STATEMENT OF DISCLOSURE

Size: px

Start display at page:

Download "STATEMENT OF DISCLOSURE"

Annabel Stevens
5 years ago
Views:

2 STATEMENT OF DISCLOSURE Presenter has no relevant financial relationships with commercial interests pertaining to the contents of this program ARB 2

3 OBJECTIVES Define medication errors and discuss data relative to medication errors in the HIV-infected populace Review the continuum of medication administration Identify types and causes of medication errors in the HIV-infected population Review examples of HIV-related medication errors Discuss strategies to reduce medication errors ARB 3

4 WHAT IS A MEDICATION ERROR? Error - an act of commission or omission that leads to an undesirable outcome or significant potential for such an outcome 1 Medication error - any preventable event that may cause or lead to inappropriate medication use or harm to a patient 2 ARB 4

5 STATISTICS > 95,000 documented medication error reports received by FDA since Per IOM s To Err Is Human, ~7,000 US deaths/yr due to preventable medication errors 3 Medication errors are still frequently made despite the inception of EMR 4 ARB 5

6 HIV MEDICATION ERRORS: CLINICAL STUDY UNIVERSITY OF NC HOSPITAL 5 Prospective investigation over a 4-month period in 2006 Review of initial inpatient regimen, during hospitalization, and upon discharge Of 68 hospitalized HIV+ patients, errors occurred with 49 (72%) 2 methods used to define errors Source prescribing (45%), dispensing (33%), documentation (18%) or delay Severity Class I unlikely to cause discomfort or deterioration Class II potential to cause discomfort or deterioration (56%) Class III potential to cause severe discomfort or deterioration ARB 6

7 HIV MEDICATION ERRORS: CLINICAL STUDY JOHNS HOPKINS BAYVIEW 6 1-year period 209 HIV admissions 77 admissions with potential error 61 uncorrected errors in 54 admissions identified Most common errors: Dosing attributable to adjusting for renal insufficiency (16.3%) Combining ART with contraindicated medications (5.2%) Incomplete ART regimen (3.8%) ARB 7

8 HIV MEDICATION ERRORS: CLINICAL STUDY BAYSTATE MEDICAL CENTER admissions with ARV therapy identified between Aug 2005 and Feb errors confirmed in 41 patients Most common error: incomplete regimen Effect of pharmacist intervention on median time until an error was corrected Pre-intervention: During intervention: ~ 84 hours ~ 15.5 hours ARB 8

9 THE MEDICATION USE PROCESS 8 Ordering Transcribing Dispensing Administering ARB 9

10 ERRORS IN THE MEDICATION USE PROCESS Ordering Transcribing Dispensing Administering E R R O R S Wrong Dose Wrong Drug Wrong Route/Form Wrong Frequency Wrong Dose Wrong Route Wrong Patient Wrong Frequency Wrong Drug Wrong Dose Wrong Route Wrong Patient Wrong Frequency Incorrect Labeling/ Drug ID Primary catch for Allergy, Drug Interactions (DD,DH,DF) Wrong Patient Wrong Dose Wrong Drug, Wrong Frequency Wrong Route

11 ERRORS IN THE MEDICATION USE PROCESS Dispensing Wrong Dose Wrong Route Wrong Patient Wrong Frequency Incorrect Labeling/ Drug ID Primary catch for Allergy, Drug Interactions (DD,DH,DF) Overdose 9 Tenofovir Renal, bone toxicity Didanosine, stavudine Lactic acidosis, pancreatitis, peripheral neuro Efavirenz, nevirapine, etravirine Drug-induced hepatitis, increased rash Protease inhibitors Lipid/glucose disturbance, hepatotoxicity Reformulation (Prezista, Triumeq) Underdose 9 Virologic failure Virus mutations Drug resistance and potential class crossresistance ARB 11

12 ERRORS IN THE MEDICATION USE PROCESS Dispensing Wrong Dose Wrong Route Wrong Patient Wrong Frequency Incorrect Labeling/ Drug ID Primary catch for Allergy, Drug Interactions (DD,DH,DF) L.A.S.A. examples Lamivudine, lamotrigine Lexiva, Lexapro, Levitra Nelfinavir, nevirapine Retrovir, ritonavir Viracept, Viramune, Viread Kaletra, Keppra, Keflex Isentress, Intelence ARB 12

13 ERRORS IN THE MEDICATION USE PROCESS General DDI with ARVs 9 Dispensing Wrong Dose Wrong Route Wrong Patient Wrong Frequency Incorrect Labeling/ Drug ID Primary catch for Allergy, Drug Interactions (DD,DH,DF) PI Rifampin Statin PPI Fluticasone NNRTI PI and NNRTI PI and NNRTI Atazanavir PI FEEDBACK ARB 13 For more comprehensive listings, please refer to drug interaction attachments and Additional Resources slide

14 NAME THAT ERROR ARB 14

15 NAME THAT ERROR ARB 15

16 NAME THAT ERROR ARB 16

17 NAME THAT ERROR ARB 17

18 CONCLUSION: STRATEGIES FOR PREVENTION The Five Rights of Medication Administration 10 Call and response Assessing drug allergies Double-checking high alert medications Pocket-sized dosage cards Single pill cocktails (if possible) ARB 18

19 CONCLUSION: STRATEGIES FOR PREVENTION Patient Info Demographic Drug Info Communication Right Medication Right Dose Eliminate communication barriers between HCP Drug ID Drug Storage Packaging/Labeling L.A.S.A Ensure proper storage of medications ARB 19

20 CONCLUSION: STRATEGIES FOR PREVENTION Drug Devices Acquisition, use, and monitoring Environmental Factors FEEDBACK Staff Ed./Competency CE Lunch & Learns Patient Ed. FEEDBACK QA & RM Organization-wide culture of safety ARB 20

21 RESOURCES Mobile Phone Apps AIDSinfo HIV/AIDS Glossary HIV ichart HIV Plus Treatment Guide Merck My Health Matters ARB 21

22 REFERENCES Institute of Medicine (IOM). To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; Studies target high rates of HIV medication errors among hospitalized patients. ID Week 2012[Press release]. October 19, Accessed Nov Daniels LM, Raasch RH, Corbett AH. Implementation of targeted interventions to decrease antiretroviralrelated errors in hospitalized patients. Am J Health Syst Pharm. 2012;69(5): Rastegar DA, Knight AM, Monolakis JS. Antiretroviral medication errors among hospitalized patients with HIV infection. Clin Infect Dis. 2006;43(7): Heelon, Skiest D, Tereso G, et al. Effect of a clinical pharmacist s interventions on duration of antiretroviral-related errors in hospitalized patients. Am J Health-Sys Pharm. 2007;64: Vogenberg F, Benjamin D. The medication-use process and the importance of mastering fundamentals. PT. 2011;36(10): Panel on antiretroviral guidelines for adults and adolescents. Guidelines for the use of antiretroviral agents in HIV-1 infected adults and adolescents. Department of Health and Human Services. Accessed Nov Federico F. The Five Rights of Medication Administration. Institute for Healthcare Improvement. Accessed Nov ARB 22

23 ARB 23

24 CONTACT INFORMATION ALSEAN R. BRYANT, PHARM.D. AHF Pharmacy 2141 K St NW Ste 606 Washington, DC Alsean.Bryant@aidshealth.org Alsean Bryant (Sean ARB 24

Medication Errors Focus on the HIV-Infected Patient

Medication Errors Focus on the HIV-Infected Patient Nimish Patel, Pharm.D., Ph.D., AAHIVP Associate Professor Albany College of Pharmacy & Health Sciences I do not have any conflict of interest in relation