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In-Hospital Antiretroviral Prescribing Errors Common and Often Uncorrected
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14th International Workshop on Clinical Pharmacology of HIV Therapy, April 22-24, 2013, Amsterdam
Mark Mascolini
More than one third of HIV patients admitted to a US hospital had antiretroviral prescribing errors during their hospital stay, and most of these errors went uncorrected before hospital discharge [1]. Failing to prescribe a needed medication was the most frequent error.
This retrospective record review focused on HIV-positive people admitted for more than 24 hours to a Midwestern US academic health center hospital between January 2009 and December 2011. The researchers compared initial inpatient antiretroviral prescribing with outpatient prescriptions, looking for omitted drugs, underdosing, overdosing, duplicate therapy, incorrect scheduling, and incorrect therapy. The investigators also figured time to correcting errors and potentially adverse drug-drug interactions during the hospital stay.
Of 416 admissions during the study period, 146 (35.1%) involved an antiretroviral prescribing error detected by the investigators. Errors proved more common in women than men than women (40.4% versus 33.3%, not significant) and more common in African Americans (42.5%) and Hispanics (33.3%) than in Caucasians (27.8%). The difference between African Americans and Caucasians was statistically significant (P = 0.002).
Of the 289 individual prescribing errors detected, prescription omission was the most common (69.2%), followed by incorrect scheduling (13.1%), overdosing (8.0%), underdosing (6.6%), incorrect therapy (2.1%), and duplicate therapy (1.0%). The highest proportion of errors involved protease inhibitors (36.3%), followed by nucleosides (29.1%), coformulations (28.1%), nonnucleosides (10.4%), and entry and integrase inhibitors (2.4%). But when the investigators compared error frequency by class as a function of total prescriptions in that class, nucleoside errors were the most frequent (31.1%) and were more likely than protease inhibitor errors (RR 1.32, 95% confidence interval 1.04 to 1.69) and coformulation errors (RR 1.59, 95% confidence interval 1.19 to 2.09). All errors were type C, meaning they caused the patient no harm.
Of 289 total errors, 55% were not corrected during the hospital stay, 31% were corrected within 24 hours, and 14% were corrected in more than 24 hours. Multivariate analysis to detect factors in error correction focused on the most common error (omission) and adjusted for age, race/ethnicity, gender, and total number of errors. If omission was one of the errors for a patient, all mistakes were 7.4 times more likely to be corrected than if omission was not one of the errors.
The investigators determined that 51 nonantiretrovirals were incorrectly coadministered with antiretrovirals according to guidelines in the University of Liverpool online drug-interaction tables. Anxiolytics accounted for the highest proportion of incorrectly prescribed non-HIV agents (almost 25%), followed by antiarrhythmics, gastrointestinal medications, lipid-lowering drugs, and antibacterials.
The researchers began targeted interventions to prevent and correct errors and to avoid antiretroviral interruptions.
Reference
1. Commers T, Sandkovsky U, Sayles H, Gross A, Devetten M, Swindells S. Antiretroviral prescribing errors and potential adverse drug-drug interactions are common with hospitalization of HIV-infected patients. 14th International Workshop on Clinical Pharmacology of HIV Therapy, April 22-24, 2013, Amsterdam. Abstract PP_01.
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