9/17/2018 1 Evaluating Emergency Department Opioid Prescribing Behaviors after Education about Mandated Use of the Pennsylvania Prescription Drug Monitoring Program Jennifer Martello, DNP, RN, FNP-BC University of Pittsburgh School of Nursing Capstone Committee Chair Dr. Brenda Cassidy, DNP, RN, PCNP-PC Assistant Professor Health Promotion and Development University of Pittsburgh School of Nursing Capstone Committee Member Dr. Ann Mitchell, PhD, RN, AHN-BC, FIAAN, FAAN Professor Health and Community Systems University of Pittsburgh School of Nursing
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9/17/2018
1
Evaluating Emergency Department Opioid Prescribing Behaviors after Education about Mandated Use of the Pennsylvania Prescription Drug Monitoring Program
Jennifer Martello, DNP, RN, FNP-BC
University of Pittsburgh
School of Nursing
Capstone Committee Chair
Dr. Brenda Cassidy, DNP, RN, PCNP-PC
Assistant Professor Health Promotion and Development
University of Pittsburgh School of Nursing
Capstone Committee Member
Dr. Ann Mitchell, PhD, RN, AHN-BC, FIAAN, FAAN
Professor Health and Community Systems
University of Pittsburgh School of Nursing
9/17/2018
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Background
National Statistics
Source: 1
Source: 2
9/17/2018
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Age-adjusted rates of drug overdose deaths by state, US 2016
6.9 to 11.0
11.1 to 13.5
13.6 to 16.0
16.1 to 18.5
18.6 to 21.0
21.1 to 52.0
Legend
Source: 1
Pennsylvania Statistics, 2016
• In 2016, 4,642 residents died from opioid overdose
• Thirteen Pennsylvanians per day
• PA overdose death rate is higher than national
average (38 vs. 20 per 100,000 population)
Source: 2
Lawrence County Statistics
Source: 2
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Patients (aged 18-85 yrs.) in ED with CC pain, 2016
972525%
3819275%
Patients w/ CC Pain
Total Patients Seen
Pennsylvania’s New Opioid Laws
Source: 3
CLINICAL MANDATE
Source: 3
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Prescription Drug Monitoring Programs
[PDMPs]
• State-based electronic databases that contain
information on controlled substance prescriptions
dispensed by pharmacies and prescribers
• Goal: Help reduce misuse and diversion of
controlled substances, including prescription opioidsSource: 4
PDMP
• Who can access– Prescribers
– Pharmacists
– Researchers
– Health insurers
– Medical licensing boards
– Law enforcement agencies
• What is monitored– Controlled substance use
by patients
– Prescribing practices of
medical practitioners
– Population-level drug use
trends
Source: 4
UPMC Initiatives to Support the Mandate
• EpicCare Tools to Support Compliance with New PA Opioid Laws
• NetAccess Navigator added screenshot of the web link to the PA
PDMP under the “medication reconciliation” tab
• Guidelines issued for “improving pain management orders”
• OAPP gathering data regarding prescriber comments/observations
about PDMPs strengths, weaknesses, areas for improvement to
share with state officials
• Centers of Excellence (COE)
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Literature Review
PDMP Effectiveness• Identifying and reducing doctor shopping
• Impact on controlled substance availability and prescribing
• Association with improved health outcomes
• Reducing drug and medical costs related to inappropriate prescribing
• Monitoring compliance and abstinence
• Assisting in substance abuse treatment
• Assisting in drug misuse prevention and surveillance efforts
• provide counseling/referral information for rehab services
• prescribe non-medical pain management therapies
– Evaluate barriers identified and impact on prescribing behaviors
What’s New� Sustainability
�Annual Education Mandates
� Consistent Use of the PDMP
� Direct link within EHR
� Health Promotion and Disease Prevention
�Drug and Alcohol Liaison
�Pain Management Referral
�Non-pharmacological treatment plan
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Reference List1. Centers for Disease Control and Prevention. WONDER: Wide-ranging online data for epidemiologic research. [Internet]. Atlanta (GA):
CDC; 2016 [cited 2016 Oct 16]. Available from http://wonder.cdc.gov
2. Drug Enforcement Agency Intelligence Report. Analysis of drug-related overdose deaths in Pennsylvania, 2015. [Internet]. Washington (DC): DEA; 2015 [cited 2016 Oct 9]. Available from https://www.dea.gov/divisions/phi/2016/phi071216_attach.pdf
3. Pennsylvania Department of Health. Prescription Drug Monitoring Program. Accessed August 5, 2016 at www.doh.pa.gov/PDMP
4. Prescription Drug Monitoring Program Center of Excellence at Brandeis University. Briefing on PDMP effectiveness.[Internet]. Bureau of Justice Assistance (BJA); Sept 2014 [cited 2016 Dec 16]. Available from www.pdmpexcellence.org
5. Finnell JT, Twillman RK, Breslan SA, Shultz J, Miller L, 2017 Sep. The role of continuing medical education in increasing enrollment in prescription drug monitoring programs. Clin Ther. 39(9), 1896-1902.
6. Kellams JR, Maye JP. 2017 Jul/Sep. The last state to grant nurse practitioners DEA licensure: An education improvement initiative on the Florida prescription drug monitoring program. J Addict Nurs. 28(3), 135-142.
7. .Lin DH, Lucas E, Murimi IB, Jackson K, Baier M, Frattaroli S, Gielen AC, Moyo P, Simoni-Wastila L, Alexander GC. 2017 Feb. Physician attitudes and experiences with Maryland’s prescription drug monitoring program (PDMP). Addiction. 112(2), 311-319.
8. Haegerich TM, Paulozzi LJ, Manns BJ, Jones CM. 2014. What we know, and don't know, about the impact of state policy and systems-level interventions on prescription drug overdose. Drug Alcohol Depend. 145, 34-47.
9. Spratling R, Powers E. 2017 Jan/Feb. Development of a data abstraction form: Getting what you need from the electronic health record. J Pediatric Health Care. 31(1), 126-130.