In the first days of every month, mortality rates due to medication errors increase as much as 25 percent above normal, according to a new study by sociology professor David Phillips and a group of co-authors.
Published in the January issue of the medical journal Pharmacotherapy, Phillips’ report used computerized death certificates from the National Center for Health Statistics as data.
He ascribed the early month death rate increase partly to pharmaceutical errors.
“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 said in a university announcement. “Pharmacy workloads go up and — in line with both evidence and experience — error rates go up as well. Our data suggest that the mortality spike occurs at least partly because of this phenomenon.”
From almost 132,000 cases of fatalities involving accidental poisoning by prescription drugs, the study’s authors found that, while only 3.2 percent of the accidental deaths were a result of harmful effects from correctly administered prescriptions, 96.8 percent of fatalities were due either to ingestion of the incorrect drug or unintentional overdose.
The results excluded suicide and homicide cases involving intentional poisoning.
Phillips and his co-authors also found that the monthly spike in deaths remained constant across age and socioeconomic groups, suggesting that it was not the result of increased consumption by people receiving government aid.
“People relying on government funds would purchase their medicines at the beginning of the month when they receive their payments,” Phillips said. “Since the results did not show any different death rates for the government-aided patients, it makes it more likely pharmacists are involved in the error.”
However, the lack of details in the report leads to questions over who exactly is to blame for medicinal errors, according to Stephen M. Setter, an assistant professor of pharmacotherapy at Washington State University and spokesperson for the American Pharmacists Association.
“The study is not detailed enough to make a direct correlation with ‘medication errors’ and an increase in fatalities,” Setter said. “For instance, the definition of ‘medication error’ is quite broad and may include a patient unintentionally overdosing. That is not a pharmacy error but rather an error made after the prescription has left the pharmacy.”
Other patient errors may also account for the fatalities, Setter said. Patients visiting the emergency room, where they may not have access to relevant information, may not know their own allergies or current medications, leading to reactions with emergency drugs.
Phillips said that while he agreed the source of the deaths is unknown, the study suggests that precaution should be taken in all areas of prescription drugs.
“We don’t know who actually makes this error. It could be the pharmacist, it could be patient, it could be doctor or it could be nurse,” he said. “Increasing pharmaceutical staff temporarily at the beginning of the month would help. Patients should also double-check their medications at the beginning of the month and know what and how much medication they are taking.”
While the report is not detailed enough to pinpoint exact solutions, further research is needed on the intriguing results, Setter said.
“The problem is not defined enough to solve,” he said. “Nonetheless the data are very interesting. More detailed studies need to be done to identify the factors associated with or causing the spike.”
Health economist for the National Association of Chain Drug Stores Laura Miller echoed Setter’s opinion on the study.
“It’s a lot of good raw data and a good start,” she said. “But this is the beginning of something, rather than [anything] conclusory. Cause of death for patients is not a clear-cut thing, and whether it is an overdose, suicide or any type of death can be arbitrary depending on the person filling out the death certificate.”
Phillips decided to conduct the study after reviewing initial numbers, showing the spike in deaths, he said.
“I wondered what kind of death spiked the largest, and I knew some poorer people cannot afford medicines except at these beginning times of the month, so I followed that lead,” Phillips said.
Phillips and his co-authors, who included former UCSD undergraduate student Jason Jarvinen and executive director of Tufts Health Care Center Rosalie Phillips — his sister — previously published other studies together, including one showing that cardiac fatalities increase during Christmas time and New Year’s.
