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Prescription Drug Monitoring Improves Patient Outcomes

A prescription drug monitoring program (PDMP) is an electronic database that captures prescription data from pharmacies for controlled substances. It is a tool for providers, clinicians, pharmacists and other authorized licensed healthcare professionals, to make informed clinical care decisions, which allows them to look up patients in the database.

The PDMP in action – Nebraska is an example

Not too long ago, Connie Pratt (program director at NeHII) and I were walking out of a hospital in a rural Nebraska community when one of the administrators called out to us to wait. The administrator wanted to tell us how a clinical team recently utilized the Nebraska Prescription Drug Monitoring Program (PDMP) and potentially saved a local patient’s life.

This patient’s husband was concerned about the rate at which she was refilling her prescriptions. He felt uncomfortable bringing this up to her, so he spoke with his wife’s nursing staff at the medical clinic. He asked if there was anything the clinical team could do. The nurse he spoke to made sure the physician consulted the PDMP during the next patient visit, and he saw some troubling activity with the patient’s prescriptions for controlled substances.

Based on results in the PDMP, the physician discussed the patient’s prescription refill history with her and intervened on behalf of her health and safety to get her into a treatment and counseling plan for substance abuse. Although it was a difficult conversation to have, the patient and her spouse were grateful for the intervention and recognized that her medication usage was becoming life-threatening.

Having been a part of the Nebraska PDMP from its inception, I was glad to know of such a perfect example why the PDMP is so important for patient safety; it shows the power of prescription monitoring when caring for a patient.

How does the PDMP work?

The PDMP shows all dispensed prescriptions the patient receives from any pharmacy in the state or from mail order pharmacies that send dispensed prescriptions into Nebraska. Providers can monitor patient medication usage and ensure adherence to treatment. Chronic pain syndromes may render opioids ineffective and alternative therapies, such as physical therapy, non-steroidal medications, cognitive and behavioral therapy, and counseling become an integral part of the treatment plan.

The PDMP acts as a safety check

The PDMP acts as a safety check when clinicians need information about prescribed medication for a patient. For a clinician to safely continue treatment and prescribe more medications, it is critical to understand the full scope of medication therapy the patient is taking from all of their providers. This leads to safer dosages and combinations and helps monitor drugs that are easy to abuse.

The PDMP is used as a safety tool to ensure the patient is not taking a mix of medications that could cause an overdose and to ensure patients are taking medications as prescribed; Nebraska statute does not allow law enforcement to have access to the database. Before the PDMP, the physician may only have known what they had personally prescribed or would have to take time to call other pharmacies to see what medications a patient had received from other providers. Now, with the Nebraska PDMP, physicians can access a comprehensive review of controlled substances at the click of a button.

Opioids, such as Vicodin or Oxycontin, are the most commonly mentioned drug when discussing drug abuse, but opioids are not the only drugs used incorrectly. Benzodiazepines (like Xanax or Valium) and stimulants (like Adderall) can be dangerous when mixed with other medications or when taken too often. For instance, a PDMP allows a clinician to see if there is a risk of mixing an opioid, a stimulant and a benzodiazepine in dangerous ways if refilled more frequently than necessary.

The PDMP focuses on outcomes

In the case with the rural husband and wife, a clinician can

• identify a patient safety problem based on dispensing history,

• discuss his/her analysis, based on information available, with the patient, and

• help redirect the clinical care to a safe treatment path.

This might include tapering the patient off the medication, counseling, therapy, and in some cases, inpatient hospitalization.

The PDMP is about optimal outcomes for the patient – reducing the risk of overdose and adverse effects. In the example I shared here, the clinical team cared about the patient and wanted to utilize clinical tools to monitor the patient’s prescriptions in order to ensure the best care possible.

 

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Kevin recently joined us for our Joint Interoperability & HIE, Nursing Informatics and Connected Health Community Roundtable to talk about The Success Story of the Prescription Drug Monitoring Program in Nebraska. Watch the webinar now!