Advancements in antiretroviral therapy (ART) have led to reductions in morbidity and mortality among people living with HIV (PLWH). In the inpatient setting, the potential for medication errors with ART is high given the number of drugs required, the use of concomitant medications for other conditions and changes in clinical status. These medication errors place inpatient PLWH at risk for drug toxicity, virologic failure and drug resistance. This study evaluates the impact of various stewardship interventions in reducing ART-related medication errors in an inpatient setting.
A retrospective review of admitted patients receiving ART during three distinct 6-month phases over three years was conducted. During Phase 1, baseline prevalence of medication errors was determined. During Phase 2, physician and pharmacist education was provided and computerized order entry implemented. Prospective audit of ART with feedback was conducted in Phase 3. Medication errors were categorized as incorrect drug regimens, incorrect dosing, contraindicated drug-drug interactions and incorrect medication reconciliation in admitted HIV clinic patients. Admitting service and presence of Infectious Diseases (ID) consultation were also recorded.
In Phase 1, 45% of 334 admissions had at least one ART error; 38% had errors at discharge. In Phase 2, 36% of 315 admissions had at least one error (p = 0.015 compared to Phase 1); 31% had errors at discharge (p = 0.039). While the prevalence of errors in Phase 3 was similar to Phase 2 on admission (36% vs. 37%, respectively, p = 0.384), there was a significant decrease in errors at discharge (31% vs. 12%, p < 0.00001) following implementation of prospective audit and feedback. Incorrect dosing was the most frequently occurring error in all three phases. The rates of errors in patients with ID consultation were similar to the overall error rates.
Despite the availability of well-established guidelines, medication errors with ART remain of clinical concern. Interventions, such as education and guideline development, can aid in reducing ART medication errors, but a committed stewardship program is necessary to elicit the greatest impact in error reduction.
S. P. Jen, None
D. Cennimo, None
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