Customized order-entry sets can prevent antiretroviral prescribing errors: A novel opportunity for antimicrobial stewardship

Yi Guo, Philip Chung, Caryn Weiss, Keith Veltri, Grace Y. Minamoto

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Patients with human immunodeficiency virus (HIV) infection on antiretroviral (ARV) therapy are at increased risk for medication errors during transitions of care between the outpatient and inpatient settings. This can lead to treatment failure or toxicity. Previous studies have emphasized the prevalence of medication errors in such patients, but few have reported initiatives to prevent errors from occurring. Methods: The study was conducted in a 1,400-bed health care center with a state-designated Acquired Immunodeficiency Syndrome (AIDS) Center in the Bronx, New York. The antimicrobial stewardship team and HIV specialists developed customized order-entry sets (COES) to guide ARV prescribing and retrospectively reviewed their effect on error rates of initial ARV orders for inpatients before reconciliation. Patient records were reviewed in six-month periods before and after intervention. The student’s t-test or Mann–Whitney U test was used to compare continuous variables; chi-square or Fisher’s exact test was used for categorical variables. Results: A total of 723 and 661 admissions were included in the pre-intervention and post-intervention periods, respectively. Overall, error rates decreased by 35% (38.0% to 24.8%, P < 0.01) with COES. Wrong doses and drug interactions decreased by more than 40% (P < 0.005). Error reductions were observed in protease inhibitor (PI)-based (43.6% versus 28.7%, P < 0.01) and non–PI-based (38.0% versus 24.4%, P = 0.02) regimens with COES. A shift in predominant drug-class errors was observed as there was a trend toward increased usage of non-PI regimens post-intervention. Admission in the pre-intervention period (adjusted odds ratio [AOR], 1.79; 95% confidence interval [CI], 1.39–2.31) and use of PI-based regimens (AOR, 2.03; 95% CI, 1.53–2.70) remained significantly associated with ARV prescribing errors after controlling for confounding factors. Conclusion: Detailed COES improved ARV prescribing habits, reduced the potential for prescribing incorrect regimens, and can prove useful and cost-effective where HIVspecific medication reconciliation is unavailable.

Original languageEnglish (US)
Pages (from-to)353-360
Number of pages8
JournalP and T
Volume40
Issue number5
StatePublished - 2015

Fingerprint

Medication Errors
Protease Inhibitors
Inpatients
Medication Reconciliation
Odds Ratio
HIV
Confidence Intervals
Patient Transfer
Virus Diseases
Treatment Failure
Drug Interactions
Habits
Acquired Immunodeficiency Syndrome
Outpatients
Students
Delivery of Health Care
Costs and Cost Analysis
Pharmaceutical Preparations
Therapeutics

Keywords

  • Antimicrobial stewardship
  • ARV
  • Computerized order entry
  • HIV
  • Medication errors

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

Customized order-entry sets can prevent antiretroviral prescribing errors : A novel opportunity for antimicrobial stewardship. / Guo, Yi; Chung, Philip; Weiss, Caryn; Veltri, Keith; Minamoto, Grace Y.

In: P and T, Vol. 40, No. 5, 2015, p. 353-360.

Research output: Contribution to journalArticle

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AU - Minamoto, Grace Y.

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