Impact of an antiretroviral stewardship strategy on medication error rates

Shea, Katherine M.; Hobbs, Athena L V; Shumake, Jason; Templet, Derek J.; Padilla-Tolentino, Eimeira; Mondy, Kristin

doi:10.2146/ajhp170420

Cited by 21 publications

(24 citation statements)

References 21 publications

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“…50 Shea et al demonstrated that the combination of prescriber education and pharmacist-led medication reconciliation was effective in reducing prescribing errors. 52 However, the combination of prescriber education and CPOE in the study by Daniels et al did not reduce prescribing errors. 48 Cann et al applied prescriber education (PE) and pharmacist partnership in an acute surgical ward, with no significant change in medication errors with 12.0 errors at pre-intervention and 10.9 errors per 100,000 patient hours [relative risk (RR) 0.92, 95% confidence interval (CI) 0.40-2.08, p = 0.835].…”

Section: Combining Intervention Typesmentioning

confidence: 90%

“…38 However, it is difficult to deduce the individual effect of prescriber education when combined with other interventions. 47,48,52,53 One cluster randomised trial investigated the effect of e-learning tools in comparison to pharmacists' targeted feedback and education. 38 In this study, prescribing errors showed no change in medication errors after prescribers finished e-learning modules.…”

Section: Discussionmentioning

confidence: 99%

“…23,51 The most common study design was a pre-post intervention design, used in 20 studies. 27,28,[30][31][32][35][36][37]40,[44][45][46][47][48][49][50][51][52][53][54] Nine studies were randomised controlled trials (RCTs. 21,[23][24][25][26]38,39,41,43 There were two quality improvement studies, 42,29 one study involved a prospective chart review with a historical control, 22 one study involved an interrupted time series design 34 and one study comprised a prospective observational design.…”

Section: Study and Patient Characteristicsmentioning

confidence: 99%

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Interventions to reduce medication errors in adult medical and surgical settings: a systematic review

Manias

Kusljic

2020

Therapeutic Advances in Drug Safety

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Background and Aims: Medication errors occur at any point of the medication management process, and are a major cause of death and harm globally. The objective of this review was to compare the effectiveness of different interventions in reducing prescribing, dispensing and administration medication errors in acute medical and surgical settings. Methods: The protocol for this systematic review was registered in PROSPERO (CRD42019124587). The library databases, MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were searched from inception to February 2019. Studies were included if they involved testing of an intervention aimed at reducing medication errors in adult, acute medical or surgical settings. Meta-analyses were performed to examine the effectiveness of intervention types. Results: A total of 34 articles were included with 12 intervention types identified. Meta-analysis showed that prescribing errors were reduced by pharmacist-led medication reconciliation, computerised medication reconciliation, pharmacist partnership, prescriber education, medication reconciliation by trained mentors and computerised physician order entry (CPOE) as single interventions. Medication administration errors were reduced by CPOE and the use of an automated drug distribution system as single interventions. Combined interventions were also found to be effective in reducing prescribing or administration medication errors. No interventions were found to reduce dispensing error rates. Most studies were conducted at single-site hospitals, with chart review being the most common method for collecting medication error data. Clinical significance of interventions was examined in 21 studies. Since many studies were conducted in a pre–post format, future studies should include a concurrent control group. Conclusion: The systematic review identified a number of single and combined intervention types that were effective in reducing medication errors, which clinicians and policymakers could consider for implementation in medical and surgical settings. New directions for future research should examine interdisciplinary collaborative approaches comprising physicians, pharmacists and nurses. Lay summary Activities to reduce medication errors in adult medical and surgical hospital areas Introduction: Medication errors or mistakes may happen at any time in hospital, and they are a major reason for death and harm around the world. Objective: To compare the effectiveness of different activities in reducing medication errors occurring with prescribing, giving and supplying medications in adult medical and surgical settings in hospital. Methods: Six library databases were examined from the time they were developed to February 2019. Studies were included if they involved testing of an activity aimed at reducing medication errors in adult medical and surgical settings in hospital. Statistical analysis was used to look at the success of different types of activities. Results: A total of 34 studies were included with 12 activity types identified. Statistical analysis showed that prescribing errors were reduced by pharmacists matching medications, computers matching medications, partnerships with pharmacists, prescriber education, medication matching by trained physicians, and computerised physician order entry (CPOE). Medication-giving errors were reduced by the use of CPOE and an automated medication distribution system. The combination of different activity types were also shown to be successful in reducing prescribing or medication-giving errors. No activities were found to be successful in reducing errors relating to supplying medications. Most studies were conducted at one hospital with reviewing patient charts being the most common way for collecting information about medication errors. In 21 out of 34 articles, researchers examined the effect of activity types on patient harm caused by medication errors. Many studies did not involve the use of a control group that does not receive the activity. Conclusion: A number of activity types were shown to be successful in reducing prescribing and medication-giving errors. New directions for future research should examine activities comprising health professionals working together.

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Section: Combining Intervention Typesmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Study and Patient Characteristicsmentioning

confidence: 99%

See 1 more Smart Citation

Interventions to reduce medication errors in adult medical and surgical settings: a systematic review

Manias

Kusljic

2020

Therapeutic Advances in Drug Safety

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“…This study reinforces the impact an HIV-trained clinical pharmacist can have on reducing inpatient medication error rates related to ART and OI medications. Previous studies have demonstrated the impact of pharmacist-led interventions on reductions in ART errors [ 2 , 17–20 , 27 ]. The value of a dedicated, multidisciplinary, ARV stewardship team has also proven benefit in reduction of inpatient ART medication error rates [ 7 , 9 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of Pharmacist-Driven Antiretroviral Stewardship and Transitions of Care Interventions on Persons With Human Immunodeficiency Virus

Brizzi

Burgos

Chiampas

et al. 2020

Open Forum Infectious Diseases

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Background Persons with human immunodeficiency virus (HIV) experience high rates of medication-related errors when admitted to the inpatient setting. Data are lacking on the impact of a combined antiretroviral (ARV) stewardship and transitions of care (TOC) program. We investigated the impact of a pharmacist-driven ARV stewardship and TOC program in persons with HIV. Methods This was a retrospective, quasi-experimental analysis evaluating the impact of an HIV-trained clinical pharmacist on hospitalized persons with HIV. Patients included in the study were adults following up, or planning to follow up, at the University of Illinois (UI) outpatient clinics for HIV care and admitted to the University of Illinois Hospital. Data were collected between July 1, 2017 and December 31, 2017 for the preimplementation phase and between July 1, 2018 and December 31, 2018 for the postimplementation phase. Primary and secondary endpoints included medication error rates related to antiretroviral therapy (ART) and opportunistic infection (OI) medications, all-cause readmission rates, medication access at time of hospital discharge, and linkage to care rates. Results A total of 128 patients were included in the study: 60 in the preimplementation phase and 68 in the postimplementation phase. After the implementation of this program, medication error rates associated with ART and OI medications decreased from 17% (10 of 60) to 6% (4 of 68) (P = .051), 30-day all-cause readmission rates decreased significantly from 27% (16 of 60) to 12% (8 of 68) (P = .03), and linkage to care rates increased significantly from 78% (46 of 59) to 92% (61 of 66) (P = .02). Conclusions A pharmacist-led ARV stewardship and TOC program improved overall care of persons with HIV through reduction in medication error rates, all-cause readmission rates, and an improvement in linkage to care rates.

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“…[10][11][12][13][14] Antiretroviral stewardship programs (ARVSPs) have been shown to decrease medication error rates and improve other outcomes. [15][16][17][18][19][20] This article reviews published literature on ARVSPs and provides guidance on key aspects of ARVSPs for those looking to implement programs at their institutions.…”

Section: Introductionmentioning

confidence: 99%

Antiretroviral Stewardship: A Review of Published Outcomes with Recommendations for Program Implementation

Michienzi

Ladak

Pérez

et al. 2020

J Int Assoc Provid AIDS Care

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Persons living with HIV (PLWHs) are at high risk for medication errors when hospitalized, but antiretroviral medications are not often evaluated by antimicrobial stewardship programs (ASPs) because they are not specifically discussed in the standards of practice. However, antiretroviral (ARV) stewardship programs (ARVSPs) have been shown to decrease medication error rates and improve other outcomes. The goal of this article is to review published literature on ARVSPs and provide guidance on key aspects of ARVSPs. A MEDLINE search using the term “antiretroviral stewardship” was conducted. Original research articles evaluating ARVSPs in hospitalized, adult PLWHs were included. Six original research articles evaluating unique inpatient ARVSPs met inclusion criteria. All 6 studies evaluating medication errors as the primary outcome found a significant reduction in errors in the postimplementation phase. Based on current standards for ASPs, we propose core elements for ARVSPs. Future organizational guidelines for antimicrobial stewardship should include official recommendations for ARV medications.

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Impact of an antiretroviral stewardship strategy on medication error rates

Abstract: An antiretroviral stewardship strategy for hospitalized HIV patients including prospective audit by staff pharmacists through use of an antiretroviral medication therapy checklist at the time of order verification decreased error rates.

Cited by 21 publications

References 21 publications

Interventions to reduce medication errors in adult medical and surgical settings: a systematic review

Interventions to reduce medication errors in adult medical and surgical settings: a systematic review

Impact of Pharmacist-Driven Antiretroviral Stewardship and Transitions of Care Interventions on Persons With Human Immunodeficiency Virus

Antiretroviral Stewardship: A Review of Published Outcomes with Recommendations for Program Implementation

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