Main Article Content
Pharmacy Service, Hospital, Pharmacists, Medication Errors, Quality Improvement, Anti-Retroviral Agents, Acquired Immunodeficiency Syndrome, HIV Infections, Inpatients, Historically Controlled Study, Illinois
Background: Based on a retrospective study performed at our institution, 38% of inpatients living with human immunodeficiency virus (HIV) were found to have a medication error involving their anti-retroviral (ARV) and/or opportunistic infection (OI) prophylaxis medications.
Objective: To determine the impact of a dedicated HIV-trained clinical pharmacist on the ARV and OI prophylaxis medication error rates at our institution.
Methods: A prospective quality improvement project was conducted over a six month period to assess the impact of a dedicated HIV-trained clinical pharmacist on the ARV and OI prophylaxis medication error rates. IRB approval received.
Results: There were 144 patients included in this analysis, who experienced a combined 76 medication errors. Compared to historical control study conducted at our institution, the percent of patients who experienced a medication error remained stable (38% vs. 39%, respectively) and the error rate per patient was similar (1.44 vs. 1.36, p=NS). The percent of medication errors that were corrected prior to discharge increased from 24% to 70% and the median time to error correction decreased from 42 hours to 11.5 hours (p<0.0001).
Conclusions: Errors relating to ARV or OI prophylaxis medications remain frequent in inpatient people living with HIV/AIDS. After multiple interventions were implemented, ARV and OI prophylaxis medication errors were corrected faster and with greater frequency prior to discharge, however, similar rates of errors for patients existed. Dedicated HIV clinicians with adequate training and credentialing are necessary to manage this specialized disease state and to reduce the overall number of medication errors associated with HIV/AIDS.
2. Snyder AM, Klinker K, Orrick JJ, Janelle J, Winterstein AG. An in-depth analysis of medication errors in hospitalized patients with HIV. Ann Pharmacother. 2011;45(4):459-468. https://doi.org/10.1345/aph.1P599
3. Pastakia SD, Corbett AH, Raasch RH, Napravnik S, Correll TA. Frequency of HIV-related medication errors and associated risk factors in hospitalized patients. Ann Pharmacother. 2008;42(4):491-497. https://doi.org/10.1345/aph.1K547
4. Mok S, Minson Q. Drug-related problems in hospitalized patients with HIV infection. Am J Health Syst Pharm. 2008;65(1):55-59. https://doi.org/10.2146/ajhp070011
5. Rao N, Patel V, Grigoriu A, Kaushik P, Brizuela M. Antiretroviral therapy prescribing in hospitalized HIV clinic patients. HIV Med. 2012;13(6):367-371. https://doi.org/10.1111/j.1468-1293.2011.00977.x
6. Purdy BD, Raymond AM, Lesar TS. Antiretroviral prescribing errors in hospitalized patients. Ann Pharmacother. 2000;34(7-8):833-838. https://doi.org/10.1345/aph.19399
7. Rastegar DA, Knight AM, Monolakis JS. Antiretroviral medication errors among hospitalized patients with HIV infection. Clin Infect Dis. 2006;43(7):933-938. https://doi.org/10.1086/507538
8. Corrigan MA, Atkinson KM, Sha BE, Crank CW. Evaluation of pharmacy-implemented medication reconciliation directed at antiretroviral therapy in hospitalized HIV/AIDS patients. Ann Pharmacother. 2010;44(1):222-223. https://doi.org/10.1345/aph.1M052
9. Chiampas TD, Kim H, Badowski M. Evaluation of the occurrence and type of antiretroviral and opportunistic infection medication errors within the inpatient setting. Pharm Pract (Granada). 2015;13(1):512. https://doi.org/10.18549/pharmpract.2015.01.512
10. Micromedex Healthcare Series. DRUGDEX System. Greenwood Village, CO: Truven Health Analytics, 2013. http://www.thomsonhc.com/
11. Harris AH, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) – A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-381. https://doi.org/10.1016/j.jbi.2008.08.010
12. Heelon M, Skiest D, Tereso G, Meade L, Weeks J, Pekow P, Rothberg MB. Effect of a clinical pharmacist’s interventions on duration of antiretroviral-related errors in hospitalized patients. Am J Health Syst Pharm. 2007;64(19):2064-2068. https://doi.org/10.2146/ajhp070072
13. Daniels LM, Raasch RH, Corbett AH. Implementation of targeted interventions to decrease antiretroviral-related errors in hospitalized patients. Am J Health Syst Pharm. 2012;69(5):422-430. https://doi.org/10.2146/ajhp110172
14. Liedtke MD, Tomlin CR, Skrepnek GH, Farmer KC, Johnson PN, Rathbun RC. HIV Pharmacist’s Impact on Inpatient Antiretroviral Errors. HIV Med 2016 Nov;17(10):717-723. https://doi.org/10.1111/hiv.12375
15. Eginger KH, Yarborough LL, Inge LD, Basile SA, Floresca D, Aaronson PM. Medication errors in HIV-infected hospitalized patients: a pharmacist’s impact. Ann Pharmacother. 2013;47(7-8):953-960. https://doi.org/10.1345/aph.1R773
16. Carcelero E, Tuset M, Martin M, De Lazzari E, Codina C, Miró J, Gatell J. Evaluation of antiretroviral-related errors and interventions by the clinical pharmacist in hospitalized HIV-infected patients. HIV Med. 2011;12(8):494-499. https://doi.org/10.1111/j.1468-1293.2011.00915.x