Impact of a pharmacy-initiated HIV admission note on medication errors within an academic hospital

Purpose: Medication errors occur frequently in the medical management of patients infected with human immunodeficiency virus (HIV). Recent studies propose the use of a pharmacy admission note to help identify and preventsuch errors during hospitalization. However, a clear reduction in the number of antiretroviral medication errors utilizing an admission note within a large, academic hospital has yet to be confirmed. Methods: A retrospective, chart-review of hospitalized HIV-seropositive patients 1 year prior to and after implementation of an admission note policy was performed with the expedited Institutional Review Board (IRB) approval. Antiretroviral medication errors were identified and compared to documented pharmacy interventions at the time of admission. Results: Twenty-seven antiretroviral medication errors existed in the pre-policy period (n = 32 admissions), with no identification or correction by pharmacy services at the time of admission. Forty-six antiretroviral medication errors were detected in the post-policy period (n = 59 admissions), of which three errors were identified in pharmacy admission notes. Common antiretroviral medication errors in the pre-policy period included incorrect dosing frequency (33.3%) and incorrect drug strength (33.3%). This contrasts with the post-policy period, during which the most frequent antiretroviral medication errors included missing antiretroviral components of known regimens (19.6%) and lack of renal or hepatic dosage adjustment (15.2%). Overall, no improvement in detection and reconciliation of medication errors occurred with admission note implementation. Conclusions: Potential obstacles in the effective use of an admission note to reduce errors do exist. Strategies for improved outcomes in our academic hospital will focus on improved training of general pharmacy staff in HIV management, providing accessible online resources, and emphasizing reconciliation between outpatient and inpatient medication regimens.