Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-09T15:11:14.006Z Has data issue: false hasContentIssue false
  • English
  • Français

Antimicrobial Stewardship Program to Reduce Antiretroviral Medication Errors in Hospitalized Patients with Human Immunodeficiency Virus Infection

Published online by Cambridge University Press:  10 May 2016

Jamie Sanders ,
Andrea Pallotta ,
Seth Bauer ,
Jennifer Sekeres ,
Ramona Davis ,
Alan Taege  and
Elizabeth Neuner
Jamie Sanders
Affiliation:
Department of Pharmacy, SoutheastHEALTH, Cape Girardeau, Missouri
Andrea Pallotta
Affiliation:
Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio
Seth Bauer
Affiliation:
Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio
Jennifer Sekeres
Affiliation:
Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio
Ramona Davis
Affiliation:
Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio
Alan Taege
Affiliation:
Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
Elizabeth Neuner*
Affiliation:
Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio
*
Department of Pharmacy, Cleveland Clinic, 9500 Euclid Avenue, Hbl05, Cleveland, OH 44195 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

Evaluate antimicrobial stewardship interventions targeted to reduce highly active antiretroviral therapy (HAART)– or opportunistic infection (Ol)–related medication errors and increase error resolution.

Design.

Retrospective before-after study.

Setting.

Academic medical center.

Patients.

Inpatients who were prescribed antiretroviral therapy before the intervention (January 1, 2011, to October 31, 2011) and after the intervention (July 1, 2012, to December 31, 2012). Patients treated with lamivudine or tenofovir monotherapy for hepatitis B were excluded.

Methods.

Antimicrobial stewardship interventions included education, modification of electronic medication records, collaboration with the infectious diseases (ID) department, and prospective audit and review of HAART and OI regimens by an ID clinical pharmacist.

Results.

Data for 162 admissions from the preintervention period and 110 admissions from the postintervention period were included. The number of admissions with a medication error was significantly reduced after the intervention (81 [50%] of 162 admissions vs 37 (34%) of 110 admissions; P < .00)1. A total of 124 errors occurred in the preintervention group (mean no. of errors, 1.5 per admission), and 43 errors occurred in the postintervention group (mean no. of errors, 1.2 per admission). The most common error types were major drug interactions and dosing in the preintervention group and renal adjustment and OI-related errors in the postintervention group. A significantly higher error resolution rate was observed in the postintervention group (36% vs 74%; P < .001). After adjustment for potential confounders with logistic regression, admission in the postintervention group was independently associated with fewer medication errors (odds ratio, 0.4 [95% confidence interval, 0.24-0.77]; P = .005). Overall, presence of an ID consultant demonstrated a higher error resolution rate (32% without a consultation vs 68% with a consultation; P = .002).

Conclusions.

Multifaceted, multidisciplinary stewardship efforts reduced the rate and increased the overall resolution of HAART-related medication errors.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 3 , March 2014 , pp. 272 - 277
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Department of Health and Human Services. Guidelines for the use of antiretroviral agents in HIV-1 infected adults and adolescents. http://www.aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf. Accessed August 10, 2012.Google Scholar
2. Pastakia, SD, Corbett, AH, Raasch, RH, Napravnik, S, Correli, TA. Frequency of HIV-related medication errors and associated risk factors in hospitalized patients. Ann Pharmacother 2008;42:491–497.CrossRefGoogle ScholarPubMed
3. Ledergerber, B, Egger, M, Erard, V, et al. AIDS-related opportunistic illnesses occurring after initiation of potent antiretroviral therapy. JAMA 1999;282:2220–2206.CrossRefGoogle ScholarPubMed
4. Egger, M, May, M, Chene, G, et al. Prognosis of HIV-1 infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies. Lancet 2002;360:119–129.CrossRefGoogle ScholarPubMed
5. Palella, FJ, Delaney, KM, Moorman, AC, et al. Declining morbidity and mortality among patients with advanced human im-munodefiency virus infection. N Engl J Med 1998;338:853–860.Google Scholar
6. Daniels, LM, Raasch, RH, Corbett, AH. Implementation of targeted interventions to decrease antiretroviral-related errors in hospitalized patients. Am J Health Syst Pharm 2012;69:422–430.Google Scholar
7. Rastegar, DA, Knight, AM, Monolakis, JS. Antiretorival medication errors among hospitalized patients with HIV infections. Clin Infect Dis 2006;43:933–938.Google Scholar
8. Rao, N, Patel, V, Grigoriu, A, Kaushik, P, Brizuela, M. Antiretroviral therapy prescribing in hospitalized HIV clinic patients. HIV Med 2012;13:267–271.CrossRefGoogle ScholarPubMed
9. Arshad, S, Rothberg, M, Rastegar, DA, Spooner, LM, Skiest, D. Survey of physician knowledge regarding antiretroviral medications in hospitalized HIV-infected patients. J Int AIDS Soc 2009; 12:1.Google Scholar
10. Carcelero, E, Tuset, M, Martin, M, et al. Evaluation of antiretroviral-related errors and interventions by the clinical pharmacist in hospitalized HIV-infected patients. HIV Med 2011;12: 494–499.CrossRefGoogle ScholarPubMed
11. Yehia, BR, Mehta, JM, Ciuffetelli, D, et al. Antiretroviral medication errors remain high but are quickly corrected among hospitalized HIV-infected adults. Clin Infect Dis 2012;55(4):593–599.Google Scholar
12. 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;45:459–468.CrossRefGoogle ScholarPubMed
13. National Coordinating Council for Medication Error Reporting and Prevention. About medication errors: what is a medication error. http://www.nccmerp.org/aboutMedErrors.html. Accessed 10 August 2012.Google Scholar
14. Micromedex 2.0. Ann Arbor, MI: Truven Health Analytics, 2014. http://www.micromedex.com. Accessed January 22, 2014.Google Scholar
15. Dellit, TH, Owens, RC, McGowan, JE, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44: 159–177.CrossRefGoogle Scholar
16. Rehm, SJ, Sekeres, JK, Neuner, E, et al. Guidelines for Antimicrobial Usage 2012-2013. West Islip, NY: Professional Communications, 2012.Google Scholar
17. 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.Google Scholar