Antiretroviral Therapy Errors Common in Community Hospital Setting

11/28/17

More than 60% of patients prescribed antiretroviral therapy (ART) at a large community teaching hospital experienced at least one prescription error, according to data presented at the American Society of Health-System Pharmacists Midyear Clinical Meeting & Exposition (December 3-7, 2017; Orlando, FL).

ART is commonly prescribed for patients living with HIV, due to their ability to reduce viral loads and slow potential CD4 decline. Despite their utility, these therapies are frequently associated with drugfood interactions, and require renal and hepatic dose adjustments. Dose delays or omissions can cause rapid resistance, necessitating the initiation of expensive and complicated new drug regimens.

Paul Lewis, PharmD, BCPS (AQ-ID), pharmacist at Johnson City Medical Center (Johnson City, TN), conducted a retrospective chart review of 67 patients (median age, 49 years; 76.2% men) treated between July 2015 and June 2017 to determine the accuracy of ART scheduling and administration, as well as the correctness of home ART upon hospital admission.

Dr Lewis reviewed charts for evidence of renal and hepatic dosing appropriateness, undocumented dose omissions, documented dose omissions, inappropriate timing of medication administration, drug interactions, delays in ART initiation, and the average duration of therapy without complete ART.

The study included data on 1143 doses, of which 68.9% (n = 787) were administered and 15.7% (n = 180) were held with documentation. The remaining 15.4% (n = 176) of doses were held without documentation.

Dr Lewis observed five patients whose ART was not appropriately renal-adjusted and one patient whose therapy was not held secondary to hepatic disease. Scheduling errors occurred in 25.4% (n = 17) of patients, and 17.9% (n = 12) were inappropriately given medication with food. Three patients experienced an unintentional interchange, and two patients experienced the inappropriate resumption of home medications.

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An analysis of all included patients showed that the average initiation delay for home ART was 25 hours, and the average duration without complete ART was 21 hours. Among patients with a dose admission, the average duration without complete ART was 59 hours (median, 48 hours; range, 12-192).

“Prescribers and pharmacists should practice with a heightened awareness to the many complications with ART initiation and continuation,” Dr Lewis said. “Further studies are needed to explore error-reducing strategies.”Cameron Kelsall