How Pharmacists Can Reduce Medication Errors Among HIV Patients

The transition from an acute hospitalization back into the community introduces ample opportunities for medication errors, and HIV patients who need dosage adjustments and intense monitoring are particularly liable to them.

Complex disease states heighten the danger of errors. In addition, transitions of care can affect adherence, which is especially important for HIV patients because missed doses can cause viral resistance and treatment failure.

Past studies have shown that ineffective antiretroviral regimens, improper dosing and frequency, and drug interactions are the most common medication errors in HIV patients. Now, an article published ahead-of-print in HIV Medicine indicates that pharmacists can reduce transition-of-care medication errors in hospitalized HIV patients.

The researchers conducted a retrospective observational study with 12-month follow-up at a single tertiary medical center in Oklahoma between September 2011 and September 2013.

Participants received standard of care in the first 12 months, but in the second half of the study, pharmacists monitored patients at admission and daily during hospitalization.

Medication errors decreased by 73.9% after pharmacist monitoring implementation, compared with the first 12 months of the study period. The pharmacist interventions decreased incorrect dosing by 90%, eliminated incorrect frequency errors, and decreased drug interactions by two-thirds.

The study authors found drug interactions to be the most common error, most likely driven by the aging HIV population’s increasingly complex medication regimens. In addition, patients with renal dysfunction (CrCl less than 50 mL/min) are more likely to have medication errors because nucleoside reverse transcriptase inhibitors need renal dosing adjustments.

Regimen errors decreased slightly from 6 instances before intervention and to 5 instances after. This relatively minor change could have been due to the fact that there was a small initial error rate, and because of the recurrent hospitalization of a single patient with therapeutic control on a nonrecommended dual antiretroviral regimen.

Patients taking protease inhibitors are more likely to experience a medication error than those receiving non-nucleoside reverse transcriptase inhibitors (NNRTIs). The protease inhibitor class, and particularly ritonavir, is fraught with drug interactions and comparatively more complex administration (eg, more frequent dosing per day) than NNRTIs.

This study was one of the largest reviews to examine the impact of pharmacist monitoring of HIV patients’ regimens. Its findings show that pharmacists can improve patient outcomes and reduce unnecessary health care spending related to medication errors.