Antiretroviral medication errors among hospitalized patients with HIV infection

Background. Highly active antiretroviral therapy (HAART) has improved survival for persons living with human immunodeficiency virus (HIV) infection. However, effective therapy requires high levels of adherence over extended periods of time. Previous studies suggest that patients receiving long-term medication are at risk for unintended medication discrepancies at the time of hospital admission. Methods. We retrospectively identified every HIV-infected patient admitted to our hospital over a 1-year period who received an antiretroviral agent. We collected information on medications and renal function from the hospital computerized provider order entry system. We reviewed the medical records for those admissions for which a potential error was identified. We defined errors using Department of Health and Human Services guidelines and included only those errors that were not corrected within 24 h after initial entry. Results. There were a total of 209 admissions during a 1-year period in which an HIV-infected patient received antiretroviral therapy. After review of the medical records for 77 admissions with a potential error, 61 uncorrected errors from 54 admissions were identified (percentage of total admissions, 25.8%; 95% confidence interval, 20.1%-32.3%). The most common type of error was an error with respect to the amount or frequency of dosage, which occurred in 34 (16.3%) of the admissions; 18 of these errors were attributable to failure to appropriately adjust dosage for renal insufficiency. The next most common error was combining antiretroviral drugs with a contra-indicated medication; this occurred in 12 (5.2%) of the admissions. Patients erroneously received ≤2 antiretroviral agents in 8 (3.8%) of the admissions and had an unexplained delay in continuing HAART in 7 (3.3%). Conclusions. HIV-infected patients receiving HAART are at substantial risk for antiretroviral medication errors at the time of hospitalization. More needs to be done to ensure that these patients receive appropriate therapy during their inpatient stay.