Zucker Jason, Mittal Jaimie, Jen Shin-Pung, Cheng Lucy, Cennimo David
Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, New York.
Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey.
Pharmacotherapy. 2016 Mar;36(3):245-51. doi: 10.1002/phar.1716. Epub 2016 Mar 6.
There is a high prevalence of HIV infection in Newark, New Jersey, with University Hospital admitting approximately 600 HIV-infected patients per year. Medication errors involving antiretroviral therapy (ART) could significantly affect treatment outcomes. The goal of this study was to evaluate the effectiveness of various stewardship interventions in reducing the prevalence of prescribing errors involving ART.
This was a retrospective review of all inpatients receiving ART for HIV treatment during three distinct 6-month intervals over a 3-year period. During the first year, the baseline prevalence of medication errors was determined. During the second year, physician and pharmacist education was provided, and a computerized order entry system with drug information resources and prescribing recommendations was implemented. Prospective audit of ART orders with feedback was conducted in the third year. Analyses and comparisons were made across the three phases of this study.
Of the 334 patients with HIV admitted in the first year, 45% had at least one antiretroviral medication error and 38% had uncorrected errors at the time of discharge. After education and computerized order entry, significant reductions in medication error rates were observed compared to baseline rates; 36% of 315 admissions had at least one error and 31% had uncorrected errors at discharge. While the prevalence of antiretroviral errors in year 3 was similar to that of year 2 (37% of 276 admissions), there was a significant decrease in the prevalence of uncorrected errors at discharge (12%) with the use of prospective review and intervention.
Interventions, such as education and guideline development, can aid in reducing ART medication errors, but a committed stewardship program is necessary to elicit the greatest impact.
新泽西州纽瓦克市的艾滋病毒（HIV）感染率很高，大学医院每年收治约600名HIV感染患者。涉及抗逆转录病毒疗法（ART）的用药错误可能会显著影响治疗效果。本研究的目的是评估各种管理干预措施在降低ART处方错误发生率方面的有效性。
这是一项对3年内3个不同的6个月期间接受ART治疗HIV的所有住院患者的回顾性研究。在第一年，确定用药错误的基线发生率。在第二年，提供医生和药剂师教育，并实施带有药物信息资源和处方建议的计算机化医嘱录入系统。在第三年对ART医嘱进行前瞻性审核并提供反馈。对本研究的三个阶段进行分析和比较。
在第一年收治的334例HIV患者中，45%至少有1次抗逆转录病毒用药错误，38%在出院时有未纠正的错误。经过教育和计算机化医嘱录入后，与基线发生率相比，用药错误率显著降低；在315例入院患者中，36%至少有1次错误，31%在出院时有未纠正的错误。虽然第3年抗逆转录病毒错误的发生率与第2年相似（276例入院患者中的37%），但通过前瞻性审核和干预，出院时未纠正错误的发生率显著降低（12%）。
教育和制定指南等干预措施有助于减少ART用药错误，但需要一个坚定的管理计划才能产生最大影响。
