Overdose Prevention: Health Burden, PDMP, and Integration into - - PDF document

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Overdose Prevention: Health Burden, PDMP, and Integration into - - PDF document

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3/11/2019 Overdose Prevention: Health Burden, PDMP, and Integration into Workflow Kevin Borcher, PharmD Felicia Quintana-Zinn, MS, MBA PDMP Director Drug Overdose Epidemiologist NEHII, Inc. Nebraska DHHS- Division of Public Health Helping

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Helping People Live Better Lives. Helping People Live Better Lives.

Felicia Quintana-Zinn, MS, MBA Drug Overdose Epidemiologist Nebraska DHHS- Division of Public Health

Overdose Prevention: Health Burden, PDMP, and Integration into Workflow

Kevin Borcher, PharmD PDMP Director NEHII, Inc.

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Define and explain the health burden in Nebraska regarding drug overdoses. Explain history of legislation surrounding the Nebraska Prescription Drug Monitoring Program Define the Nebraska Prescription Drug Monitoring Program and its use (includes information on patient alerts regarding high doses of opioids, dangerous combinations of

  • pioids and benzodiazepines, possible risky behaviors around opioids and using the

Nebraska Pain Management Guidance in combination with the PDMP) Explain how patient alerts, medication history and using the Nebraska Pain Management Guidance in combination with the PDMP can be integrated into daily workflow

Objectives

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  • Nebraska’s drug overdose death rate has increased over the last decade –

9.8 overdose deaths for every 100,000 people in 2017 up from 3.6 in 2004.

  • The U.S. drug overdose death rate per 100,000 people was 21.7 in 2017

up from 9.3 in 2004.

  • 2017: 183 people in Nebraska died of a drug overdose
  • At least 59 involved opioids
  • 2016: 128 people in Nebraska died of a drug overdose
  • At least 38 involved opioids

Nebraska Drug Overdose Health Burden

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All Drug-related and Opioid-related Overdose Fatalities, Nebraska, 2006 - 2017

2 4 6 8 10 12

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Age adjusted rates per 100,000 Drug overdose Opioid related

Data source: Nebraska Vital Records, 2006-2017

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National Drug Overdose Deaths Involving Benzodiazepines, by Opioid Involvement Number Among All Ages, 1999-2017

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Opioids contributed to up to 35% of Drug Overdose Deaths in Nebraska, 2016

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Combatting the Opioid Epidemic

  • Multi-faceted approach
  • Prevention
  • Drug take-back programs
  • Education
  • Schools
  • Healthcare professionals
  • Continuing competency
  • Pain Management Guidance Document
  • Improve prescribing practices
  • Treatment/recovery
  • Naloxone
  • Identification/monitoring
  • PDMP

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What is a PDMP?

  • A Prescription Drug Monitoring Program (PDMP) is an electronic database that

tracks controlled substance prescriptions in a state. PDMPs can provide health authorities timely information about prescribing and patient behaviors that contribute to the epidemic and facilitate a nimble and targeted response.1

  • Tool to allow healthcare professionals to make better informed decisions

relating to the treatment and safety of the patient

  • 1CDC. https://www.cdc.gov/drugoverdose/pdmp/states.html
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Nebraska’s PDMP: Details

  • Patient safety model; many other models are diversion based
  • Nebraska 1st (and currently only) state to include both controlled and non-

controlled substances

  • Allow prescribers and pharmacists to monitor the care and treatment of their

patients

  • Alerts and information provided in system, designed to inform and provide easy

access to resources

  • Prevent the misuse of controlled substances that are prescribed

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Nebraska’s PDMP: Details

  • Operated by DHHS and uses NeHII HIE platform
  • Developed with DrFirst as PDMP vendor
  • Funded through federal grants
  • Dispensers must submit data
  • Nebraska pharmacies
  • Mail order pharmacies
  • Dispensing practitioners with a pharmacy permit
  • Delegated dispensers
  • Veterinarians (dispensing CS II-IV only)
  • All dispensed prescription drugs reported
  • Reported on a daily basis
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HIE Pathway for HIE participants PDMP Pathway Prescribers (MD, PA, APRN, DDS) Dispensers (RP) Designees (RN, Pharm tech)

NeHII HIE users

Website url: www.nehii.org

Provider Access

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Workflow: Patient Search

  • Multiple ways to search for patients
  • Typical Name Search
  • Initial Patient Search
  • Ad hoc Patient Search
  • Quick Patient Search
  • Allows for quick access to patients
  • Examples: Chronic pain, frequent monitoring
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Ad hoc Patient Search

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Cross Name Search

Allows a reverse name search if the pharmacy entered the patient’s name in reverse (e.g., Clark Kent vs. Kent Clark)

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Add Alias/Nickname to Search

Allows a second name or nickname to be searched (e.g., Richard and Dick, Robert and Bob)

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Patient Search

  • 1. Enter patient

demographics to search

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Patient Search

  • 2. Select

patients to save

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Patient Search

  • 3. Combine the selected

patients

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Patient Notes: Provided by DHHS (Currently: Patient Disputing records May be expanded in the future) Clinical Patient Safety Alerts

FQ9

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Slide 20 FQ9 Kevin, we will want to discuss the key points on this slide that need to be said.

Felicia Quintana-Zinn, 2/28/2019

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More Information and Pain Management Guidance Document

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More Information and Pain Management Guidance Document

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Morphine Milligram Equivalent (MME) Alert

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Multiple Provider Episode Alert

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Overlapping Opioids and Benzodiazepines Alert

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Risk Score Alert

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Provider’s Patient Dashboard

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Provider’s Patient Dashboard

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Provider’s Patient Dashboard

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Provider Patient Dashboard – Adding Patients

Add a new patient to the Provider Patient Dashboard

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Provider Patient Dashboard – Adding Patients

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Provider Patient Dashboard – Adding Patients

Save the selected patients to the Dashboard

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Provider Patient Dashboard – Adding Patients

Create and save a patient dashboard name

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Provider Patient Dashboard – Editing Patient List

Add or remove patients from a profile

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Provider Patient Dashboard – Editing Patient List

Add and combine the patients

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Provider Patient Dashboard – Editing Patient List

Save the selected patients to the existing patient profile list

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Risk Score Alert

Re-sort for easier medication reconciliation

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Reporting All Dispensed Prescriptions

  • Required reporting as of January 1, 2018
  • Comprehensive medication history
  • 10 x more data than traditional PDMP’s that include controlled substances only
  • Patient safety tool
  • Allows clinicians to make better informed decisions
  • Identify medications from multiple prescribers and pharmacies
  • Identify potential drug interactions, allergies
  • Provides a valuable resource in the event of natural disasters, system power interruptions
  • Tool for medication reconciliation

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Successful Medication Reconciliation System

Accurate list Comprehensive list Up-to-date list Ease of access within clinical workflow Cost-effective

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Overall Value of the PDMP

  • Powerful tool
  • Opioid/controlled substance dispensed prescription review
  • Comprehensive medication history
  • Dispensed prescriptions from all dispensers
  • Timely
  • Reported within one day of dispensing
  • No cost to query
  • Ease of access
  • Interoperability
  • Workflow integration
  • Directly access through HIE
  • Single Sign On
  • Patient Safety

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Q & A

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dhhs.ne.gov

@NEDHHS @NEDHHS NebraskaDHHS

PDMP Staff Contact Information

PDMP Support Line pdmp@nehii.org 402-506-9900

Kevin Borcher PDMP Director, NeHII KBorcher@nehii.org 402-506-9900 Ext. 106 Felicia Quintana-Zinn Drug Overdose Epidemiologist Felicia.Quintana-Zinn@Nebraska.gov 402-471-0379 Davidson Wissing Drug Overdose Prevention Coordinator Davidson.Wissing@Nebraska.gov 402-471-0835