SAN DIEGO – Half of all HIV-positive inpatients experience antiretroviral medication errors during their stay, and these errors often go undetected and uncorrected, suggest a pair of studies reported in poster sessions at IDWeek 2012.
In the first study, a team led by Elizabeth A. Neuner, Pharm.D., of the Cleveland Clinic reviewed the electronic medical records of 162 HIV-positive adults admitted to the hospital during a 10-month period.
Dr. Elizabeth A. Neuner, of the Cleveland Clinic in Cleveland, Ohio
During a median hospital stay of 4 days, there were 126 medication errors, for a rate of 1.6 errors per admission. On a per-patient basis, 50% of patients had at least one medication error.
The most common medication errors were major drug interactions (26%), incorrect dosing (20%), and interactions involving contraindicated medications (12%).
Fully 65% of the errors were neither detected nor corrected during the patient’s stay, according to Dr. Neuner. Errors were significantly more likely to be detected and resolved if an infectious disease physician was consulted on the case (47% vs. 15%, P = .002), "so I think getting an ID consult can help with the resolution rate," she commented in an interview.
"We have focused a lot on quality improvement efforts in the hospital to try to reduce the number of errors that happen and also improve the resolution rate," she said. "It has really been a multidisciplinary approach. We have focused on education and transitions of care. We updated our electronic medication files to include common dose buttons and dose frequencies and removed buttons and frequencies that weren’t relevant anymore. And we have been doing some stewardship efforts in collaboration with the infectious disease physicians."
In the second study, a team led by Natasha N. Pettit, Pharm.D., of the University of Chicago began a program to evaluate the highly active antiretroviral therapy (HAART) regimens of HIV-positive inpatients within 12-24 hours of hospital admission or initiation of HAART regimens.
Given their complexity, "HAART regimens have a high potential for drug-drug interactions, adverse drug events, and dosing errors. Missed doses or inadvertent changes in therapy can quickly lead to resistance or toxicity," Dr. Pettit said in an interview.
Among the 155 patients whose regimens were evaluated in a 17-month period, 49% had a regimen containing some kind of error. Of these patients, 47% were errors related to drug dosage and 6% were related to drug interactions.
Protease inhibitors were significantly more often associated with errors, compared with other classes of antiretroviral medications, she said.
Interventions at or prior to the point of order entry, including providing resources to prescribers who may be less familiar with HAART regimens, can give some guidance while physicians are entering orders for these complex regimens, Dr. Pettit said. A process for reconciliation of HAART regimens before orders are placed also is recommended.
IDWeek is the combined annual meeting of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.
Dr. Neuner and Dr. Pettit disclosed no relevant conflicts of interest.