Evaluation of Antibiotic-Associated Medication Errors in Hemodialysis Patients Krishnan Brown, Cortney Dodson, Julie Ann Justo Palmetto Health Richland PGY1 Pharmacy - Columbia, SC
Background/Purpose: There are a variety of approaches to administering antibiotics in hospitalized hemodialysis patients. It was hypothesized a local standard procedure of profiling antibiotics as on call as needed (or PRN) for intermittent hemodialysis (IHD) led to increased medication-related errors. The purpose of this study was to compare the antibiotic-associated medication error rate in patients receiving PRN versus scheduled dosing with IHD.
Methodology: This retrospective, observational cohort study was performed in patients with monomicrobial gram-negative bloodstream infections at a single health system from January 1, 2010 to December 31, 2017. Inclusion criteria included end-stage renal disease requiring hemodialysis for at least two weeks and initiation of IV antibiotics within 72 hours of index blood culture collection. Patients were divided into groups based on IV antibiotic scheduling: PRN (e.g. on call PRN HD MWF) versus scheduled (e.g. Q24h). The dosing group was defined by the initial regimen of the qualifying antibiotic agent which was maintained for at least 48 hours. Data collection included medication error rate, comorbid conditions, source of bloodstream infection, bloodstream isolate, severity of illness, duration of therapy, ICU length of stay, time to culture clearance, and 14-day mortality. Baseline categorical variables were assessed using a chi-square test or Fisher_x0019_s exact test and baseline continuous variables were assessed using Student_x0019_s t test or Mann-Whitney U test, as appropriate. Univariable and multivariable logistic regression was used to evaluate the impact of PRN versus scheduled dosing on the antibiotic-associated medication error rate, after adjusting for potential confounders.
Presentation Objective: Compare the medication error rate of antibiotic therapy in patients with gram-negative bloodstream infections receiving IV antibiotic therapy as PRN versus scheduled dosing with IHD.
Self-Assessment: Which type of error is the most common in the administration of antibiotic therapy in hemodialysis patients?
