Reply to Holtzman and Gallagher

TO THE EDITOR—We thank Holtzman and Gallagher for their interest in our work [1].Consistent with our study, which identified antiretroviral (ARV) medication errors in 29% of admissions during the first hospital day [2], they report an error rate of 26% among hospitalized human immunodeficiency virus (HIV)– infected patients prescribed ARV medications at Temple University Hospital in Philadelphia, PA [1]. We would like to clarify a misunderstanding by Holtzman and Gallagher of our study methods. As we stated in the methods section of our paper, our study was a retrospective review of ARV medication errors, and not an evaluation of a pharmacist intervention [2]. Two clinical pharmacists retrospectively reviewed medical orders to identify ARV medication errors for study purposes, and were not present in real time to 1586 • CID 2012:55 (1 December) • Notes Financial support. R. D. M was supported by the National Institutes of Health [K24 DA 00432, R01DA11602, R01 AA 16893]. J. P. M was supported by the National Institutes of Health [K24 AI073957]. Potential conflict of interests. All authors: No reported conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. Baligh R. Yehia,1 Jimish M. Mehta,2 Danielle Ciuffetelli,2 Richard D. Moore,3 Paul A. Pham,3 Joshua P. Metlay,1 and Kelly A. Gebo3 1 Department of Medicine, University of Pennsylvania Perelman School of Medicine, 2Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia; and 3Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland CORRESPONDENCE References 1. Holtzman CW, Gallagher JC. Antiretroviral medication errors among hospitalized HIVinfected adults [ published online ahead of print 23 August 2012]. Clin Infect Dis 2012; 55:1584–5. 2. Yehia BR, Mehta JM, Ciuffetelli D, et al. Antiretroviral medication errors remain high but are quickly corrected among hospitalized HIVinfected adults. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America 2012; 55:593–9. 3. Heelon M, 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 Syst Pharm 2007; 64:2064–8. Correspondence: Baligh R. Yehia, MD, University of Pennsylvania Perelman School of Medicine, 1309 Blockley Hall, 423 Guardian Dr, Philadelphia, Pennsylvania 19104 (byehia@ upenn.edu). Clinical Infectious Diseases 2012;55(11):1586 © The Author 2012. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals. . DOI: 10.1093/cid/cis724 Reply to Holtzman and Gallagher identify and correct medication errors. At Johns Hopkins Hospital, the HIV/ AIDS service has a specialized clinical pharmacist who reviews all medications administered on the prior day. However, our study included not only patients admitted to the HIV/AIDS service, but also those admitted to medicine, surgery, obstetrics and gynecology, neurology, and psychiatry. These other services do not routinely include pharmacists on the rounding team. Since we did not specifically evaluate a clinical pharmacist intervention on medication orders, we offered clinical pharmacy review of medication orders as a possible reason for the decline in errors on the second day of hospitalization for two reasons: (1) prior studies have demonstrated the efficacy of clinical pharmacists in decreasing ARV medication errors [3], and (2) 64% of our study patients were admitted to the HIV/AIDS service, which has a dedicated HIV clinical pharmacist. Other interventions, both educational and technological, may also be important to correcting ARV medication errors that occur early in hospitalization.  (...truncated)