Deaths related to medication errors appear to rise sharply during the first few days of each month, suggesting that hectic pharmacies may be at least partly to blame, according to researchers.

Their study of U.S. death certificates for the years 1979 through 2000 found that deaths attributed to prescription-drug errors showed a 25 percent spike in the first week of each month compared with the last week of the month.

No other major cause of death showed such a large calendar-related shift, according the report in the January issue of Pharmacotherapy.

Because other research has documented a glut of prescription medication purchases at the beginning of each month, the new findings point to the possibility that errors at busy pharmacies may be contributing to the monthly spike in prescription-related deaths, according to the study authors.

The early-month buying spree is believed to reflect the timing of government assistance payments to the elderly and poor. Payments in the form of welfare and Social Security pensions and disability all typically arrive at the start of the month, and many recipients may use these benefits to pay for their medications.

Pharmacies, faced with a sharp upturn in demand, may be more prone to errors - from putting incorrect information on drug labels to giving the wrong drug altogether - and pharmacists may have less time to discuss medication precautions with patients, the study’s lead author, Dr. David P. Phillips, told Reuters Health.

“We know that pharmacists are unusually busy at the beginning of the month,” said Phillips, a sociologist at the University of California, San Diego.

This study, he noted, couldn’t reveal the extent to which pharmacists, patients or doctors may contribute to the monthly rise in fatal prescription errors. But, Phillips said, “It’s clear that something has broken down,” and it’s likely that pharmacy errors are at least partly to blame.

He and his colleagues considered certain other explanations - such as the overall higher use of prescriptions leading to more early-month deaths - and found these could not explain their findings.

If, for example, prescription use jumped at the start of the month but pharmacy errors did not, then the rise in deaths should be concentrated among low-income patients. But the researchers found no such evidence.

This study, Phillips and his colleagues note, is the first to document such a monthly spike in deaths related to medication errors. The research is based on two decades’ worth of death certificates for more than 47 million Americans; however, the authors point out, it is limited by gaps in detail, including specific information about patients and their pharmacies.

Smaller, more detailed studies could help better define the reasons for the monthly increase in fatal prescription errors, according to Phillips.

There are, he noted, some potential ways to address deaths caused by pharmacy errors. Government programs, Phillips said, could spread out payments to the elderly and poor over the course of the month to discourage early-month runs on pharmacies. It might also help, he added, for pharmacists to work fewer hours at month’s end, then bump up their hours during the busy first week of the month.

SOURCE: Pharmacotherapy, January 2005.