Evaluation of medication errors in patients infected with human immunodeficiency virus treated with antiretroviral therapy

Medication errors occur in 5–30% of hospitalized patients infected with human immunodeficiency virus (HIV)-infected patients, considerably higher than rates reported in non-HIV-infected individuals.1,–3 This high rate of medication errors is concerning because patient adherence to antiretroviral therapy is essential for reducing viral load, preventing HIV-associated complications, and minimizing drug resistance.4 We conducted a study to assess the frequency of antiretroviral therapy errors and evaluate specific types of errors at admission. Errors attributable to prescribing or dispensing were also noted. This prospective study was conducted at a large academic medical center. The majority of HIV-infected patients admitted to this center are referred from an HIV clinic, which currently serves over 5000 patients with HIV or acquired immune deficiency syndrome (AIDS). The study protocol was reviewed and approved by the medical center’s institutional review board. HIV-infected patients admitted to the medical center between February and April 2010 were included if they were at least 18 years old and were receiving antiretroviral therapy before admission. Patients’ last antiretroviral prescription had to be filled within the 35 days before admission to indicate adherence and reflect their most current regimen. Patients receiving antiretroviral therapy for prophylaxis were excluded. An electronically generated list with antiretroviral therapy orders written in the previous 24 hours was used to identify eligible patients. The orders were compared with their outpatient regimen, which was obtained from medical or pharmacy records. When an error was identified, a pharmacy practice resident, with assistance from a clinical pharmacy specialist in infectious diseases, contacted prescribers to correct all antiretroviral therapy errors and address any potential drug–drug interactions. Recommendations were made to prescribers based on 2009 practice guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents, the most recent version at the time.5