P-990. Impact of a Pharmacy Resident-led Antiretroviral Stewardship Program (ARVSP)

TL;DR

A pharmacy resident-led program improved antiretroviral therapy management for HIV patients by identifying medication errors and drug interactions.

Contribution

Demonstrates feasibility of non-infectious disease trained pharmacy residents leading antiretroviral stewardship in hospitalized HIV patients.

Findings

Residents identified over 100 unique interventions including drug interactions and medication errors.

Most drug interactions involved absorption issues, but high-risk interactions were also found.

Residents reported improved independence in patient care and medication reconciliation.

Abstract

Due to a 120% increase in patients living with HIV (PLWH) admitted to our institution over the prior 3-year period, a pharmacy resident-driven ARVSP was implemented to augment the existing antimicrobial stewardship program. This study evaluated the feasibility and impact of an ARVSP conducted by non-infectious diseases trained, post-graduate year 1 (PGY1) pharmacy residents at a large, academic medical center.Figure 1:Chart review documentation via an Epic i-Vent.Table 1:Summary Data.OI = Opportunistic Infections, PPx = Prophylaxis, TOC = Transitions of Care, DDI = Drug-Drug Interaction, EMR = Electronic Medical Record

Chart review documentation via an Epic i-Vent.

Summary Data.

OI = Opportunistic Infections, PPx = Prophylaxis, TOC = Transitions of Care, DDI = Drug-Drug Interaction, EMR = Electronic Medical Record

This was a single-center, retrospective pilot study. From 7/1/2022 to 2/1/2023 the PGY1 ARVSP followed a standard operating procedure (SOP) for evaluating medication regimens of admitted PLWH on antiretroviral (ARV) therapy. The SOP included a checklist to minimize prescribing errors, drug-drug interactions (DDI), and optimize ARV regimens for admitted patients, particularly with changing clinical status. Daily chart reviews included external prescription history, outpatient notes, inpatient medications, and clinical status (Figure 1). Patient interviews were conducted to confirm ARV regimens, drug allergies, home medications, outpatient HIV follow-up plan, and barriers to medication access.Table 2:Drug Interaction Summary.CYP = cytochrome P450, High-risk = anticoagulants, antiplatelets, antiepileptics, antiarrhythmics, HMG-CoA reductase inhibitors, antipsychotics, and antibioticsTable 3:PGY1 individual survey responses.PGY1 = post graduate year 1; HIV = human immunodeficiency virus; ARVs = antiretrovirals

Drug Interaction Summary.

CYP = cytochrome P450, High-risk = anticoagulants, antiplatelets, antiepileptics, antiarrhythmics, HMG-CoA reductase inhibitors, antipsychotics, and antibiotics

PGY1 individual survey responses.

PGY1 = post graduate year 1; HIV = human immunodeficiency virus; ARVs = antiretrovirals

A total of 220 patients were reviewed during the 7-month ARVSP pilot period. Over 100 unique interventions were identified by the ARVSP team, including DDI, dosage adjustments, need for opportunistic infection prophylaxis, incorrect route of administration, or incorrect dose/regimen resumed inpatient (Table 1). The majority of the DDI identified involved potential issues with drug absorption but a significant number of high-risk and CYP-mediated DDI were also found (Table 2). PGY1 residents were surveyed throughout the pilot and self-identified improvement to the level of independence in patient interviewing, reconciling medications, and documenting clinical activities in the medical record (Table 3).

PGY1 residents implemented ARVSP activities into their daily workflow without limiting their direct patient care responsibilities. They successfully identified ARV medication errors and reported improvements in their ability to manage ARV pharmacotherapy. PGY1 pharmacy residency programs can adapt similar ARVSPs to augment their training programs and support medication optimization in this high-risk patient population.

All Authors: No reported disclosures

Figures