ART errors common on day of hospital admission in patients with HIV

Issue: September 2012

Although antiretroviral medication errors are common among hospitalized patients with HIV at admission, they are usually corrected within 48 hours, recent data suggest.

Perspective from Darius Rastegar, MD

“ART medication errors occurred in almost a third of all HIV-infected patients on the first day of admission, but errors are quickly corrected,” Baligh Yehia, MD, a fellow in infectious diseases at the University of Pennsylvania, told Infectious Disease News. “This may be a consequence pharmacist review of medications on the second day. We also noted that protease inhibitors accounted for the majority of errors and that patients admitted to surgical services were also at increased risk for errors.”

Baligh Yehia

Yehia and colleagues conducted a retrospective review of medication orders within the first 48 hours of hospitalization for patients with HIV. The patients were admitted between Jan. 1 and Dec. 31, 2009. There were four types of errors: incomplete regimen, incorrect dosage, incorrect schedule and nonrecommended drug-drug combinations.

Among the 702 admissions during this time frame, 380 were prescribed ART on the first day of hospitalization. There were 145 medication errors in 110 admissions on the first day. Incomplete regimen was responsible for 58% of the errors and incorrect dosage accounted for 38% of the errors. After analyzing the dosing errors, 70% were in protease inhibitors.

Another 308 admissions were prescribed ART on the second day of hospitalization and there were 22 errors out of 21 admissions. Half of the errors were due to incorrect dosing and the other half were due to incorrect scheduling. All of the scheduling errors were protease inhibitors, as were 73% of the dosing errors.

“Providers caring for people living with HIV should be aware of the high frequency of ART medication errors and be careful when ordering patients’ ART regimens,” Yehia said. “Specifically, they should be diligent in double-checking the accuracy of ART regimens with the patient, their primary HIV provider and the medical record.”

References:

Yehia B. Clin Infect Dis. 2012;55:593-599.

Disclosures:

Dr.Yehia reports no relevant financial disclosures.

Perspective

Darius Rastegar, MD

This study reinforces that patients with HIV are at risk for medication errors when they are admitted to the hospital. This is important because gaps in medication put them at risk of acquiring resistant virus.

The initial error rate in this study was similar to previous studies, but the majority was corrected within 24 hours. The relatively low rate of persistent errors (7%) is probably attributable to the fact that two-thirds of these patients were admitted to an HIV/AIDS ward with dedicated pharmacists who reviewed the antiretroviral regimens. Most hospitals do not have these resources and I suspect that the persistent error rate is higher at many other institutions.

I think there are a number of things which can help reduce the error rate: 1. medical records which can follow the patient and be accessed wherever they receive care; 2. routine pharmacist review of regimens; 3. better computer order entry systems; and 4. empowering patients to be more knowledgeable about their medications and vigilant to make sure they are receiving the proper medications, especially during transitions in care.

Darius Rastegar, MD

Associate professor of Medicine

Johns Hopkins University

Disclosures: Dr. Rastegar reports no relevant financial disclosures.