Errors related to antiretroviral therapy (ART) among hospitalized patients with HIV can have a significant long-term negative impact, including treatment failure and drug resistance, as well as increasing healthcare costs, said Meshell Maxam, PharmD, at the MAD-ID 2022 (Making a Difference in Infectious Diseases) stewardship meeting.
“Things can really go downhill for these patients after that first medication error,” said Dr. Maxam, an HIV/infectious diseases clinical pharmacy specialist at Kaiser Permanente, in Atlanta.
Studies show medication errors are common among hospitalized HIV patients, Dr. Maxam noted. One prospective study conducted at the University of Florida found 77% of patients experienced on antiretroviral (ARV) medications suffered opportunistic infection (OI)-related medication errors, with the most prevalent error types, including:
- missing doses (20%),
- underdosing (13%),
- overdosing (13%),
- therapy omission (13%), and
- drug-drug interaction (12%).
“There were 2.7 errors per patient, and 54% of the errors occurred within 24 hours of admission,” Dr. Maxam said.
Three large studies of medication errors in hospitalized patients with HIV conducted at major academic medical centers found the error rate to range from 35% to 55%.
“The most common errors among patients who came in on components of ARV medication was for one to be left off or even not restarting the regimen,” Dr. Maxam said. “Other common errors involved dosing and drug-drug interactions. What is even more concerning is that when those errors were identified, anywhere from 6% to 66% of them were not corrected. So we have some work to do” (J Antimicrob Chemother 2014;69[1]:262-267; Ann Pharmacother 2013;47[7-8]:953-960; poster 1048 presented at IDWeek 2012).
A review of ARV regimens by an antimicrobial stewardship program (ASP) team can significantly decrease medication errors, according to Dr. Maxam. One study compared error rates before and after implementation of an ASP intervention. While the overall medication error rates were comparable (119 pre- and 124 post-implementation), the difference in detected and corrected errors was dramatic. Only 13 of the 119 errors that occurred before intervention (11%) were detected, compared with 105 of the 124 post-intervention errors (85%; P<0.001). Errors at discharge were 106 in the pre-implementation group and 18 in the post-implementation group (P<0.001) (Ann Pharmacother 2020;54[8]767-774).
6 ART Strategies to Avoid Errors
1. Tracking and reporting utilization. “If you’re adding an ARV to your formulary, it’s important to then evaluate how it is being used,” said Meshell Maxam, PharmD. “Is it being given to the right patients? Should you be using it at all?”
2. Prompt and accurate medication reconciliation. “Your ARV stewardship pharmacist should be able to take the patient’s medication list and figure out what the patient should be getting by calling the previous pharmacy or HIV clinic, and come away more confident that the medication list is accurate,” she said.
3. Assistance with transitions of care and linkage to community care. “It’s important to have a process in place allowing patients to get an emergent three-day supply of their ARV medications, but it’s also essential to link them to care,” Dr. Maxam said. “It does no one a service to give them a 30-day prescription but no infectious disease clinic to follow up with.”
4. Optimizing order sets. “This takes a lot of work on the front end, but relieves you from potential errors on the back end,” she said. “In addition to creating them, you have to go back periodically to optimize them.”
5. Prospective audits and feedback.
6. Managing the formulary. “You need to understand what are the most common regimens and how to get around the more costly medications and still provide what the patient needs,” she said.
By Gina Shaw
Source : Infectious Disease Special Edition
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