title: Antimicrobial stewardship program to reduce antiretroviral medication errors in hospitalized patients with human immunodeficiency virus infection.
abstract: OBJECTIVE
  Evaluate antimicrobial stewardship interventions targeted to reduce highly active antiretroviral therapy (HAART)- or opportunistic infection (OI)-related medication errors and increase error resolution.
  
  
  METHODS
  Retrospective before-after study.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  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.
authors: Department of Pharmacy, SoutheastHEALTH, Cape Girardeau, Missouri.
authors: Jamie
authors: J
authors: Sanders
authors: Andrea
authors: A
authors: Pallotta
authors: Seth
authors: S
authors: Bauer
authors: Jennifer
authors: J
authors: Sekeres
authors: Ramona
authors: R
authors: Davis
authors: Alan
authors: A
authors: Taege
authors: Elizabeth
authors: E
authors: Neuner
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D017723:Drug Utilization Review; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007297:Inpatients; D008297:Male; D008508:Medication Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D019380:Anti-HIV Agents