Use of EMR Does Not Reduce Prescription Drug Errors with HIV Medications

Study results presented at IDWeek 2012 in San Diego show that the EMR use by hospitals does not curb high rates of medication errors involving the complex antiretroviral regimens used in HIV treatment.

Despite technological advances in electronic medical record (EMR) systems, the rate of computerized prescription errors in hospital admissions of patients with HIV hover as high as 50%, according to data from three studies presented at IDWeek 2012, the first joint annual meeting of the Infectious Diseases Society of America (ISDSA), Society for Healthcare Epidemiology of America (SHEA), HIV Medicine Association (HIVMA), and Pediatric Infectious Diseases Society (PIDS).

The complexity of HIV treatments contribute to the problem, especially when people entering data into the EMR may not know enough about the drugs to spot errors such as a harmful drug to drug interactions, according to researchers.

One retrospective study conducted at the Cleveland Clinic in 2011 looked at 162 admission charts of patients with HIV and found a 50% error rate in antiretroviral therapy (HAART) prescriptions, according to lead researcher Elizabeth Neuner, PharmD. Furthermore, two-thirds of those mistakes were never identified before patients went home.

“This told us that medication errors with antiretrovirals and opportunistic infection medications occurred commonly in 50% of our admissions and that a majority of them were not resolved by the time that they were discharged,” Neuner said.

The changing nature of HIV care and treatment may explain the high volume of mistakes because many hospital physicians are less familiar with HAART regimens now that more and more care is done in outpatient settings, according to Neuner, an infectious disease clinical pharmacist at the Cleveland Clinic.

The high error rate increases the chances that patients with HIV might be given the wrong drugs, and that could lead to treatment failure or toxicity through dosage, timing, or other medication errors, the researchers said.

To address the study findings, the Cleveland Clinic adopted quality improvement measures to educate all inpatient pharmacists about potentially harmful drug interactions with HAART medications and gave suggestions on how to better coordinate care between inpatient and outpatient settings. Computerized dosing and frequency alerts were also added to the Clinic’s EMR system.

Similar errors were found in an 18-month study at the University of Chicago Medical Center that reviewed 155 HAART regimens connected to patient admission records. Nearly half the initial hospital-prescribed regimens required modification, according to lead research Natasha Pettit, PharmD, a University of Chicago Medicine clinical pharmacy specialist.

“Seeing that high of an error rate was obviously surprising to us because at our institution we are using computerized physician order entry systems,” Pettit said.

In response, the center developed a detailed dosing guideline that also addresses drug to drug interactions, and how and when to consider medication adjustments. On the technology front, it addedan EMR computer link to the guideline so that it can be easily referenced during ordering of drugs, Pettit said.

To resolve the multiple drug errors that occurred during admission lead researcher Jean Lee, PharmD, said her HIV outpatient clinic set out to enter and maintain patients’ HAART prescriptions in a hospital’s EMR system. The shared information meant emergency department doctors could switch the regimen from outpatient to inpatient with a simple computer click. The changed resulted in fewer medical errors and better care for the clinic patients when they were hospitalized, Lee said.