Antiretroviral Medication Errors Research Articles

Impact of a standardized order set and medication-use process on medication error rates in sexual assault patients presenting to the emergency department for HIV nonoccupational postexposure prophylaxis.

To evaluate the impact of a standardized order set and medication-use process on antiretroviral medication errors in sexual assault (SA) patients presenting to the emergency department (ED) for nonoccupational postexposure prophylaxis (nPEP). In November 2019, a multidisciplinary group collaborated on an initiative to improve the nPEP medication-use process for SA patients presenting to the EDs within a large integrated health system. Electronic medical records of patients 13 years of age or older who presented for SA examination and were prescribed nPEP during the pre- (February 2018-August 2019) and poststandardization (February 2020-August 2021) periods were included. The primary objective was to compare the proportion of patients experiencing a medication error before and after SA/nPEP process standardization. Data regarding the following medication errors were evaluated: incomplete regimen; inappropriate/duplicative regimen; dosing, frequency, or quantity prescribed error; and initiation of nPEP without an HIV test. Two hundred six patients met criteria for inclusion. A higher proportion of patients experienced medication errors in the prestandardization group relative to the poststandardization group (46.5% vs 11.9%, P < 0.001). Fifty-five errors were observed in the prestandardization group, compared to 16 errors in the poststandardization group. The majority of errors in the prestandardization group were directly related to antiretroviral regimens, while the majority of errors in the poststandardization group involved initiation of nPEP without an HIV test. The standardization of the SA/nPEP process was associated with significantly lower medication error rates. Optimization of medication-use technology is an effective strategy in reducing medication errors.

CO129 Pharmacist-Led Medication Review to Reduce Antiretroviral Therapy Errors in HIV/AIDS Patients: A Systematic Review

People with HIV/AIDS (PWHA) frequently encounter antiretroviral (ARV) medication errors. Clinical pharmacists with specialized training in ARV therapy are able to resolve these errors. However, there is less evidence to clarify the impact of clinical pharmacist interventions on medication errors management in PWHA. Therefore, we aim to systematically determine the impact of pharmacist interventions in the management of ARV medications.

Impact of an Antimicrobial Stewardship Team on Reducing Antiretroviral Medication Errors.

Background: Numerous interventions have been used to reduce medication errors related to antiretroviral (ARV) therapy for hospitalized patients with HIV. Objective: This study assessed the impact of an antimicrobial stewardship (ASP) team intervention on reducing the rate of ARV therapy errors in patients admitted to an academic medical center. Methods: This observational, retrospective study included patients who received ARV therapy from June 2016 to December 2017. The primary outcome was evaluation of ASP team performance in detecting ARV medication errors in the inpatient setting. Errors were further categorized by type (interaction, dosing, regimen). The Mann-Whitney U test and χ2 tests were utilized to analyze continuous and categorical data, respectively. Results: Medication errors occurred in 51% of patients in the preintervention group (n = 152) and 48% of patients in the postintervention group (n = 203; P = 0.43). The most frequent medication error type was drug interactions in both groups, involving integrase strand transfer inhibitors and polyvalent cations (64% vs 67%). There was a significant difference between preintervention and postintervention groups regarding number of errors detected (13 vs 106, P < 0.001), corrected (12 vs 86, P < 0.001), and persisting at discharge (106 vs 18, P < 0.001). Conclusion and Relevance: Review of ARV regimens by an ASP team significantly decreased medication errors. Drug interactions are the most common medication error found in HIV-positive patients admitted to our academic center.

Evaluation of human immunodeficiency virus medication errors in a community hospital following the implementation of a pharmacist‐led antiretroviral stewardship program

AbstractIntroductionCombination antiretroviral therapy has greatly improved survivability in people living with human immunodeficiency virus (PLWH); however, medication‐related problems can attenuate virologic suppression and lead to therapeutic failure and drug resistance. The prevalence of antiretroviral (ARV) medication errors in hospitalized PLWH is highly variable, but it is clear that the potential for errors increases with the transition to inpatient care. Pharmacist‐led ARV stewardship programs in large, academic institutions have demonstrated reductions in ARV errors during hospitalizations, but the feasibility of such programs in smaller, community hospitals in the Deep South remains unclear.MethodsWe conducted a retrospective quasi‐experimental study of non‐pregnant, adult PLWH admitted to a community hospital between 2014 and 2018. The primary objective was to compare the percentage of admissions associated with a composite of ARV medication errors (inappropriate regimens, inaccurate dosing, delayed dosing, and major drug‐drug interactions [DDIs]) before and after implementation of an ARV stewardship program.ResultsThe percentage of admissions associated with the primary composite of ARV medication errors decreased by 70% between the pre‐intervention (56 [70%] of 80 admissions) and post‐intervention period (13 [21.3%] of 61 admissions). The percentage of admissions associated with inappropriate ART regimens, major DDIs, and multiple ARV errors all decreased by more than 80%. There was no significant difference in the percentage of admissions associated with renal, non‐renal, or delayed dosing errors despite an overall decrease in error frequency.DiscussionA significant reduction in ARV medication error rates comparable to those reported in similar studies conducted at large, academic institutions was observed. The impact of this innovative pharmacist‐led ARV stewardship program provides additional evidence of the effectiveness of such programs in community hospitals with modest personnel resources.

HIV Pharmacist's Impact on Inpatient Antiretroviral Errors.

Transitions in care between out-patient and in-patient settings provide ample opportunity for medication errors to occur in HIV-infected patients. The purpose of this study was to examine the effectiveness of an HIV pharmacist monitoring service in decreasing antiretroviral medication errors in a large south central teaching hospital in the USA. A retrospective, observational study was conducted to examine the frequency of antiretroviral medication errors in HIV-seropositive patients with hospital admissions between 1 September 2011 and 30 September 2013 at a single tertiary care centre in Oklahoma. Patient assignment to the 12-month pre-intervention and intervention study periods was determined by admission date. Demographic, laboratory, and in-patient medication data were collected. Bivariate analyses were conducted using χ2 analysis with the Yates correction factor for continuity to examine frequencies in specific antiretroviral classes and error categories. A multivariable Poisson regression was employed to examine the frequency of medication errors before and after initiation of the pharmacist service. Medication errors were examined in a total of 330 patient admissions during the 2-year study period. A multivariable-adjusted decrease of 73.9% in the number of errors was observed between the pre-intervention and intervention periods (P < 0.001). Patients on protease inhibitor regimens or with impaired renal function had 2.6-fold and 2.8-fold higher numbers of errors, respectively (P < 0.001). HIV pharmacist monitoring can decrease medication errors in HIV-infected patients as they transition between out-patient and in-patient care. Patients receiving protease inhibitor-based therapy or with renal insufficiency are at higher risk for medication errors upon admission.

Impact of Stewardship Interventions on Antiretroviral Medication Errors in an Urban Medical Center: A 3-Year, Multiphase Study.

There is a high prevalence of HIV infection in Newark, New Jersey, with University Hospital admitting approximately 600 HIV-infected patients per year. Medication errors involving antiretroviral therapy (ART) could significantly affect treatment outcomes. The goal of this study was to evaluate the effectiveness of various stewardship interventions in reducing the prevalence of prescribing errors involving ART. This was a retrospective review of all inpatients receiving ART for HIV treatment during three distinct 6-month intervals over a 3-year period. During the first year, the baseline prevalence of medication errors was determined. During the second year, physician and pharmacist education was provided, and a computerized order entry system with drug information resources and prescribing recommendations was implemented. Prospective audit of ART orders with feedback was conducted in the third year. Analyses and comparisons were made across the three phases of this study. Of the 334 patients with HIV admitted in the first year, 45% had at least one antiretroviral medication error and 38% had uncorrected errors at the time of discharge. After education and computerized order entry, significant reductions in medication error rates were observed compared to baseline rates; 36% of 315 admissions had at least one error and 31% had uncorrected errors at discharge. While the prevalence of antiretroviral errors in year 3 was similar to that of year 2 (37% of 276 admissions), there was a significant decrease in the prevalence of uncorrected errors at discharge (12%) with the use of prospective review and intervention. 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.

Impact of Stewardship Interventions on Antiretroviral Medication Errors in an Urban Medical Center: A Three Year, Multiphase Study

Impact of Stewardship Interventions on Antiretroviral Medication Errors in an Urban Medical Center: A Three Year, Multiphase Study

Evaluation of the occurrence and type of antiretroviral and opportunistic infection medication errors within the inpatient setting

Previous data reports inpatient antiretroviral (ARV) and opportunistic infection (OI) medication errors in as many as 86% of patients, with averages ranging from 1.16-2.7 errors/patient. To determine the occurrence and type of inpatient ARV and OI medication errors at our institution. A retrospective, observational, electronic medical chart review of patients with HIV/AIDS admitted between February 15, 2011- May 22, 2012 was conducted to assess the occurrence and type of ARV and OI medication errors. Secondary outcomes included assessing each medication with an error and evaluating its potential for a medication error, calculating a medication error rate per patient, evaluating whether a non-formulary (NF) medication impacted the error potential, determining whether a clinical pharmacist on service decreased the medication error rate, and assessing whether patients who experienced an error were more likely to have a longer length of stay (LOS). Analysis included descriptive statistics, averages, and Spearmen rank correlation. There were 344 patients included in this analysis, 132 (38%) experienced 190 medication errors (1.44 errors/patient). An omitted order was the most frequent ARV error and accounted for 30% (n=57) of total errors. There were 166 patients requiring OI medications, 37 patients experienced 39 medication errors. Omitting OI prophylaxis accounted for 31 errors. Only 45 of 190 (24%) errors were corrected prior to discharge. Being prescribed at least 1 NF medication was correlated with increased errors (n=193 patients "on NF medication", p<0.025, r=0.12). Coverage of a service by a clinical pharmacist did not affect the number of errors. Patients experiencing an error had a longer LOS (p=0.02). Errors relating to ARV and OI medications are frequent in HIV-infected inpatients. More errors occurred in patients receiving NF medications. Suggested interventions include formulary revision, education, and training. Dedicated HIV clinicians with adequate training and credentialing may improve the management of this specialized disease state.

Antimicrobial Stewardship Program to Reduce Antiretroviral Medication Errors in Hospitalized Patients with Human Immunodeficiency Virus Infection

Evaluate antimicrobial stewardship interventions targeted to reduce highly active antiretroviral therapy (HAART)- or opportunistic infection (OI)-related medication errors and increase error resolution. Retrospective before-after study. Academic medical center. Inpatients who were prescribed antiretroviral therapy before the intervention (January 1, 2011, to October 31, 2011) and after the intervention (July 1, 2012, to December 31, 2012). Patients treated with lamivudine or tenofovir monotherapy for hepatitis B were excluded. Antimicrobial stewardship interventions included education, modification of electronic medication records, collaboration with the infectious diseases (ID) department, and prospective audit and review of HAART and OI regimens by an ID clinical pharmacist. Data for 162 admissions from the preintervention period and 110 admissions from the postintervention period were included. The number of admissions with a medication error was significantly reduced after the intervention (81 [50%] of 162 admissions vs 37 (34%) of 110 admissions; P < .00)1. A total of 124 errors occurred in the preintervention group (mean no. of errors, 1.5 per admission), and 43 errors occurred in the postintervention group (mean no. of errors, 1.2 per admission). The most common error types were major drug interactions and dosing in the preintervention group and renal adjustment and OI-related errors in the postintervention group. A significantly higher error resolution rate was observed in the postintervention group (36% vs 74%; P < .001). After adjustment for potential confounders with logistic regression, admission in the postintervention group was independently associated with fewer medication errors (odds ratio, 0.4 [95% confidence interval, 0.24-0.77]; P = .005). Overall, presence of an ID consultant demonstrated a higher error resolution rate (32% without a consultation vs 68% with a consultation; P = .002). Multifaceted, multidisciplinary stewardship efforts reduced the rate and increased the overall resolution of HAART-related medication errors.

In-hospital antiretroviral medication errors common

In-hospital antiretroviral medication errors common

In-hospital antiretroviral medication errors common

In-hospital antiretroviral medication errors common

Impact of outpatient electronic medical record on antiretroviral errors among hospitalized patients

Inappropriate antiretroviral therapy puts patients infected with human immunodeficiency virus (HIV) at high risk for toxicities and the development of drug-resistant virus. While multiple studies have found high rates of antiretroviral medication errors among hospitalized patients infected with HIV

Reply to Holtzman and Gallagher

To The Editor—We thank Holtzman and Gallagher for their interest in our work [1]. Consistent with our study, which identified antiretroviral (ARV) medication errors in 29% of admissions during the first hospital day [2], they report an error rate of 26% among hospitalized human immunodeficiency virus (HIV)–infected patients prescribed ARV medications at Temple University Hospital in Philadelphia, PA [1]. We would like to clarify a misunderstanding by Holtzman and Gallagher of our study methods. As we stated in the methods section of our paper, our study was a retrospective review of ARV medication errors, and not an evaluation of a pharmacist intervention [2]. Two clinical pharmacists retrospectively reviewed medical orders to identify ARV medication errors for study purposes, and were not present in real time to identify and correct medication errors. At Johns Hopkins Hospital, the HIV/AIDS service has a specialized clinical pharmacist who reviews all medications administered on the prior day. However, our study included not only patients admitted to the HIV/AIDS service, but also those admitted to medicine, surgery, obstetrics and gynecology, neurology, and psychiatry. These other services do not routinely include pharmacists on the rounding team. Since we did not specifically evaluate a clinical pharmacist intervention on medication orders, we offered clinical pharmacy review of medication orders as a possible reason for the decline in errors on the second day of hospitalization for two reasons: (1) prior studies have demonstrated the efficacy of clinical pharmacists in decreasing ARV medication errors [3], and (2) 64% of our study patients were admitted to the HIV/AIDS service, which has a dedicated HIV clinical pharmacist. Other interventions, both educational and technological, may also be important to correcting ARV medication errors that occur early in hospitalization.

Antiretroviral Medication Errors among Hospitalized HIV-Infected Adults

Antiretroviral Medication Errors among Hospitalized HIV-Infected Adults

Antiretroviral medication errors remain high but are quickly corrected among hospitalized HIV-infected adults.

Antiretroviral therapy (ART) medication errors can lead to drug resistance, treatment failure, and death. Prior research suggests that ART medication errors are on the rise in US hospitals. This analysis provides a current estimate of inpatient antiretroviral prescribing errors. Retrospective review of medication orders during the first 48 hours of hospitalization for patients with human immunodeficiency virus (HIV) infection admitted to the Johns Hopkins Hospital between 1 January and 31 December 2009. Errors were classified as (1) incomplete regimen, (2) incorrect dosage, (3) incorrect schedule, and (4) nonrecommended drug-drug combinations. Multivariable regression was used to identify factors associated with errors. A total of 702 admissions occurred in 2009. Of these, 380 had ART medications prescribed on the first day and 308 on the second day of hospitalization. A total of 145 ART medication errors in 110 admissions were identified on the first day (29%), and 22 errors were identified in 21 admissions on the second day (7%). The most common errors were incomplete regimen and incorrect dosage or schedule. Protease inhibitors accounted for the majority of dosing and scheduling errors (71%-73%). Compared with patients admitted to the HIV/AIDS service, those admitted to surgical services were at increased risk of errors (adjusted odds ratio, 3.10; 95% confidence interval, 1.18-8.18). ART medication errors are common among hospitalized HIV-infected patients on the first day of admission, but most are corrected within 48 hours. Interventions are needed to safeguard patients and prevent serious complications of ART medication errors especially during the first 24 hours of hospitalization.

Identification and Prevention of Antiretroviral Medication Errors at an Academic Medical Center

Background Patients with human immunodeficiency virus (HIV) taking antiretroviral therapy are at an increased risk for medication-related problems when transitioning into the inpatient setting. Methodology A retrospective chart review was used to find common highly active antiretroviral therapy (HAART)-related medication problems for 50 adult and pediatric patients who were admitted during the calendar year 2007 with a diagnosis of HIV at a 478-bed academic medical center. The results from the retrospective review were used to design a pilot program that consisted of a pharmacist making interventions when potential medication-related problems were identified. Data were collected after implementation of the program to assess whether this corrective measure decreased medication concerns associated with HAART. Results Results from the retrospective review revealed that 24% of patients did not have a complete home medication list on admission. HAART was discontinued in 21 patients (42%) and, of these, 14 patients (67%) did not have an appropriate reason documented. Antiretroviral medications were not appropriately dosed and scheduled for 18% of patients. For patients managed by the pilot program, the documentation of home medication lists improved by 24% and matching inpatient orders to the patient's home regimens improved by 26%. Only 9% of the HIV patients admitted had their medications discontinued for more than 24 hours, and all of those patients had an appropriate reason documented. The rate at which antiretroviral medications were appropriately dosed and scheduled increased by 21%. Conclusion Pharmacists can play a vital role in reducing medication errors for HIV patients admitted to the hospital.

Factors Associated With Antiretroviral Therapy Adherence and Medication Errors Among HIV-Infected Injection Drug Users

Active drug use is often associated with poor adherence, but few studies have determined psychosocial correlates of adherence in injection drug users (IDUs). Of 1161 Intervention for Seropositive Injectors-Research and Evaluation study enrollees, 636 were taking antiretrovirals. We assessed self-reported adherence to self-reported antiretroviral regimens and medication errors, which we defined as daily doses that were inconsistent with standard or alternative antiretroviral prescriptions. Most subjects (75%, n=477) self-reported good (>or=90%) adherence, which was strongly associated with an undetectable viral load. Good adherence was independently associated with being a high school graduate, not sharing injection equipment, fewer depressive symptoms, positive attitudes toward antiretrovirals, higher self-efficacy for taking antiretrovirals as prescribed, and greater sense of responsibility to protect others from HIV. Medication errors were made by 54% (n=346) and were strongly associated with a detectable viral load and fewer CD4 cells. Errors were independently associated with nonwhite race and with depressive symptoms, poorer self-efficacy for safer drug use, and worse attitudes toward HIV medications. Modifiable factors associated with poor adherence, including depressive symptoms and poor self-efficacy, should be targeted for intervention. Because medication errors are prevalent and associated with a detectable viral load and fewer CD4 cells, interventions should include particular efforts to identify medication taking inconsistent with antiretroviral prescriptions.

ARV Medication Errors: Experience of a Community-Based HIV Specialty Clinic and Review of the Literature

ObjectiveTo describe antiretroviral (ARV) medication errors reported within a community Human Immunodeficiency Virus (HIV) clinic, identify potential strategies to prevent errors, and review the literature pertaining to ARV medication errors.DesignReview of voluntarily reported ARV errors. Errors were classified using the National Coordinating Council for Medication Error Reporting and Prevention (NCC-MERP) Index. The clinic's medication distribution process was also analyzed.SettingCommunity-based clinic with HIV-experienced clinicians in an urban setting.ResultsThirty-seven errors were reported over 3 years; 81.1% of these were classified as NCC-MERP category C. Most errors resulted from lapses in clinic and pharmacy systems of care (n = 21). Pharmacy and clinic prescribing errors were less (n = 11).ConclusionARV medication errors were notable. Changes in drug distribution and prescribing processes may reduce future ARV medication errors.

Renal consequences of HIV and HIV therapy

To highlight the latest data documenting new concerns about renal function in HIV-infected patients, with regard to acute renal failure with its known burden of mortality and prolonged hospitalization, antiretroviral medication errors potentially enhancing the risk of the emergence of viral resistance, outcome of HIV dialysis patients, and renal involvement in the immune restoration inflammatory syndrome. The incidence of acute renal failure in HIV-infected patients is increasing, secondary to ageing, chronic kidney disease and liver disease. Histological documentation is critical for the best diagnosis. Antiretroviral medication errors are very frequently encountered in HIV-infected patients, which may be associated with decreased survival as a result of the under/over-prescription of highly active antiretroviral therapy in chronic kidney disease or end-stage renal disease. Evaluating the glomerular filtration rate with plasma creatinine and one of the validated formulae is critical in HIV-infected patients to determine the optimum follow-up strategy and critical therapeutic measures, such as drug dosage adaptation. High-risk radiological diagnostic procedures or potentially nephrotoxic drugs should be used with caution. These measures should reduce the rate of progression of chronic kidney disease. Increasing numbers of dialysed HIV-infected patients emphasize the need for the better coordination of care.

Antiretroviral Medication Errors among Hospitalized Patients with HIV Infection

Highly active antiretroviral therapy (HAART) has improved survival for persons living with human immunodeficiency virus (HIV) infection. However, effective therapy requires high levels of adherence over extended periods of time. Previous studies suggest that patients receiving long-term medication are at risk for unintended medication discrepancies at the time of hospital admission. We retrospectively identified every HIV-infected patient admitted to our hospital over a 1-year period who received an antiretroviral agent. We collected information on medications and renal function from the hospital computerized provider order entry system. We reviewed the medical records for those admissions for which a potential error was identified. We defined errors using Department of Health and Human Services guidelines and included only those errors that were not corrected within 24 h after initial entry. There were a total of 209 admissions during a 1-year period in which an HIV-infected patient received antiretroviral therapy. After review of the medical records for 77 admissions with a potential error, 61 uncorrected errors from 54 admissions were identified (percentage of total admissions, 25.8%; 95% confidence interval, 20.1%-32.3%). The most common type of error was an error with respect to the amount or frequency of dosage, which occurred in 34 (16.3%) of the admissions; 18 of these errors were attributable to failure to appropriately adjust dosage for renal insufficiency. The next most common error was combining antiretroviral drugs with a contraindicated medication; this occurred in 12 (5.2%) of the admissions. Patients erroneously received <or=2 antiretroviral agents in 8 (3.8%) of the admissions and had an unexplained delay in continuing HAART in 7 (3.3%). HIV-infected patients receiving HAART are at substantial risk for antiretroviral medication errors at the time of hospitalization. More needs to be done to ensure that these patients receive appropriate therapy during their inpatient stay.