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ID specialists helped reduce medical errors for patients with HIV
SAN FRANCISCO — Hospital providers often make mistakes involving medication for antiretroviral therapy for patients with HIV who are admitted to the hospital for other conditions, such as diabetes of cardiovascular complications. However, those medication errors were significantly reduced by an intervention by infectious disease specialists, researchers reported here at ID Week 2013.
"Our study found that with a multifaceted, multidisciplinary stewardship team, we were able to significantly reduce the rate of medication errors with antiretroviral medications, as well as significantly increase the rate of resolution for when those errors happened," Elizabeth A. Neuner, PharmD, an infectious disease clinical pharmacist at Cleveland Clinic, said during a press conference.
Elizabeth A. Neuner
Neuner and colleagues compared the rates of medication errors in 162 patients with HIV who were treated at the hospital before a targeted intervention was implemented with those of 110 patients who took part in the intervention. The intervention included pharmacy education, updating electronic medication drug files, collaboration with the infectious disease department, and a daily medication profile review by an infectious disease clinical pharmacy specialist. Patients with hepatitis B who were treated with lamivudine or tenofovir monotherapy were excluded from the study.
Results indicated that the rate of medication errors was significantly lower after the intervention (34%) compared with rates before the intervention was implemented (50%; P<.001). A total of 124 errors (mean, 1.5 errors per patient) occurred in the pre-intervention group compared with 43 errors (mean, 1.2 per patient) in the post-intervention group.
Among the pre-intervention group, the most common medication errors included major drug interactions (26%) and dosing (20%). Among the post-intervention group, the most common errors were renal dosing (28%) and opportunistic infection-related medication errors (21%).
The researchers observed a significantly higher rate of error resolution in the post-intervention group (36% vs. 74%; P<.001). The median time to the resolution of medication errors was also significantly lower in the post-intervention group (23 hours; 95% CI, 5.7-39.3) compared with the pre-intervention group (180 hours; 95% CI, 73.5-258.6).
The presence of an infectious disease specialist significantly increased the rate at which medication errors were resolved, the researchers added (32% vs. 68%; P=.002).
Michael A. Horberg, MD, director of HIV/AIDS for Kaiser Permanente, said medication errors represent a "real problem" in the treatment of patients with HIV. Horberg was not involved in the study.
"The important role of the ID clinician and the ID clinical pharmacist … is increasingly critical to quality care and quality outcomes, and it is getting more and more important getting it right the first time," he said.
For more information:
Sanders J. Abstract #176. Presented at: ID Week 2013; Oct. 2-6, 2013; San Francisco.
Disclosure: Neuner reports no relevant financial disclosures.