Pharmacy drug errors may be worst at the start of each month

• In the first few days of each month, fatalities due to medication errors rise by as much as 25 percent above normal, according to new research by University of California, San Diego sociologist David Phillips.
• Published in the January issue of Pharmacotherapy, the journal of the American College of Clinical Pharmacy, the study is the first to document a beginning-of-the-month spike in deaths attributed to mistakes in prescription drugs.
• The primary suspect, Phillips says, is a beginning-of-the-month increase in pharmacy workloads and a consequent increase in their error rates.
• "Government assistance payments to the old, the sick and the poor are typically received at the beginning of each month.
• Because of this, there is a beginning-of-the-month spike in purchases of prescription medicines," Phillips says.
• Phillips and his coauthors examined all United States death certificates from 1979 through 2000 to analyze the 131,952 deaths classified as fatal poisoning accidents from drugs.
• A small number, 3.2 percent, of the deaths were from adverse effects of the right drug in the right dose.
• The study excluded deaths from overdose of street drugs or from intentional poisoning (suicide or homicide).
• The beginning-of-the-month mortality spike was particularly pronounced in people for whom the mistakes proved rapidly fatal -- those who were dead on arrival at a hospital, died in the emergency department or as outpatients.
• In this category, deaths jumped by 25 percent above normal.
• But could it be that the mortality spike is due not to pharmacy error but simply to the increased number of people buying, then consuming drugs?
• If increased consumption alone was to blame, the researchers reasoned, mortality would be highest in the groups relying on government assistance and therefore purchasing their medicines at the start of the month.