title: Impact of Stewardship Interventions on Antiretroviral Medication Errors in an Urban Medical Center: A 3-Year, Multiphase Study.
abstract: BACKGROUND
  There is a high prevalence of HIV infection in Newark, New Jersey, with University Hospital admitting approximately 600 HIV-infected patients per year. Medication errors involving antiretroviral therapy (ART) could significantly affect treatment outcomes. The goal of this study was to evaluate the effectiveness of various stewardship interventions in reducing the prevalence of prescribing errors involving ART.
  
  
  METHODS
  This was a retrospective review of all inpatients receiving ART for HIV treatment during three distinct 6-month intervals over a 3-year period. During the first year, the baseline prevalence of medication errors was determined. During the second year, physician and pharmacist education was provided, and a computerized order entry system with drug information resources and prescribing recommendations was implemented. Prospective audit of ART orders with feedback was conducted in the third year. Analyses and comparisons were made across the three phases of this study.
  
  
  RESULTS
  Of the 334 patients with HIV admitted in the first year, 45% had at least one antiretroviral medication error and 38% had uncorrected errors at the time of discharge. After education and computerized order entry, significant reductions in medication error rates were observed compared to baseline rates; 36% of 315 admissions had at least one error and 31% had uncorrected errors at discharge. While the prevalence of antiretroviral errors in year 3 was similar to that of year 2 (37% of 276 admissions), there was a significant decrease in the prevalence of uncorrected errors at discharge (12%) with the use of prospective review and intervention.
  
  
  CONCLUSIONS
  Interventions, such as education and guideline development, can aid in reducing ART medication errors, but a committed stewardship program is necessary to elicit the greatest impact.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, New York.
authors.forename: Jason
authors.initials: J
authors.lastname: Zucker
authors.affiliation: Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey.
authors.forename: Jaimie
authors.initials: J
authors.lastname: Mittal
authors.affiliation: Pharmaceutical Care Division, University Hospital, Newark, New Jersey.
authors.forename: Shin-Pung
authors.initials: SP
authors.lastname: Jen
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, New York.
authors.forename: Lucy
authors.initials: L
authors.lastname: Cheng
authors.affiliation: Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey.
authors.forename: David
authors.initials: D
authors.lastname: Cennimo
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004502:Education, Medical, Continuing / Q000458:organization & administration; D004513:Education, Pharmacy, Continuing / Q000458:organization & administration; D055695:Electronic Prescribing / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006785:Hospitals, University / Q000592:standards / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control / Q000706:statistics & numerical data; D008875:Middle Aged; D009515:New Jersey; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: ART therapy; HIV management; stewardship