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

Rishi Batra, Jane Wolbach-Lowes, Susan Swindells, Kimberly K Scarsi, Anthony T Podany, Harlan Sayles, Uriel Sandkovsky

Research output: Contribution to journalArticle

6 Citations (Scopus)

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 HIVinfected 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× more 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.

Original languageEnglish (US)
Pages (from-to)555-559
Number of pages5
JournalAntiviral Therapy
Volume20
Issue number5
DOIs
StatePublished - Jan 1 2015

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Electronic Health Records
Pharmacists
Prescriptions
HIV
Incidence
Logistic Models
Medication Reconciliation
Medication Errors
Medical Records
Inpatients
Outpatients

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

@article{e080ecf4fff245ffb1c6b7384f06b9da,
title = "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",
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 HIVinfected 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× more 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.",
author = "Rishi Batra and Jane Wolbach-Lowes and Susan Swindells and Scarsi, {Kimberly K} and Podany, {Anthony T} and Harlan Sayles and Uriel Sandkovsky",
year = "2015",
month = "1",
day = "1",
doi = "10.3851/IMP2930",
language = "English (US)",
volume = "20",
pages = "555--559",
journal = "Antiviral Therapy",
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TY - JOUR

T1 - 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

AU - Batra, Rishi

AU - Wolbach-Lowes, Jane

AU - Swindells, Susan

AU - Scarsi, Kimberly K

AU - Podany, Anthony T

AU - Sayles, Harlan

AU - Sandkovsky, Uriel

PY - 2015/1/1

Y1 - 2015/1/1

N2 - 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 HIVinfected 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× more 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.

AB - 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 HIVinfected 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× more 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.

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U2 - 10.3851/IMP2930

DO - 10.3851/IMP2930

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JF - Antiviral Therapy

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