failure. Several interventions were introduced to reduce this high error rate including: physician and pharmacy education, utilization of computerized provider order management (CPOM) and ordering instructions and drug reference links in CPOM. This analysis evaluated the current state of medication errors after the implementation of these interventions.
A retrospective review of PLWH on ART administered during admissions from July 1, 2013 to December 31, 2013 was conducted. Medication errors were categorized as incomplete drug regimen, incorrect drug dosing, mismatched home ART (in HIV clinic patients whose records were available), and contraindicated drug-drug interactions. We also categorized medication errors by admitting specialty. The methodology was unchanged from our earlier study.
A total of 315 admissions of PLWH were reviewed. Of these, 115 admissions (37%) had at least one medication error, an 18% relative error reduction. Of the 158 errors identified, incorrect drug dosing was the most common error (34%), followed by incomplete drug regimen (28%). Of note, there was a significant increase in co-administration of high dose histamine type 2 blockers and atazanavir (170% increase). Patients followed in the HIV clinic had similar ART error rates while inpatient as our prior study. Although, ART errors were again significantly reduced by infectious diseases (ID) consultation; the overall error rate reduction did not significantly change after these interventions. Again, surgical and medical services had the highest ART errors.
Overall, interventions such as additional education and guidelines can aid in reducing ART errors but they are not sufficient to eliminate them entirely. A more comprehensive approach is needed to prevent and reverse the detrimental consequences of ART errors in this community with such a high prevalence of HIV. We propose a dedicated infectious diseases and/or pharmacy stewardship that review ART on a daily basis.
J. Zucker, None
S. P. Jen, None
D. Cennimo, None
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