Presentation Abstract

Session: 099-Antiretroviral Therapy of HIV-1 Infection
Sunday, Sep 18, 2011, 11:15 AM - 1:15 PM
Presentation Title: H2-794 - HIV-Specialized Pharmacists’ Impact on Prescribing Errors in Hospitalized Patients on Antiretroviral Therapy
Location: Exhibit Hall F1
Poster Board Number: 281
Presentation Number: H2-794
Pres. Time: Sunday, Sep 18, 2011, 11:15 AM - 1:15 PM
Category: H1
Keywords: pharmacist; medication errors; antiretroviral therapy 
Author(s): B. A. Merchen, Bachelors (BA or AB or BS) - Student1, L. Gerzenshtein, Pharm.D. - Infectious Diseases Clinical Pharmacist 2, K. K. Scarsi, Pharm.D. - Research Assistant Professor of Medicine 3,2, C. Achenbach, M.D., M.P.H. - Assistant Professor of Medicine 3, M. Postelnick, B.Pharm. - Senior Infectious Diseases Pharmacist 2, R. M. Zavod, Ph.D. - Associate Professor 1, K. M. Darin, Pharm.D. - Research Associate 3,2;
1Midwestern Univ. Chicago Coll. of Pharmacy, Downers Grove, IL, 2Northwestern Mem. Hosp., Chicago, IL, 3Northwestern Univ. Feinberg Sch. Of Med., Chicago, IL.
Financial Disclosures:  B. A. Merchen, None..
L. Gerzenshtein, None..
K. K. Scarsi, None..
C. Achenbach, None..
M. Postelnick, None..
R. M. Zavod, None..
K. M. Darin, None.
Abstract: Background: Hospitalized HIV-infected patients on antiretroviral therapy (ART) are at high risk for prescribing errors, resulting in excess morbidity and health care costs. Review of ART by an HIV-specialized pharmacist may reduce medication error-related harm. Methods: We performed a retrospective, descriptive analysis of medication errors in HIV-infected patients on ART admitted to a tertiary care hospital over a 3-year period. Error severity was graded based on potential for inpatient and post-discharge harm by two pharmacists and a physician with HIV expertise using the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) Index for Categorizing Medication Errors. Associated healthcare costs were based on published estimates of cost avoidance for each category. Results: A total of 551 errors were identified in 248 patients (381 hospital admissions, 11.59 errors/100 patient-days). Most errors (383, 69.5%) occurred within 24 hours of admission. The median time to error correction was 23 hours. Table 1 describes the types of errors identified.
Table 1. Type of Medication Errors Identified by Category (n=551), n (% of errors)
Drug dosing error175 (31.8)
Drug administration error (timing, route, food)120 (21.8)
Drug interaction111 (20.1)
Incorrect ART (omission, substitution, addition or duplication)72 (13.1)
Missing or unnecessary opportunistic infection prophylaxis or treatment28 (5.1)
Drug formulation issue (solution, fixed dose tablet, etc.)27 (4.9)
Medication reconciliation issue of non-ART (omission and duplication)8 (1.5)
Related to adverse effect or allergy4 (0.7)
Laboratory monitoring recommendation5 (0.9)
Miscellaneous1 (0.2)
Based on the NCC MERP Index, 316 (57.4%) errors required monitoring or intervention to preclude harm during admission; 369 (66.9%) had potential to cause temporary or permanent harm if not corrected prior to discharge. Pharmacist intervention resulted in an estimated cost avoidance of $24,273/year and $124,080/year, respectively. Conclusions: In hospitalized patients on ART, medication review by a pharmacist with expertise in HIV therapeutics could be a cost effective approach to reducing healthcare costs and harm associated with medication errors.

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