Despite advances in electronic medical records, mistakes still are commonly made in the prescription of antiretroviral medications for hospitalized HIV-positive patients, according to two studies.
However, increased clinical education can help to greatly decrease medical errors, according to the studies. And electronic records can be a key part of the solution, a third study found.
The studies were scheduled for presentation at the inaugural IDWeek meeting, which runs through Oct. 21 in San Diego.
“Treatment of HIV infection is complex, involving the administration of multiple drugs that often have the potential for major interactions,” Joel E. Gallant, MD, IDWeek chairman for the HIV Medicine Association, said in a news release.
“Hospitalized patients are at risk for serious medication errors, especially when drugs are added or changed by physicians without HIV expertise. These studies emphasize the critical importance of electronic medical records and early expert consultation in hospitalized HIV-infected patients to prevent dangerous and costly medication errors.”
Two studies described the challenges hospitals face in ensuring that patients infected with HIV are not put at risk of treatment failure or drug toxicity through dosage, timing or other errors with antiretroviral therapy.
Researchers at the Cleveland Clinic looked retrospectively at the charts for 162 admissions of HIV patients over a 10-month period in 2011. The rate of prescription errors in their HAART regimens was 50%, and two-thirds of those mistakes were not identified and resolved before the patients were discharged.
Lead researcher Elizabeth Neuner, PharmD, an infectious disease clinical pharmacist at the clinic, pointed to the changing nature of HIV care as one explanation. Many hospital clinicians are less familiar with HAART regimens because much HIV care now is administered in outpatient settings, she said.
“The number and complexity of medications used to treat HIV and an unfamiliarity with seeing patients with these medications can lead to errors,” Neuner said.
Since the study, the Cleveland Clinic has implemented numerous quality improvement measures, including increased education about potential drug interactions with antiretroviral medications and greater coordination of care between inpatient and outpatient settings. The clinic also added dosing and frequency alerts to its electronic medical records system.
Similar error rates were seen over an 18-month period by the University of Chicago Medical Center. In that study, researchers reviewed 155 HAART regimens, which had been evaluated within 24 hours of the patients admission. Nearly half the initial hospital-prescribed HAART regimens required intervention, most typically to modify dosages.
Natasha Pettit, PharmD, a clinical pharmacy specialist with University of Chicago Medicine, said teaching hospitals could have high error rates in part because their medical and pharmacy residents do not have much experience with HIV drugs early in their training.
“A first-year resident may not know the nuances related to administering these medications appropriately,” she said. “Data indicate that hospitals need to provide additional educational training and create innovative ways to catch and prevent these errors.”
The University of Chicago Medical Center responded to the findings by developing dosing cards with cautions on drug interactions, timing recommendations and other safety points. They are planning a more detailed evaluation as a step toward modifying HAART medication order entry in their electronic records system.
A third study, based in Michigan, looked at the impact on medication mistakes when an HIV outpatient clinic worked to actively maintain patients antiretroviral prescriptions in a major hospitals electronic records system. The error rate plunged by 93% among clinic patients who later were admitted to the hospital.
The approach required extensive preparation by Special Immunology Services, the HIV clinic at Saint Marys Health Care. Although the two are affiliated, their electronic medical records systems do not communicate, and the drug records of nearly 900 clinic patients had to be individually uploaded and then continually updated in the hospital system. Meetings followed with ED physicians through much of 2010. Educational notices went out through various hospital communications to other physicians, nurses and other departments.
“It resulted in better care for our patients when they were hospitalized,” said Jean Lee, PharmD, the studys lead researcher and a clinical pharmacist for HIV medicine at Special Immunology Services. In addition, based on a sample of 20 HIV-positive patients, the researchers found that the direct costs of medication errors fell by 85%.