Beware 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.
Total 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.
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. “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.”
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