Do Pharmacy Errors Spike at Start of the Month?

Study suggests rise in death rates may be due, in part, to drug mishaps

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HealthDay Reporter

TUESDAY, Jan. 11, 2005 (HealthDayNews) -- Statistics suggest Americans are more likely to die at the start of each month than any other time, and now researchers think they've found one possible culprit: mistakes in prescription drug use.

The primary suspect, the researchers said, could be a beginning-of-the-month increase in pharmacists' workloads and a subsequent rise in error rates. While such errors wouldn't account for the entire trend, they may be a major factor in the higher death rates, according to the study that said deaths from drug mishaps rose by as much as 25 percent during the first days of each month.

Why the jump in deaths around that time? Perhaps because that's when many people are suddenly flush with cash, said study co-author David Phillips, a professor of sociology at the University of California, San Diego. Patients get Social Security and welfare checks at the beginning of the month, and that's when "they rush in to get medicines that they can't afford in the preceding month," he said.

But Stephen Setter, an assistant professor of pharmacotherapy at Washington State University, cautions that many people -- including caregivers and patients themselves -- are responsible for drug errors.

Phillips had previously discovered that deaths as a whole increase by about 1 percent at the start of each month. "I was interested in whether one or another particular cause of death shows the spike more strongly," he said.

To figure out if medication errors played a role, Phillips and his colleagues analyzed 131,952 U.S. death certificates from 1979 to 2000 that indicated deaths were caused by accidental effects from legal drugs.

The findings appear in the January issue of Pharmacotherapy, the journal of the American College of Clinical Pharmacy.

Nearly all the deaths -- 96.8 percent -- resulted from errors, not because someone took the correct dose of the correct drug. However, the statistics didn't point to the responsible party.

For those who died quickly -- including those in the emergency room or on their way to a hospital -- deaths were 25 percent above normal at the beginning of the month.

The death rate due to medication errors went up by only 6.6 percent among people already hospitalized, perhaps indicating they weren't as likely to run out and buy medicine at the beginning of the month, Phillips said.

The researchers also found that the rise in beginning-of-the-month deaths affected both young and old, rich and poor. But why would the wealthy be just as likely to die if they weren't waiting until the start of the month to buy prescription drugs with money from welfare checks?

Phillips has a theory: Pharmacists are overwhelmed by poorer people coming in at the beginning of the month. "When pharmacists are unusually busy, they're more likely to make mistakes."

Setter agreed that it seems pharmacists do get busier at the start of the month. "As you increase the speed that the work has to be done, we set ourselves up for more errors," he said.

But the additions of computer systems and extra technicians over the last few years should help prevent errors, he said. And, he added, some medication errors have nothing to do with pharmacists.

"You see patients take their medicine in the dark, they take their wife's medicine, their dog's medicine," Setter said. "There's a lot that goes into that definition of medication error. We really need to have more specific information."

Phillips agreed and said he hopes to see more research. For now, however, he said pharmacists and patients need to make extra efforts to check prescriptions at the beginning of the month. "There's the potential there to save a lot of lives," he said.

More information

To learn more about pharmacists, visit the U.S. Department of Labor.

SOURCES: David Phillips, Ph.D., professor, sociology, University of California, San Diego; Stephen Setter, Pharm.D., assistant professor, pharmacotherapy, Washington State University, Spokane; January 2005 Pharmacotherapy

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