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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])
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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

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