Medication deaths spike early in month, study finds

A California researcher who likes crunching death certificate data has discovered that fatalities from prescription drugs spike at the beginning of the month, and he suggests that it's tied to pharmacist workload.

Deaths from prescription drugs are 25% higher during the first week of the month compared with the last week of the previous month, according to David Phillips, Ph.D., sociology professor, University of California, San Diego. Along with his student Jason Jarvinen and his sister, Rosalie Phillips, M.Ph., director, Tufts Health Care Institute, he examined 47 million computerized death certificates issued in the United States between 1979 and 2000. The search found 131,952 deaths from prescription drug errors.

At the beginning of the month, there is a spike in government payments to individuals, which results in a rise in Rx purchases and in increased pharmacy workload, according to the research published in the January issue of Pharmacotherapy. The authors posit that a rise in pharmacy errors may play a role in the increased deaths.

"We can be confident that there is a big spike in deaths at the beginning of the month," Phillips told Drug Topics. "We can be much less confident as to what is causing the spike. There were errors, but we don't know if they were errors in the pharmacy because we don't know where the errors occurred."

The study's rationale for a link between workload and medication errors was based on the work of previous researchers who surveyed pharmacists but did not actually observe them at work to determine when errors were more likely to occur. Phillips said he was unaware of the work of the late Anthony Grasha, Ph.D., psychology professor at the University of Cincinnati. Grasha's studies of retail pharmacists in action showed that high Rx volume did not translate into more errors. In fact, he found that pharmacists were more prone to make mistakes under low workload conditions due to boredom, a reduced ability to focus on tasks, and disruptions in personal work rhythms.

"This research makes some assumptions about drug errors," said Doug Hoey, senior VP-practice affairs, National Community Pharmacists Association. "The crux of the whole matter is accidental overdose and taking the wrong medication, which have nothing to do with getting the medication from the pharmacist. Rather than pointing a finger of blame at pharmacists, it shows even more reason to have the pharmacist involved to prevent those things."

Additional research is needed to examine the monthly medication death spike in more detail, said Phillips. "It would be interesting to know if these spikes are stronger for one type of pharmacy over another," he said. "The next step is to try to understand it better and control it better to save lives."