Impact of an Electronic Medical Record on the Incidence of Antiretroviral Prescription Errors and HIV Pharmacist Reconciliation on Error Correction among Hospitalized HIV-Infected Patients. Issue 5 (July 2015)

• Record Type: Journal Article
• Authors: Batra, Rishi; Wolbach-Lowes, Jane; Swindells, Susan; Scarsi, Kimberly K; Podany, Anthony T; Sayles, Harlan; Sandkovsky, Uriel
• Is Part Of: Antiviral therapy. Volume 20:Issue 5(2015)
• Page Start: 555
• Page End: 559
• Publication Date: 2015-07
• Subjects: Antiviral agents -- Periodicals; Antiviral Agents -- therapeutic use; Virus Diseases -- therapy; Viruses -- drug effects; Antiviral agents; Periodical; Electronic journals; Periodicals; 616.9106
• DOI: 10.3851/IMP2930
• Languages: English
• ISSNs: 1359-6535

Abstract

Background: Previous review of admissions from 2009–2011 in our institution found a 35.1% error rate in antiretroviral (ART) prescribing, with 55% of errors never corrected. Subsequently, our institution implemented a unified electronic medical record (EMR) and we developed a medication reconciliation process with an HIV pharmacist. We report the impact of the EMR on incidence of errors and of the pharmacist intervention on time to error correction. Methods: Prospective medical record review of HIV-infected patients hospitalized for >24 h between 9 March 2013 and 10 March 2014. An HIV pharmacist reconciled outpatient ART prescriptions with inpatient orders within 24 h of admission. Prescribing errors were classified and time to error correction recorded. Error rates and time to correction were compared to historical data using relative risks (RR) and logistic regression models. Results: 43 medication errors were identified in 31/186 admissions (16.7%). The incidence of errors decreased significantly after EMR (RR 0.47, 95% CI 0.34, 0.67). Logistic regression adjusting for gender and race/ethnicity found that errors were 61% less likely to occur using the EMR (95% CI 40%, 75%; P <0.001). All identified errors were corrected, 65% within 24 h and 81.4% within 48 h. Compared to historical data where only 31% of errors were corrected in <24 h and 55% were never corrected, errors were 9.4 xmore likely to be corrected within 24 h with HIV pharmacist intervention ( P <0.001). Conclusions: Use of an EMR decreased the error rate by more than 50% but despite this, ART errors remained common. HIV pharmacist intervention was key to timely error correction.