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For Inpatients, HIV Medication Errors Common — Then Promptly Corrected

Posted Jun 17 2012 7:09am

Several papers have shown that antiretrovirals may be incorrectly prescribed for hospitalized patients with HIV. How do they do at Johns Hopkins — the site of one of the best comprehensive HIV programs in the country (and perennial US News and World Report #1 Hospital in the Universe)?

As described in a  new CID paper , investigators reviewed ART medication orders from all hospital admissions among HIV-infected patients in 2009 (702 admissions among 388 patients). In 380 admissions, ART was prescribed on the first day of hospitalization, and in 29% of these, a medication error occurred (145 total). By the second day of hospitalization, however, the error rate had dropped to 7%.

The most common errors were incomplete regimens (for example, prescribing only the PI component and leaving off the NRTIs), but incorrect doses, incorrect dosing frequency, and significant drug-drug interactions were also noted.

Not surprisingly, errors were more common with PI-based components, as these have a wider range of recommended doses, generally require ritonavir, and have more drug-drug interactions. (Plus, let’s face it it’s easier to get right single pill regimens — Atripla one PO QHS — than salvage regimens, pretty much all of which include boosted PIs.) There were significantly more errors on surgical services. The authors attribute the rapid correction of medication errors to their using clinical pharmacy review of medication orders.

These results are certainly consistent with our experience as well:  Patients with HIV who require hospitalization often report that on the first day in the hospital, the regimens that they have been taking so meticulously are given incorrectly.

Since hospitalizations among HIV patients are steadily declining, and the vast majority of antiretrovirals are prescribed by a relatively small number of clinicians, we can’t expect hospitalists and medical housestaff to be familiar with these medications. Having them reviewed by a clinical specialist in HIV is critical — a practice we’ve adopted at our hospital as well.

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