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

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 People Live Better Lives. Helping People Live Better Lives. Objectives 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 opioids 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 Helping People Live Better Lives. Helping People Live Better Lives. 1

3/11/2019 Nebraska Drug Overdose Health Burden  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  Helping People Live Better Lives. Helping People Live Better Lives. All Drug-related and Opioid-related Overdose Fatalities, Nebraska, 2006 - 2017 12 10 Age adjusted rates per 100,000 8 6 Drug overdose Opioid related 4 2 0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Data source: Nebraska Vital Records, 2006-2017 Helping People Live Better Lives. Helping People Live Better Lives. 2

3/11/2019 National Drug Overdose Deaths Involving Benzodiazepines, by Opioid Involvement Number Among All Ages, 1999-2017 Helping People Live Better Lives. Helping People Live Better Lives. Opioids contributed to up to 35% of Drug Overdose Deaths in Nebraska, 2016 Helping People Live Better Lives. Helping People Live Better Lives. 3

3/11/2019 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 Helping People Live Better Lives. Helping People Live Better Lives. 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 1 CDC. https://www.cdc.gov/drugoverdose/pdmp/states.html Helping People Live Better Lives. Helping People Live Better Lives. 4

3/11/2019 Nebraska’s PDMP: Details • Patient safety model; many other models are diversion based • Nebraska 1 st (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 Helping People Live Better Lives. Helping People Live Better Lives. 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 Helping People Live Better Lives. Helping People Live Better Lives. 5

3/11/2019 Provider Access Website url: www.nehii.org NeHII HIE users PDMP users PDMP Pathway HIE Pathway Prescribers (MD, PA, APRN, DDS) for HIE Dispensers (RP) participants Designees (RN, Pharm tech) Helping People Live Better Lives. Helping People Live Better Lives. 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 Helping People Live Better Lives. Helping People Live Better Lives. 6

3/11/2019 Ad hoc Patient Search Helping People Live Better Lives. Helping People Live Better Lives. 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) Helping People Live Better Lives. Helping People Live Better Lives. 7

3/11/2019 Add Alias/Nickname to Search Allows a second name or nickname to be searched (e.g., Richard and Dick, Robert and Bob) Helping People Live Better Lives. Helping People Live Better Lives. Patient Search 1. Enter patient demographics to search Helping People Live Better Lives. Helping People Live Better Lives. 8

3/11/2019 Patient Search 2. Select patients to save Helping People Live Better Lives. Helping People Live Better Lives. Patient Search 3. Combine the selected patients Helping People Live Better Lives. Helping People Live Better Lives. 9

3/11/2019 Patient Notes: Provided by DHHS (Currently: Patient Disputing records May be expanded in the future) FQ9 Clinical Patient Safety Alerts 10

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

3/11/2019 More Information and Pain Management Guidance Document Helping People Live Better Lives. Helping People Live Better Lives. More Information and Pain Management Guidance Document Helping People Live Better Lives. Helping People Live Better Lives. 11

3/11/2019 Helping People Live Better Lives. Helping People Live Better Lives. Morphine Milligram Equivalent (MME) Alert Helping People Live Better Lives. Helping People Live Better Lives. 12

3/11/2019 Helping People Live Better Lives. Helping People Live Better Lives. Multiple Provider Episode Alert Helping People Live Better Lives. Helping People Live Better Lives. 13

3/11/2019 Helping People Live Better Lives. Helping People Live Better Lives. Overlapping Opioids and Benzodiazepines Alert Helping People Live Better Lives. Helping People Live Better Lives. 14

3/11/2019 Helping People Live Better Lives. Helping People Live Better Lives. Risk Score Alert Helping People Live Better Lives. Helping People Live Better Lives. 15

3/11/2019 Provider’s Patient Dashboard Helping People Live Better Lives. Helping People Live Better Lives. Provider’s Patient Dashboard Helping People Live Better Lives. Helping People Live Better Lives. 16

3/11/2019 Provider’s Patient Dashboard Helping People Live Better Lives. Helping People Live Better Lives. Provider Patient Dashboard – Adding Patients Add a new patient to the Provider Patient Dashboard Helping People Live Better Lives. Helping People Live Better Lives. 17

3/11/2019 Provider Patient Dashboard – Adding Patients Helping People Live Better Lives. Helping People Live Better Lives. Provider Patient Dashboard – Adding Patients Save the selected patients to the Dashboard Helping People Live Better Lives. Helping People Live Better Lives. 18

3/11/2019 Provider Patient Dashboard – Adding Patients Create and save a patient dashboard name Helping People Live Better Lives. Helping People Live Better Lives. Provider Patient Dashboard – Editing Patient List Add or remove patients from a profile Helping People Live Better Lives. Helping People Live Better Lives. 19

3/11/2019 Provider Patient Dashboard – Editing Patient List Add and combine the patients Helping People Live Better Lives. Helping People Live Better Lives. Provider Patient Dashboard – Editing Patient List Save the selected patients to the existing patient profile list Helping People Live Better Lives. Helping People Live Better Lives. 20

3/11/2019 Risk Score Alert Re-sort for easier medication reconciliation Helping People Live Better Lives. Helping People Live Better Lives. Helping People Live Better Lives. Helping People Live Better Lives. 21