Errors in prescribing HIV-1 protease inhibitors

OBJECTIVE: The purpose of this study was to describe and quantify errors in dosage frequency associated with written medical orders, compared to manufacturer's recommendations and current therapeutic recommendations for protease inhibitors, for persons living with HIV disease/AIDS who were receiving home care services. METHODS: A convenience sample was used for a univariate descriptive study to collect information from client records on the dosing intervals prescribed for three protease inhibitors: indinavir, ritonavir, and saquinavir. The study took place between December 1, 1996, and January 15, 1997, at a certified home health agency (CHHA) in New York City. The final sample accrued consisted of 202 adults who were receiving home care. The mean age of the sample was 42 years (SD = 9.43), ranging from 24 to 69 years. The majority were people of color, and Medicaid was the principle payor source for all health care needs. The main outcome measure was the number of errors in dosage frequency documented in written medical orders for protease inhibitors RESULTS: Protease inhibitors were ordered for 91 (45.1%) of the sample. Of the total number of medical orders for protease inhibitors, according to manufacturer's recommendations and current therapeutic recommendations, incorrect dosing schedules were noted in 36 (39.6%) of the records. Additional findings included errors in the dosages of drug prescribed and orders for protease inhibitors as monotherapy. CONCLUSIONS: Errors identified with ordering protease inhibitors included the incorrect frequency, the incorrect dose, and the ordering of protease inhibitor as a monotherapeutic agent instead of in combination with other recommended antiretroviral agents. Making clinicians aware of these problems may assist in reducing the incidence of these errors.