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Best Practices: Prescription Monitoring and Narcotic Guidelines

Best Practices: Prescription Monitoring and Narcotic Guidelines. WSHA Presenters. Carol Wagner Senior VP, Patient Safety . Amber Theel Director, Patient Safety . Additional Presenters. Washington State Medical Association. Sacred Heart Medical Center . Washington State

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Best Practices: Prescription Monitoring and Narcotic Guidelines

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  1. Best Practices: Prescription Monitoring and Narcotic Guidelines

  2. WSHA Presenters Carol Wagner Senior VP, Patient Safety Amber Theel Director, Patient Safety

  3. Additional Presenters Washington State Medical Association Sacred Heart Medical Center Washington State Department of Health Susan Peterson Associate Director, Legislative, Regulatory and Legal Affairs • Chris Baumgartner, Director • Prescription Monitoring Program • Dr. Darin Neven, ED Physician

  4. Web Conference Objectives • Background on ER is for Emergencies • Best Practice: Prescription Monitoring Program and Narcotic Guidelines • What is PMP? • How does it work? • How can we help? • Questions and comments

  5. An Opportunity Redirecting Care to the Most Appropriate Setting

  6. Partnering for Change • Washington State Hospital Association • Washington State Medical Association • Washington Chapter of the American College of Emergency Physicians

  7. State Approaches to Curbing ER Use

  8. If Unsuccessful Revert to the no-payment policy. $38 million in annual cuts!

  9. Seven Best Practices

  10. The Seven Best Practices • Electronic health information • Patient education • PRC client information/identification • PRC client care plans • Narcotics guidelines • Prescription monitoring • Use of feedback information

  11. E) Narcotic Guidelines Goal: Reduce drug-seeking and drug-dispensing to frequent ER users • Implement ACEP guidelines for prescribing and monitoring of narcotics • Direct patients to better resources • Track data and follow-up with providers who excessively prescribe

  12. How to Accomplish • Change hospital policy to conform with ACEP guidelines: • Prohibit long-acting opioids and discourage injections • Screen patients for substance abuse • Refer patients suspected of Rx abuse to treatment • Other • Train ER prescribers in narcotic guidelines

  13. How to Accomplish, continued • Consider joining this “oxy-free” movement • When guidelines have been implemented, hospitals have seen significant drop in visits 13

  14. F) Prescription Monitoring Goal: Ensure coordination of prescription drug prescribing practices • Enroll providers in Prescription Monitoring Program: electronic online database with data on patients prescribed controlled substances • Target enrollment for ER providers : • 75% by June 15, 2012 • 90% by December 31, 2012

  15. How to Accomplish • WSMA and WA/ACEP encourage members to sign up • Educate and encourage medical staff to enroll • Hospitals track enrollment of ER prescribers to report to HCA by June 15 and December 31, 2012

  16. Washington State Prescription Monitoring Program:Background and History Carl Nelson, Director of Political Affairs Washington State Medical Association

  17. PMP Legislative History HB 3320 by Rep. Hinkle in 2006. HB 1553 by Rep. Hinkle, Rep. Morrell and others in 2007. SB 5930 The Blue Ribbon Commission. 2007 Session Laws, Chapter 259, section 42 through 45. Providers oppose licensure tax. Funding source remains issue.

  18. Washington State Hospital Association WA Prescription Monitoring Program Chris Baumgartner, Director Overview - 2012

  19. 12.3 10.5 9.7 3.7 5.3 11.1 9.2 7.1 7.4 3.1 9.8 10.5 4.8 12.7 4.1 16.0 12.5 NH 11.7 8.2 10.8 18.4 VT7.9 21.1 8.7 11.7 MA 12.5 7.1 7.6 10.4 15.1 RI 11.1 CT 11.1 10.0 14.2 NJ 7.5 16.8 DE 9.8 12.5 20.4 10.5 9.4 MD 12.5 10.2 8.6 DC 8.8 10.0 8.2 17.9 13.6 9.0 9.9 Age-adjusted rate per 100,000 population 9.1-11.4 3.1-9.0 11.5-21.1 Unintentional and Undetermined Intent Drug Overdose Death Rates by State, 2007

  20. Non-medical Use of Pain Relievers 12 or Older, 2007 & 2008 Source: National Survey on Drug Use & Health, SAMSHA

  21. The PMP Solution:An Overview • Designed to improve patient safety and prevent prescription drug abuse by keeping records of all dispenser transactions • Store and evaluate records for illicit use of prescription drugs • Generate reports to aide prescribers, dispensers, law enforcement, and licensing entities in stopping illicit use

  22. Status of Prescription Drug Monitoring Programs (PDMPs) GU VT ME WA NHMARICTNJDEMD DC MT ND MN NY OR WI SD ID MI WY PA IA NE OH IN IL NV WV UT VA CO KS KY CA MO NC TN OK SC NM AZ AR Operational PDMPs Enacted PDMP legislation, but program not yet operational Legislation pending GA AL MS TX LA AK FL HI Research is current as of April 26, 2012

  23. Implementation Update 2011 2012 • Begin Data Collection – October 1 • Begin Mandatory Reporting – October 7 • Begin DOH/PMP Staff/Licensing Board Access – October 26 • Begin Oversight Agencies Access – November 15 • Begin Pilot Data Requestor Access – December 1 • Begin Data Requestor Access – January 4 • Begin Law Enforcement/Prosecutorial Agencies Access – January 4 • Begin Medical Examiners/Coroners Access – February 1 • Operations, Maintenance, Enhancements – ongoing

  24. DOH’s Goals for Washington’s PMP • To give practitioners an added tool in patient care • To allow prescribers and dispensers to have more information at their disposal for making decisions • To get those who are addicted into proper treatment • To help stop prescription overdoses • To educate the population on the dangers of misusing prescription drugs • To make sure that those who do need scheduled prescription drugs receive them • To curb the illicit use of prescription drugs

  25. System Overview • Weekly Submission • Schedules II-V • - ASAP 4.1 Data Submitted Reports Sent Reports Sent Reports Sent *Other groups may also receive reports other than those listed

  26. Who Isn’t Required to Submit Data • Prescriptions provided to patients receiving inpatient care at hospitals • Practitioners who directly administer a drug • A licensed wholesale distributor or manufacturer • Pharmacies operated by the Department of Corrections • VA or other federally operated pharmacies • Canadian pharmacies that are not licensed to dispense in Washington

  27. Who Has Access • Prescribers & dispensers - in regards to their patients • Licensing boards – in regards to investigations • Individuals – in regards to any prescription dispensed to them • DOH/Vendor – in regards to program operation • Law Enforcement/Prosecutor – for bona fide specific investigations • Medical Examiner/Coroner – cause of death determination • HCA (Medicaid), L&I (Worker’s Comp), DOC (Offenders) • De-identified information may be provided for research and education

  28. Highest Number of Scripts Per Person by County • Data pulled 03/30/12, Jan2011-Feb2012, US 2009 Census Estimates

  29. * Data pulled 03/30/12 covers CY 2011 Top 10 Drugs by Rx Count

  30. * Data pulled 3/30/12 Just Two Months of Prescriptions!(January – February 2012)

  31. Generated Reports • A series of reports can be developed as data collection progresses. Reports include: • Patient history reports • Reports that show that patients have exceeded a threshold considered a safe level of dispensing • Prescriber history reports • De-identified reports for research/education • Other reports can be generated for specialized interests and needs

  32. Sub-accounts for Prescribers • The rule allows for “licensed health care practitioner authorized by a prescriber” to access information as a delegate • Any health professional licensed by the department can have a sub-account • Prescribers will be able to link sub-accounts to their main account to make requests on their behalf

  33. Two Factor Authentication • Virtual tokens authenticate a user’s device (process is similar to online banking) • The device can be a desktop, laptop, tablet, or smart phone • Once a device is enrolled the user can simply login with their username and password • Additional computers can be enrolled

  34. PMP Registration: 5,204 Total Prescribers • Pharmacists – 1,681 • Medical Doctor – 2,706 • Medical Limited – 71 • Physician Fellowship – 0 • Teaching/Research – 2 • Osteopathic Physician – 239 • Osteopathic Limited – 6 • Physician Assistant – 519 • Osteopathic PA – 13 • Nurse Practitioner – 753 • Dentist – 770 • Dental Com. Resident – 0 • Dental UW Resident – 1 • Dental Faculty – 0 • Podiatric Phys. – 37 • Naturopaths – 34 • Optometrist – 40 • Veterinarian - 13

  35. Provider Requests(as of 4/12/2012) • 95,794 patient history requests have been made • 2,043 prescriber history requests have been made

  36. Provider Quote "Now that I've started using this system, it's almost hard for me to imagine how I was practicing medicine without it. Whenever I prescribe scheduled meds now, I routinely search the Prescription Monitoring Program database, to ensure that the patient isn't getting similar meds from another provider. It is amazing to me how often this search reveals that the patient actually was getting such meds somewhere else, and just not providing this information. Finding this out helps prevent abuse of the system and thus keep costs down for everyone. Most importantly, it helps to keep patients safe and allows us to get them the help that they truly need."

  37. www.wapmp.org

  38. Uses for Prescribers/Pharmacists • Prescription history of a current or a new patient • Check for addiction or undertreated pain • Check for misuse, multiple prescribers • Check for drug interactions or other harm • Use reports for compliance with pain contracts • Prescription history of transactions linked to a DEA number • Check for fraudulent scripts • Regular monthly reporting

  39. PMP Education Materials Timeline • Brand design - DONE • Dispenser Requirement Factsheet - DONE • Public factsheet - DONE • Provider factsheet – DONE • FAQs – DONE • Quick Tips - DONE

  40. Future Enhancements • Share data with other State PMPs • Interface with the Emergency Department Information Exchange • Education programs • Health information exchange • Outcome evaluation

  41. Program Contact • Chris Baumgartner, Program Director • Phone: 360.236.4806 • Email: prescriptionmonitoring@doh.wa.gov • Website: http://www.doh.wa.gov/hsqa/PMP/default.htm

  42. Experience in the Hospital

  43. Sacred Heart Medical Center • How are the ER providers incorporating the narcotic guidelines into their practice at Sacred Heart? • How does the prescription monitoring program assist them in their efforts? • What are the challenges?

  44. Next Steps How We Will Help

  45. Review: What Do You Need to Do? Reduce drug-seeking and drug-dispensing to frequent ER users and coordinate prescription drug prescribing practices • Implement ACEP guidelines for prescribing and monitoring of narcotics • Direct patients to better resources • Track data and follow-up with providers who are outliers • Enroll ER physicians in Prescription Monitoring Program • 75% by June 15, 2012 • 90% by December 31, 2012

  46. Quick Action Needed! Hospitals must submit attestations and best practice checklists to HCA by June 15, 2012

  47. For More Information Carol Wagner, Senior VP, Patient Safety (206) 577-1831, carolw@wsha.org Amber Theel, Director, Patient Safety Practices (206) 577-1820, ambert@wsha.org

  48. Questions and Comments

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