Program Schedule

1557
Impact of HIV Pharmacist Reconcilation on Correction of Antiretroviral Prescription Errors Among Hospitalized HIV-Infected Patients

Session: Poster Abstract Session: HIV Treatment: Outcomes, Adherence, and Toxicities
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • HIVMedErrors IDSA.JPG (1.0 MB)
  • Background: Antiretroviral therapy (ART) prescribing errors are common in hospitalized HIV-infected patients, which may cause patient harm and increase healthcare-associated costs. Previously, we retrospectively reviewed admissions from 2009-2011 and found a 35.1% error rate in ART prescribing, 35% of which were corrected within 24 hs. Subsequently, we developed a medication reconciliation process with an HIV pharmacist, and our institution implemented a unified electronic medical record (EMR).

    Methods: We prospectively reviewed the medical records of HIV-infected patients admitted to the hospital for >24 hs between 3/9/2013 - 3/10/2014. An HIV pharmacist reconciled outpatient ART prescriptions with inpatient orders within 24 hs of admission. Errors were classified as omission; wrong drug; incorrect dose; drug-drug interactions (DDIs); and incorrect scheduling. Time to error correction was recorded. Error rates were compared to our retrospective evaluation and relative risks (RR) calculated.  Logistic regression models were used to compare error rate with use of EMR, and proportion of errors corrected at 24 hs with prospective HIV pharmacist intervention, both compared to historical data.

    Results: In 186 admissions for 105 patients, we identified 43 medication errors in 31 admissions (16.7%). The most common error was incorrect scheduling (42%), followed by drug omission and DDIs. All identified errors were corrected, 65% within 24 hs and 81.4% in 48 hs. Using a unified EMR decreased the risk of error occurrence compared to not using a unified system (RR 0.47, 95% CI: 0.34, 0.67).  Logistic regression adjusting for gender and race found that errors were 61% less likely to occur using the EMR (95% CI: 40%-75%; p<0.001). The second model, after adjusting for gender, race and total number of errors, found that errors were 9.4 times more likely to be corrected within 24 hs with pharmacist intervention (p<0.001).

    Conclusion: Use of an EMR decreased the error rate by more than 50% but the HIV pharmacist intervention was key to timely error correction. Two thirds of errors were corrected within 24 hs and no error was left uncorrected. Even with the implementation of an EMR, ART errors were common, but prospective HIV pharmacist intervention enabled rapid correction.

    Rishi Batra, BS1, Jane Wolbach-Lowes, PharmD2,3, Susan Swindells, MBBS3, Kimberly Scarsi, PharmD2,3, Anthony Podany, PharmD2, Harlan Sayles, MS4 and Uriel Sandkovsky, MD, FACP3, (1)College of Medicine, University of Nebraska Medical Center, Omaha, NE, (2)College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, (3)Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, (4)College of Public Health, University of Nebraska Medical Center, Omaha, NE

    Disclosures:

    R. Batra, None

    J. Wolbach-Lowes, None

    S. Swindells, None

    K. Scarsi, None

    A. Podany, None

    H. Sayles, None

    U. Sandkovsky, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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