New UCSD Research Shows Deadly Drug Mistakes
Spike At The Start Of Each Month, Suggests Pharmacy Errors
By Inga Kiderra
not the ides but the start of March – and April and May
and every 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.
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. “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.”
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 vast majority, 96.8 percent, resulted from medication errors
– the “wrong drug given or taken,” or “accidental
overdose of drug,” or “drug taken inadvertently.”
The study excluded
deaths from overdose of street drugs or from intentional poisoning
(suicide or homicide).
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
numbers of U.S. deaths related to medication errors (±
1.96 standard errors) on each of the first 14 days of the
month (days 1 to 14) and the last 14 days of the preceding
month (days -14 to -1), 1979-2000. The panel shows data
for patients who were dead on arrival and for those who
died in the emergency room and as outpatients. The horizontal
solid line shows total numbers of deaths from all causes.
The dotted line indicates the average number of deaths that
would be expected if the numbers did not fluctuate around
the first day of the month. The bar graph indicates the
total number of deaths from fatal medication errors. The
upper limit is set at 1.40 x daily average, whereas the
lower limit is set at 0.85 x daily average.
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?
To test this, Phillips
and coauthors ran analyses on populations of the elderly and
the poor. 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.
spike was similar across groups, however. The spike was as evident
in the young and well-off as in the elderly and poor, suggesting
the problem was at least partly due to an increase in pharmacy
error at the beginning of the month.
Phillips notes that
the National Center for Health Statistics database used in the
study did not contain highly specific clinical information –
no information on prescription type, dosage, days supply, etc.
– and he urges further research with data richer in this
kind of detail.
To reduce the medication-error
death rate, Phillips suggests that pharmacies (that don’t
already do so) consider increasing staffing levels at the beginning
of the month and that government officials consider spreading
assistance payments out over the entire month.
“Even in the
absence of policy changes or further research,” Phillips
says, “it is appropriate for both patients and clinical
staff to be especially careful to check the accuracy of their
prescriptions at the beginning of each month. If this is done,
it seems plausible that some lives will be saved.”
are Jason R. Jarvinen, sociology student, UCSD, and Rosalie
Phillips, executive director of the Tufts Health Care Center,
Media Contact: Inga
Kiderra (858) 822-0661