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Chastain DB, Curtis J, Tang E, Young HN, Ladak AF. ART-related medication errors in hospitalized people with HIV in the INSTI-era: analysis from 2 health systems in South Georgia, U.S. AIDS Care 2024; 36:832-839. [PMID: 37614179 DOI: 10.1080/09540121.2023.2248564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 08/11/2023] [Indexed: 08/25/2023]
Abstract
ABSTRACTART-related medication errors occur at high rates in hospitalized people with HIV (PWH), but few studies included modern regimens. As such, we evaluated ART-related medication errors in hospitalized PWH in an era where use of INSTI-based regimens dominate. This multi-center, retrospective cohort included PWH at least 18 years hospitalized in South Georgia, U.S. between March 2016 and March 2018. Of those eligible for inclusion, 400 were randomly selected and included. Three hundred sixty-three inpatient ART-related medication errors occurred in 203 patients during the study period due to incorrect scheduling (44%), an incorrect or incomplete regimen (27%), and drug-drug interactions (27%). Approximately 25% of errors persisted to discharge. Medication errors were more likely to occur in patients receiving NNRTI- or PI-containing multi-tablet regimens, whereas those receiving INSTI-containing multi-tablet regimens were less likely to experience a medication error. ART-related medication errors are less likely in patients receiving INSTI-containing multi-tablet regimens. Ensuring appropriate transition of ART throughout hospitalization remains an area in need of significant improvement.
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Affiliation(s)
- Daniel B Chastain
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Albany, GA, USA
| | - Jessica Curtis
- Department of Pharmacy, Geisinger Medical Center, Danville, PA, USA
| | - Emily Tang
- Department of Pharmacy, NewYork-Presbyterian Hospital Enterprise, New York, NY, USA
| | - Henry N Young
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Athens, GA, USA
| | - Amber F Ladak
- Department of Medicine, Division of Infectious Disease, Augusta University, Augusta, GA, USA
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2
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Bernard GB, Montalvo S, Ivancic S, Eckardt P, Kehn-Yao Poon K, Parmar J, Sherman EM, Andrade DC. Implementation of a pharmacist-led ARVSP in an academic hospital to reduce ART errors. J Am Pharm Assoc (2003) 2022; 62:S47-S52. [DOI: 10.1016/j.japh.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/05/2021] [Indexed: 10/18/2022]
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Bernard GB, Montalvo S, Ivancic S, Eckardt P, Kehn-Yao Poon K, Parmar J, Sherman EM, Andrade DC. Implementation of a pharmacist-led ARVSP in an academic hospital to reduce ART errors. J Am Pharm Assoc (2003) 2021; 62:264-269. [PMID: 34474965 DOI: 10.1016/j.japh.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/30/2021] [Accepted: 08/05/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The primary objective was to compare the percentage of Antiretroviral Therapy (ART) uncorrected errors during hospital admission before and after the implementation of an Antiretroviral Stewardship Program (ARVSP). PRACTICE DESCRIPTION This was a 2-year single-center, pre-post quality improvement study. Included in the study were admitted patients at least 18 years of age, diagnosed with human immunodeficiency virus (HIV), and taking at least 1 antiretroviral. The baseline percentage of uncorrected ARV errors was retrospectively determined during the first year. The second year consisted of implementing an ARVSP that prospectively audited ART orders. The ARVSP consisted of a pharmacy resident, a medical resident, an infectious disease, HIV trained pharmacist, an infectious disease physician, and ancillary health care providers. The impact of the ARVSP was assessed by comparing the percentage of uncorrected errors between the 2 time periods. RESULTS The number of uncorrected errors were 64.1% versus 31.1% before and after ARVSP implementation, respectively (P < 0.05). Delay in therapy errors were statistically significantly reduced (30.1% vs. 22.2%; P < 0.05). The time to overall correction of any error before ARVSP was 3.1 days, and after ARVSP, it was 1.8 days (P = 0.11). CONCLUSION Implementation of an ARVSP reduces the number of uncorrected antiretroviral-related errors. Because health care resources are finite and focused on the acute care of hospitalized patients, this multidisciplinary practice model may provide a practical approach for similar institutions to improve antiretroviral stewardship surveillance in the inpatient setting.
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Gates PJ, Hardie RA, Raban MZ, Li L, Westbrook JI. How effective are electronic medication systems in reducing medication error rates and associated harm among hospital inpatients? A systematic review and meta-analysis. J Am Med Inform Assoc 2021; 28:167-176. [PMID: 33164058 PMCID: PMC7810459 DOI: 10.1093/jamia/ocaa230] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 09/07/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis to assess: 1) changes in medication error rates and associated patient harm following electronic medication system (EMS) implementation; and 2) evidence of system-related medication errors facilitated by the use of an EMS. MATERIALS AND METHODS We searched Medline, Scopus, Embase, and CINAHL for studies published between January 2005 and March 2019, comparing medication errors rates with or without assessments of related harm (actual or potential) before and after EMS implementation. EMS was defined as a computer-based system enabling the prescribing, supply, and/or administration of medicines. Study quality was assessed. RESULTS There was substantial heterogeneity in outcomes of the 18 included studies. Only 2 were strong quality. Meta-analysis of 5 studies reporting change in actual harm post-EMS showed no reduced risk (RR: 1.22, 95% CI: 0.18-8.38, P = .8) and meta-analysis of 3 studies reporting change in administration errors found a significant reduction in error rates (RR: 0.77, 95% CI: 0.72-0.83, P = .004). Of 10 studies of prescribing error rates, 9 reported a reduction but variable denominators precluded meta-analysis. Twelve studies provided specific examples of system-related medication errors; 5 quantified their occurrence. DISCUSSION AND CONCLUSION Despite the wide-scale adoption of EMS in hospitals around the world, the quality of evidence about their effectiveness in medication error and associated harm reduction is variable. Some confidence can be placed in the ability of systems to reduce prescribing error rates. However, much is still unknown about mechanisms which may be most effective in improving medication safety and design features which facilitate new error risks.
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Affiliation(s)
- Peter J Gates
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Rae-Anne Hardie
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Magdalena Z Raban
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
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Afreen N, Padilla-Tolentino E, McGinnis B. Identifying Potential High-Risk Medication Errors Using Telepharmacy and a Web-Based Survey Tool. Innov Pharm 2021; 12. [PMID: 34007681 PMCID: PMC8102974 DOI: 10.24926/iip.v12i1.3377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background and Introduction: Obtaining patient medication histories during emergency department (ED) admissions is an important step towards identifying potential errors that could otherwise remain in the patient’s active medication list. This is a descriptive report of a standardized, electronic data collection tool created to document potential medication errors in patients receiving high-risk medications during ED admissions. Materials and Methods: Trained pharmacy technicians completed a survey following medication history collection using a secure web platform called REDCap®. Data collected included patient-specific information, the number and type of high-risk medications, and potential medication errors identified in the collection process. Results: During a pilot period of April 2019 to October 2020, 191 patient records were completed using the survey tool. Out of a total of 1088 medications recorded, 41% were considered high-risk medications. 42% of potential medication errors were classified as high-risk medication errors. Results from this survey tool demonstrated that 58% of high-risk medication orders could potentially result in a medication error that can be carried through patient admission and discharge. Discussion: Accurate medication history and transitions of care can significantly impact patient quality of life. The cost of addressing a medication related-adverse event is also substantial. Based on published reports, annual gross savings to a hospital is estimated to be $4532 per harmful error in 2020, after adjusting for inflation. This equated to approximately $1,182,852 in estimated savings for Ascension Texas in 18 months. Nationwide, preventing potential medication errors in an outpatient setting can save on average $3.5 billion per year. Conclusion: This web-based survey tool has improved the quality and efficiency of potential error identification during medication history collection by pharmacy technicians. This information can be easily retrieved and aid in discussions regarding medication reconciliation at the leadership level and impact patient treatment outcomes by developing virtual processes that may result in fewer medication related events.
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Affiliation(s)
- Nishat Afreen
- Pharmacy Intern, PharmD Candidate 2021, University of Texas at Austin College of Pharmacy, and Pharmacy Technician, Ascension Seton Department of Pharmacy
| | - Eimeira Padilla-Tolentino
- Ascension Texas Department of Research, and Clinical Instructor, University of Texas at Austin College of Pharmacy
| | - Brandy McGinnis
- Area Director of Continuity of Care, Ascension Texas Department of Pharmacy, and Clinical Instructor, University of Texas at Austin College of Pharmacy
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Brizzi MB, Burgos RM, Chiampas TD, Michienzi SM, Smith R, Yanful PK, Badowski ME. Impact of Pharmacist-Driven Antiretroviral Stewardship and Transitions of Care Interventions on Persons With Human Immunodeficiency Virus. Open Forum Infect Dis 2020; 7:ofaa073. [PMID: 32855982 PMCID: PMC7444735 DOI: 10.1093/ofid/ofaa073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 08/20/2020] [Indexed: 02/06/2023] Open
Abstract
Background Persons with human immunodeficiency virus (HIV) experience high rates of medication-related errors when admitted to the inpatient setting. Data are lacking on the impact of a combined antiretroviral (ARV) stewardship and transitions of care (TOC) program. We investigated the impact of a pharmacist-driven ARV stewardship and TOC program in persons with HIV. Methods This was a retrospective, quasi-experimental analysis evaluating the impact of an HIV-trained clinical pharmacist on hospitalized persons with HIV. Patients included in the study were adults following up, or planning to follow up, at the University of Illinois (UI) outpatient clinics for HIV care and admitted to the University of Illinois Hospital. Data were collected between July 1, 2017 and December 31, 2017 for the preimplementation phase and between July 1, 2018 and December 31, 2018 for the postimplementation phase. Primary and secondary endpoints included medication error rates related to antiretroviral therapy (ART) and opportunistic infection (OI) medications, all-cause readmission rates, medication access at time of hospital discharge, and linkage to care rates. Results A total of 128 patients were included in the study: 60 in the preimplementation phase and 68 in the postimplementation phase. After the implementation of this program, medication error rates associated with ART and OI medications decreased from 17% (10 of 60) to 6% (4 of 68) (P = .051), 30-day all-cause readmission rates decreased significantly from 27% (16 of 60) to 12% (8 of 68) (P = .03), and linkage to care rates increased significantly from 78% (46 of 59) to 92% (61 of 66) (P = .02). Conclusions A pharmacist-led ARV stewardship and TOC program improved overall care of persons with HIV through reduction in medication error rates, all-cause readmission rates, and an improvement in linkage to care rates.
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Affiliation(s)
- Marisa B Brizzi
- Department of Pharmacy, University of Cincinnati Health, Cincinnati, Ohio, USA
| | - Rodrigo M Burgos
- Department of Pharmacy Practice, Section of Infectious Diseases Pharmacotherapy, University of Illinois at Chicago College of Pharmacy, Chicago, Illinois, USA
| | - Thomas D Chiampas
- Department of Pharmacy Practice, Section of Infectious Diseases Pharmacotherapy, University of Illinois at Chicago College of Pharmacy, Chicago, Illinois, USA
| | - Sarah M Michienzi
- Department of Pharmacy Practice, Section of Infectious Diseases Pharmacotherapy, University of Illinois at Chicago College of Pharmacy, Chicago, Illinois, USA
| | - Renata Smith
- Department of Pharmacy Practice, Section of Infectious Diseases Pharmacotherapy, University of Illinois at Chicago College of Pharmacy, Chicago, Illinois, USA
| | - Paa Kwesi Yanful
- Department of Pharmacy, Methodist Health System, Dallas, Texas, USA
| | - Melissa E Badowski
- Department of Pharmacy, University of Cincinnati Health, Cincinnati, Ohio, USA
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7
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Koren DE, Scarsi KK, Farmer EK, Cha A, Adams JL, Pandit NS, Chang J, Scott J, Hardy WD. A Call to Action: The Role of Antiretroviral Stewardship in Inpatient Practice, a Joint Policy Paper of the Infectious Diseases Society of America, HIV Medicine Association, and American Academy of HIV Medicine. Clin Infect Dis 2020; 70:2241-2246. [PMID: 32445480 PMCID: PMC7245143 DOI: 10.1093/cid/ciz792] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 08/12/2019] [Indexed: 12/01/2022] Open
Abstract
Persons living with human immunodeficiency virus (HIV) and others receiving antiretrovirals are at risk for medication errors during hospitalization and at transitions of care. These errors may result in adverse effects or viral resistance, limiting future treatment options. A range of interventions is described in the literature to decrease the occurrence or duration of medication errors, including review of electronic health records, clinical checklists at care transitions, and daily review of medication lists. To reduce the risk of medication-related errors, antiretroviral stewardship programs (ARVSPs) are needed to enhance patient safety. This call to action, endorsed by the Infectious Diseases Society of America, the HIV Medicine Association, and the American Academy of HIV Medicine, is modeled upon the success of antimicrobial stewardship programs now mandated by the Joint Commission. Herein, we propose definitions of ARVSPs, suggest resources for ARVSP leadership, and provide a summary of published, successful strategies for ARVSP that healthcare facilities may use to develop locally appropriate programs.
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Affiliation(s)
- David E Koren
- Temple University Hospital, Philadelphia, Pennsylvania
| | - Kimberly K Scarsi
- Department of Pharmacy Practice and Science, University of Nebraska Medical Center College of Pharmacy, Omaha
| | - Eric K Farmer
- LifeCare Clinic at Indiana University Health, Indianapolis
| | - Agnes Cha
- Division of Pharmacy Practice, Arnold and Marie Schwartz College of Pharmacy and Health Sciences at Long Island University, Brooklyn, New York
| | - Jessica L Adams
- Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy at University of the Sciences, Pennsylvania
| | - Neha Sheth Pandit
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore
| | - Jennifer Chang
- Kaiser Permanente at Los Angeles Medical Center, Pomona, California
| | - James Scott
- Western University of Health Sciences College of Pharmacy, Pomona, California
| | - W David Hardy
- Johns Hopkins School of Medicine, Baltimore, Maryland
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8
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Bunn HT, Hester EK, Maldonado RA, Childress D. Evaluation of human immunodeficiency virus medication errors in a community hospital following the implementation of a pharmacist‐led antiretroviral stewardship program. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Haden T. Bunn
- Clinical Pharmacokinetics Research Lab Clinical Center‐Pharmacy, National Institutes of Health Bethesda Maryland
| | - E. Kelly Hester
- Department of Pharmacy Practice Harrison School of Pharmacy Auburn Alabama
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9
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Michienzi SM, Ladak AF, Pérez SE, Chastain DB. Antiretroviral Stewardship: A Review of Published Outcomes with Recommendations for Program Implementation. J Int Assoc Provid AIDS Care 2020; 19:2325958219898457. [PMID: 31955657 PMCID: PMC6971958 DOI: 10.1177/2325958219898457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 11/11/2019] [Accepted: 12/09/2019] [Indexed: 12/04/2022] Open
Abstract
Persons living with HIV (PLWHs) are at high risk for medication errors when hospitalized, but antiretroviral medications are not often evaluated by antimicrobial stewardship programs (ASPs) because they are not specifically discussed in the standards of practice. However, antiretroviral (ARV) stewardship programs (ARVSPs) have been shown to decrease medication error rates and improve other outcomes. The goal of this article is to review published literature on ARVSPs and provide guidance on key aspects of ARVSPs. A MEDLINE search using the term "antiretroviral stewardship" was conducted. Original research articles evaluating ARVSPs in hospitalized, adult PLWHs were included. Six original research articles evaluating unique inpatient ARVSPs met inclusion criteria. All 6 studies evaluating medication errors as the primary outcome found a significant reduction in errors in the postimplementation phase. Based on current standards for ASPs, we propose core elements for ARVSPs. Future organizational guidelines for antimicrobial stewardship should include official recommendations for ARV medications.
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Affiliation(s)
- Sarah M. Michienzi
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL, USA
| | - Amber F. Ladak
- Division of Infectious Disease, Augusta University, Augusta, GA, USA
| | - Sarah E. Pérez
- Department of Pharmacy Practice & Administrative Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Daniel B. Chastain
- Department of Clinical and Administrative Pharmacy, University of Georgia, Albany, GA, USA
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10
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Wingler MJB, Stover KR, Barber KE, Wagner JL. An Evaluation of Pharmacist-Led Interventions for Inpatient HIV-Related Medication Errors. J Pharm Technol 2019; 35:235-242. [PMID: 34752524 DOI: 10.1177/8755122519856728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Inpatient HIV-related medication errors occur in up to 86% of patients. Objective: To evaluate the number of antiretroviral therapy (ART)- and opportunistic infection (OI)-related medication errors following the implementation of pharmacist-directed interventions. Methods: This quasi-experiment assessed adult patients with HIV who received ART, OI prophylaxis, or both from December 1, 2014, to February 28, 2017 (pre-intervention) or December 1, 2017, to February 28, 2018 (post-intervention). Pre-intervention patients were assessed retrospectively; verbal and written education were provided (intervention); prospective audit and feedback was conducted for post-intervention patients. The primary outcome was rate of ART errors between groups. Secondary outcomes included rate of OI errors, time to resolution of ART and OI errors, types of errors, and rate of recommendation acceptance. Results: Sixty-seven patients were included in each group. ART errors occurred in 44.8% and 32.8% (P = .156), respectively. OI prophylaxis errors occurred in 11.9% versus 9% (P = .572), respectively. Medication omission decreased significantly in the post-intervention group (31.3% vs 11.9%; P = .006). Pharmacist-based interventions increased in the post-intervention group (6.3% vs 52.9%; P = .001). No statistical difference was found in time to error resolution (72 vs 48 hours; P = .123), but errors resolved during admission significantly increased (50% vs 86.8%; P < .001). No difference was found in rate of intervention acceptance (100% vs 97%). Conclusion and Relevance: ART and OI prophylaxis errors resolved a day faster in the pharmacist-led, post-intervention period, and there was a trend toward error reduction. Future interventions should target prescribing errors on admission using follow-up education and evaluation of medication reconciliation practices in HIV-infected patients.
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Affiliation(s)
| | - Kayla R Stover
- University of Mississippi Medical Center, Jackson, MS, USA.,University of Mississippi School of Pharmacy, Jackson, MS, USA
| | - Katie E Barber
- University of Mississippi School of Pharmacy, Jackson, MS, USA
| | - Jamie L Wagner
- University of Mississippi School of Pharmacy, Jackson, MS, USA
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11
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DePuy AM, Samuel R, Mohrien KM, Clayton EB, Koren DE. Impact of an Antiretroviral Stewardship Team on the Care of Patients With Human Immunodeficiency Virus Infection Admitted to an Academic Medical Center. Open Forum Infect Dis 2019; 6:ofz290. [PMID: 31338383 PMCID: PMC6639729 DOI: 10.1093/ofid/ofz290] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 06/17/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Interdisciplinary antiretroviral stewardship teams, comprising a human immunodeficiency virus pharmacist specialist, an infectious diseases physician, and associated learners, have the ability to assist in identification and correction of inpatient antiretroviral-related errors. METHODS Electronic medical records of patients with antiretroviral orders admitted to our hospital were evaluated for the number of interventions made by the stewardship team, number of admissions with errors identified, risk factors for occurrence of errors, and cost savings. Risk factors were analyzed by means of multivariable logistic regression. Cost savings were estimated by the documentation system Clinical Measures. RESULTS A total of 567 admissions were included for analysis in a 1-year study period. Forty-three percent of admissions (245 of 567) had ≥1 intervention, with 336 interventions in total. The following were identified as risk factors for error: multitablet inpatient regimen (odds ratio, 1.834; 95% confidence interval, 1.160-2.899; P = .009), admission to the intensive care unit (2.803; 1.280-6.136; P = .01), care provided by a surgery service (1.762; 1.082-2.868; P = .02), increased number of days reviewed (1.061; 1.008-1.117; P = .02), and noninstitutional outpatient provider (1.375; .972-1.946; P = .07). The 1-year cost savings were estimated to be $263 428. CONCLUSIONS Antiretroviral stewardship teams optimize patient care through identification and correction of antiretroviral-related errors. Errors may be more common in patients with multitablet inpatient regimens, admission to the intensive care unit, care provided by a surgery service, and increased number of hospital days reviewed. Once antiretroviral-related errors are identified, the ability to correct them provides cost savings.
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Affiliation(s)
- Ashley M DePuy
- Department of Pharmacy Services, Temple University Hospital, Philadelphia, Pennsylvania
| | - Rafik Samuel
- Section of Infectious Diseases, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Kerry M Mohrien
- Department of Pharmacy Services, Temple University Hospital, Philadelphia, Pennsylvania
| | - Elijah B Clayton
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - David E Koren
- Department of Pharmacy Services, Temple University Hospital, Philadelphia, Pennsylvania
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12
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Pettit NN, Han Z, Choksi A, Voas-Marszowski D, Pisano J. Reducing medication errors involving antiretroviral therapy with targeted electronic medical record modifications. AIDS Care 2019; 31:893-896. [PMID: 30669851 DOI: 10.1080/09540121.2019.1566512] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Medication errors are common among HIV-infected patients on anti-retroviral therapy (ART), especially when transitioning to the inpatient setting. In previous studies, medication error rates among hospitalized patients on ART have been reported to exceed 50%. When patients receiving ART are admitted to the hospital, medication errors can be prevented through optimization of administration instructions and dosing defaults in order-entry screens in the electronic medical record (EMR). We sought to evaluate the impact of EMR modifications (defaulted doses, frequencies, and administration instructions) implemented to improve the order-entry process and reduce errors. All adult patients admitted between 10/1/2010-3/31/2012 (pre-EMR modification) and 10/1/2013-3/31/2014 (post-EMR modification) that continued on ART upon admission were included. The primary outcome was the overall rate of medication errors identified through review by the antimicrobial stewardship program (ASP). We also characterized the types of medication errors identified during the two time periods. Following EMR modifications, the medication error rate identified through ASP review was reduced from 50.2% to 28.2% (P < 0.01). The number of medication related errors relating to dosage (regimens requiring dose optimization, renal dose adjustment, and dose timing) were reduced by 22% (P < 0.01). Modifications at the anti-retroviral medication order-entry screens in the EMR significantly reduced medication errors, particularly with respect to dosing and dose timing.
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Affiliation(s)
- Natasha N Pettit
- a Department of Pharmacy , University of Chicago Medicine , Chicago , IL , USA
| | - Zhe Han
- a Department of Pharmacy , University of Chicago Medicine , Chicago , IL , USA
| | - Anish Choksi
- a Department of Pharmacy , University of Chicago Medicine , Chicago , IL , USA
| | | | - Jennifer Pisano
- b Department of Medicine, Section of Infectious Diseases and Global Health , University of Chicago Medicine , Chicago , IL , USA
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13
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Mehta D, Kohn B, Blumenfeld M, Horowitz HW. To Assess the Success of Computerized Order Sets and Pharmacy Education Modules in Improving Antiretroviral Prescribing. J Pharm Pract 2017; 31:450-456. [PMID: 28877642 DOI: 10.1177/0897190017729599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess the success of order set and pharmacist training improvement (OSPTI) in improving prescription of antiretroviral therapy (ART) in a tertiary care, public, teaching hospital. METHODS In this pre-OSPTI (January 2012 through June 2013) and post-OSPTI study (July 2013 through September 2014), an infectious disease pharmacist reviewed all patients on ART. A review of intervention data in July 2013 led to order-set changes in the hospital's computerized order entry system for frequently intervened on antiretrovirals: ritonavir, tenofovir, emtricitabine/tenofovir disoproxil fumarate (FTC/TDF), and lamivudine. Concurrently, case-based education modules were conducted to help pharmacists identify ART errors. The number of patients on ART, number of interventions, and types of ritonavir interventions were compared between pre- and post-OSPTI periods. RESULTS In the pre-OSPTI period, an average of 239 patients were reviewed per quarter compared to an average of 216 per quarter in the post-OSPTI period. After implementing enhanced order sets, the number of interventions decreased by approximately 34% ( P < .0001). The number of ritonavir interventions decreased on average by 45% ( P < .0001), although the types of ritonavir interventions were similar. CONCLUSION Enhanced antiretroviral order sets and pharmacy education modules improved ART prescription by reducing the overall number of antiretroviral interventions required per quarter. This modality was effective in improving prescribing of ART and reducing the need for pharmacist interventions.
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Affiliation(s)
- Dhara Mehta
- 1 Bellevue Hospital Center (BHC), New York, NY, USA
| | - Bella Kohn
- 1 Bellevue Hospital Center (BHC), New York, NY, USA
| | | | - Harold W Horowitz
- 1 Bellevue Hospital Center (BHC), New York, NY, USA.,2 New York University School of Medicine, New York, NY, USA.,3 Division of Infectious Disease, NYP Brooklyn Methodist Hospital, Brooklyn, NY, USA
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14
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Durham SH, Badowski ME, Liedtke MD, Rathbun RC, Pecora Fulco P. Acute Care Management of the HIV-Infected Patient: A Report from the HIV Practice and Research Network of the American College of Clinical Pharmacy. Pharmacotherapy 2017; 37:611-629. [PMID: 28273373 DOI: 10.1002/phar.1921] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patients infected with human immunodeficiency virus (HIV) admitted to the hospital have complex antiretroviral therapy (ART) regimens with an increased medication error rate upon admission. This report provides a resource for clinicians managing HIV-infected patients and ART in the inpatient setting. METHODS A survey of the authors was conducted to evaluate common issues that arise during an acute hospitalization for HIV-infected patients. After a group consensus, a review of the medical literature was performed to determine the supporting evidence for the following HIV-associated hospital queries: admission/discharge orders, antiretroviral hospital formularies, laboratory monitoring, altered hepatic/renal function, drug-drug interactions (DDIs), enteral administration, and therapeutic drug monitoring. RESULTS With any hospital admission for an HIV-infected patient, a specific set of procedures should be followed including a thorough admission medication history and communication with the ambulatory HIV provider to avoid omissions or substitutions in the ART regimen. DDIs are common and should be reviewed at all transitions of care during the hospital admission. ART may be continued if enteral nutrition with a feeding tube is deemed necessary, but the entire regimen should be discontinued if no oral access is available for a prolonged period. Therapeutic drug monitoring is not generally recommended but, if available, should be considered in unique clinical scenarios where antiretroviral pharmacokinetics are difficult to predict. ART may need adjustment if hepatic or renal insufficiency ensues. CONCLUSIONS Treatment of hospitalized patients with HIV is highly complex. HIV-infected patients are at high risk for medication errors during various transitions of care. Baseline knowledge of the principles of antiretroviral pharmacotherapy is necessary for clinicians managing acutely ill HIV-infected patients to avoid medication errors, identify DDIs, and correctly dose medications if organ dysfunction arises. Timely ambulatory follow-up is essential to prevent readmissions and facilitate improved transitions of care.
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Affiliation(s)
- Spencer H Durham
- Department Pharmacy Practice, Auburn University Harrison School of Pharmacy, Auburn, Alabama
| | - Melissa E Badowski
- Section of Infectious Diseases, Department of Pharmacy Practice, University of Illinois at Chicago, College of Pharmacy, Chicago, Illinois
| | - Michelle D Liedtke
- Department of Clinical and Administrative Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - R Chris Rathbun
- Department of Clinical and Administrative Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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