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Study Links Fatal Errors To Pharmacists' Workload

Researchers find mistakes surge at the beginning of the month

Jan 8, 2005 | Houston Chronicle A surge in pharmacist workloads at the beginning of every month may have led to fatal medication errors that have killed more than 6,000 people a year, a study of more than 47 million death certificates found.

That surprising finding is prompting researchers to ask government agencies to consider spreading out social service payments, for pharmacies to increase staffing at the first of the month and for consumers to exercise special care in checking their prescriptions.

At the beginning of the month, there is a sharp increase in government payments to the elderly, sick and poor, resulting in higher traffic at retail pharmacies as lower-income patients fill their prescriptions, according to research published in this month's Pharmacotherapy, the Journal of the American College of Clinical Pharmacy.

"You've got a situation where pharmacists are abnormally busy and it's documented that pharmacists make more errors when they're busy. The two things together prompted us to predict there would be this spike in deaths from medication errors," said David Phillips, a professor of sociology at the University of California. "And indeed, that turned out to be the case."

The study didn't address how the errors occur or precisely who may be committing them.

Pharmacist David Hayes, a professor at the University of Houston's College of Pharmacy who works several times a month at a grocery's pharmacies, said the link sounds plausible, particularly in lower-income neighborhoods with larger Medicaid populations.

"The first of the month is not a pleasant experience. It's very busy," Hayes said. "If you're a pharmacist, you worry more at the end of the day about the things you did during the day at the first of the month, if you're in those areas."

To investigate their theory, lead author Phillips and his colleagues looked at 47.7 million computerized death certificates on a database maintained by the National Center for Health Statistics. They started with 1979 because that is when statisticians began using a special coding system to categorize causes of death, and ended with 2000, the year of the most recent data.

Researchers examined death data including date, cause, location of death, age, gender, years of education and substance abuse status. They used years of education to measure socioeconomic status because a positive correlation has been established between the two.

They focused on deaths resulting from poisoning accidents from drugs. One category, "accidental overdose of drug, wrong drug given or taken in error, and drug taken inadvertently," accounted for nearly all of the deaths.

The researchers found that between 1979 and 2000, fatal medication errors dipped sharply at the end of the month when people may be out of money and can't buy medicine.

At the beginning of the month when social service payments come in fatal errors soared, showing a spike of as much as 25 percent above normal at the beginning of the month, leading to 125,000 deaths in the time frame studied. The increase in fatal medication errors didn't vary by socioeconomic status and wasn't larger for substance abusers than for others.

Identification of the death spike and the search for causes can potentially reduce the number of deaths from medication errors, the researchers said.

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