Evaluation of Anti-Tuberculosis Medication Errors at an Urban University Hospital
Combination therapy with Isoniazid, a Rifamycin, Pyrazinamide and Ethambutol is the standard of care for active tuberculosis (TB) treatment. Errors in medication administration could lead to inadvertent underdosing and resistance development, or significant side effects with overdosing. Given the recent nationwide focus on medication errors we attempted to establish the incidence of TB medication errors at University Hospital in Newark, NJ, a community with a relatively high prevalence of TB compared with the rest of the United States.
A retrospective review of anti-TB medications prescribed during admissions between July 2010 - June 2013 was conducted at University Hospital in Newark, NJ. Data was compared to the 2003 CDC guidelines for TB management. Medication errors were classified as improper drug regimen, incorrect dosing, incorrect medication adjustment for kidney and liver dysfunction and errors associated with concomitant highly active anti-retroviral therapy (HAART) use. We also categorized errors by consulting and admitting service at time of initiation.
A total of 72 admissions withsuspected, active TB were reviewed during the study period. 42 admissions (58%) had at least one error. Of the 63 total errors identified, the most common errors involved incorrect dosing of pyrazinamide (45%) followed by Ethambutol (25%). Of the 19 patients on concomitant HAART therapy, 37% were dosed incorrectly. Of the three patients in our study with creatinine clearance < 30 ml/min, not one had appropriate renal dosing. Medication error rate was not significantly different whether the patient had an Infectious Disease (ID) consult (63.6%), a Pulmonology consult (57.4%), or both (61.3%).
TB medication error rates are high among inpatients with suspected active TB despite frequent practice exposure. While this is the first recent study to evaluate inpatient anti-TB medication errors, our findings are consistent with those seen in studies of HIV medication errors at this institution and nationwide. The development of certain interventions, such as EMR reminders or mandatory pharmacist consults, could potentially reduce this error rate in the future.
J. Zucker, None
S. P. Jen, None
D. Cennimo, None
A. Patrawalla, None