title: Impact of an electronic medical record on the incidence of antiretroviral prescription errors and HIV pharmacist reconciliation on error correction among hospitalized HIV-infected patients.
abstract: BACKGROUND
  Previous review of admissions from 2009-2011 in our institution found a 35.1% error rate in antiretroviral (ART) prescribing, with 55% of errors never corrected. Subsequently, our institution implemented a unified electronic medical record (EMR) and we developed a medication reconciliation process with an HIV pharmacist. We report the impact of the EMR on incidence of errors and of the pharmacist intervention on time to error correction.
  
  
  METHODS
  Prospective medical record review of HIV-infected patients hospitalized for >24 h between 9 March 2013 and 10 March 2014. An HIV pharmacist reconciled outpatient ART prescriptions with inpatient orders within 24 h of admission. Prescribing errors were classified and time to error correction recorded. Error rates and time to correction were compared to historical data using relative risks (RR) and logistic regression models.
  
  
  RESULTS
  43 medication errors were identified in 31/186 admissions (16.7%). The incidence of errors decreased significantly after EMR (RR 0.47, 95% CI 0.34, 0.67). Logistic regression adjusting for gender and race/ethnicity found that errors were 61% less likely to occur using the EMR (95% CI 40%, 75%; P<0.001). All identified errors were corrected, 65% within 24 h and 81.4% within 48 h. Compared to historical data where only 31% of errors were corrected in <24 h and 55% were never corrected, errors were 9.4× more likely to be corrected within 24 h with HIV pharmacist intervention (P<0.001).
  
  
  CONCLUSIONS
  Use of an EMR decreased the error rate by more than 50% but despite this, ART errors remained common. HIV pharmacist intervention was key to timely error correction.
authors.affiliation: Department of Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Rishi
authors.initials: R
authors.lastname: Batra
authors.forename: Jane
authors.initials: J
authors.lastname: Wolbach-Lowes
authors.forename: Susan
authors.initials: S
authors.lastname: Swindells
authors.forename: Kimberly K
authors.initials: KK
authors.lastname: Scarsi
authors.forename: Anthony T
authors.initials: AT
authors.lastname: Podany
authors.forename: Harlan
authors.initials: H
authors.lastname: Sayles
authors.forename: Uriel
authors.initials: U
authors.lastname: Sandkovsky
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D057286:Electronic Health Records; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1 / Q000187:drug effects; D006760:Hospitalization; D006801:Humans; D008297:Male; D008508:Medication Errors; D010595:Pharmacists; D011446:Prospective Studies
chemical_list: D044966:Anti-Retroviral Agents