591. Impact of an Antimicrobial Stewardship (ASP) Initiative Evaluating Antiretroviral Regimens for HIV-Positive Patients

Abstract

BackgroundAdvancements in the development of antiretrovirals (ARVs) have led to reduced HIV-related morbidity and mortality and improved patient adherence. Despite the simplicity of current ARV regimens, medication errors still frequently occur. This study evaluated the impact of an antimicrobial stewardship (ASP) team in identifying and reducing ARV medication errors.MethodsA retrospective study was conducted to evaluate ARV medication errors pre -and post-implementation of an ASP initiative in HIV-positive patients admitted between July 2016 and December 2017. The ASP team consisted of a PGY2 infectious diseases (ID) pharmacy resident and an ID clinical specialist. The ASP intervention occurred upon admission and consisted of a comprehensive ARV review to assess for dosing, drug–drug interaction, and completeness of regimen. The following endpoints were assessed: incidence of errors, classification of errors, and the number of errors detected/corrected.ResultsThree hundred and fifty-six patients were included in the analysis; 153 patients in the pre-intervention group and 203 patients in the post-intervention group. A total of 243 errors were identified in 175 patients; 119 errors (n = 78) in the pre-intervention group and 124 (n = 97) in the post-intervention group. The overall number of errors were stratified by classification: dosing (42/243; 17%), drug–drug interaction (159/243; 66%), and completeness of regimen (42/243; 17%). Drug–drug interactions involving integrase inhibitors and cations were the most frequently occurring medication error in both cohorts. There was a statistically significant difference in errors detected, and subsequently corrected in the pre-intervention group compared with the post-intervention group (12/119 vs. 85/124, P < 0.001). Of the 39 errors that were missed by the ASP team, six were not detected, 12 occurred post-review, and 21 were not accepted by the primary team.ConclusionPharmacists play a vital role in mitigating errors in HIV-infected patients upon hospital admission. However, continuous review throughout the hospital course and at discharge, as well as education of all practitioners, is critical to preventing propagation of errors.Disclosures All authors: No reported disclosures.