Oversight Reduces HIV Prescription Errors

Laird Harrison

October 05, 2013

SAN FRANCISCO — Better record keeping, education, and vigilance by infectious disease clinicians and pharmacists can reduce the rate of prescription errors for HIV-infected patients hospitalized for other reasons, new research shows.

Such reforms significantly reduced the rate of prescribing errors from 50% to 34% at the Cleveland Clinic(P = .008), said Elizabeth Neuner, PharmD, an infectious diseases clinical pharmacist. "They allow more effective prescribing."

Dr. Neuner presented the research to reporters attending a news conference here at IDWeek 2013.

Antiretroviral drug regimens for HIV are typically complicated and can be difficult for patients to follow, she noted.

When HIV-infected patients are hospitalized for non-HIV conditions, hospital providers who are unfamiliar with the complexities of HIV therapy can make errors. The consequences include adverse effects, a loss of viral protection, and drug interactions, she told Medscape Medical News.

"We wanted to take a more focused look at those patients because they are at such high risk for medication errors," she said.

To reduce these errors, the Cleveland Clinic implemented a program that involved education, modification of the electronic drug file to help guide the accurate prescribing of medications, a daily medication profile review by a pharmacist specializing in HIV, and the involvement of an infectious disease physician.

In their study, Dr. Neuner and her team evaluated 162 HIV-infected patients hospitalized for another reason before the program was implemented and 110 patients hospitalized after it started.

Table. Prescribing Errors Before and After Program Implementation

Outcome Preprogram Postprogram P Value

Errors resolved

36% 74% .001

Time to resolve errors

180 hours 23 hours .002

Cases with errors

50% 34% .008

The researchers found that infectious disease specialists provided valuable input. Errors were corrected more often when patients were evaluated by a specialist than when they were not (68% vs 32%; P = .002).

For example, the specialists corrected inaccurate antiretroviral medications and dosages, adjusted regimens in which a new medication, such as for heart problems or diabetes, was interacting with an antiretroviral medication, and revised therapy to address a new problem, such as kidney injury.

In some cases, physicians opted not to correct the error because the patient was doing well on the therapy and the benefits outweighed the risks.

Michael Horberg, MD, national director for HIV/AIDS at Kaiser Permanente Medical Group in Rockville, Maryland, pointed out that Kaiser hospitals are using a similar system to prevent errors.

"When these patients come in, they sometimes remember to bring their medications, and they sometimes don't," he told Medscape Medical News. "If we can't get hold of their primary care physician, we're at a loss. In such cases, the roles of the infectious disease clinician and pharmacist are increasingly critical to quality of care and quality outcomes."

Dr. Horberg and Dr. Neuner have disclosed no relevant financial relationships.

IDWeek 2013. Abstract 176. Presented October 3, 2013.

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