Evaluation of human immunodeficiency virus medication errors in a community hospital following the implementation of a pharmacist-led antiretroviral stewardship program

IntroductionCombination antiretroviral therapy has greatly improved survivability in people living with human immunodeficiency virus (PLWH); however, medication-related problems can attenuate virologic suppression and lead to therapeutic failure and drug resistance. The prevalence of antiretroviral (ARV) medication errors in hospitalized PLWH is highly variable, but it is clear that the potential for errors increases with the transition to inpatient care. Pharmacist-led ARV stewardship programs in large, academic institutions have demonstrated reductions in ARV errors during hospitalizations, but the feasibility of such programs in smaller, community hospitals in the Deep South remains unclear. MethodsWe conducted a retrospective quasi-experimental study of non-pregnant, adult PLWH admitted to a community hospital between 2014 and 2018. The primary objective was to compare the percentage of admissions associated with a composite of ARV medication errors (inappropriate regimens, inaccurate dosing, delayed dosing, and major drug-drug interactions [DDIs]) before and after implementation of an ARV stewardship program. ResultsThe percentage of admissions associated with the primary composite of ARV medication errors decreased by 70% between the pre-intervention (56 [70%] of 80 admissions) and post-intervention period (13 [21.3%] of 61 admissions). The percentage of admissions associated with inappropriate ART regimens, major DDIs, and multiple ARV errors all decreased by more than 80%. There was no significant difference in the percentage of admissions associated with renal, non-renal, or delayed dosing errors despite an overall decrease in error frequency. DiscussionA significant reduction in ARV medication error rates comparable to those reported in similar studies conducted at large, academic institutions was observed. The impact of this innovative pharmacist-led ARV stewardship program provides additional evidence of the effectiveness of such programs in community hospitals with modest personnel resources.