Increasing Drug Screens and Prescription Drug Monitoring Program Assessments for Patients Enrolled in Opioid Replacement Therapy
Abstract
**Please note that the full text is embargoed** ABSTRACT: Opioid use disorder is an epidemic that has a devastating impact on public health,
morbidity and mortality, and the escalating economic burden of healthcare (U.S.
Department of Health & Human Services, 2013). The rates of prescriptive and nonprescriptive
opioid misuse are on the rise (Compton, Boyle, & Wargo, 2015). One
approach in managing opioid use disorder is opioid replacement therapy (ORT). In
response to increasing rates of opioid use disorder, the Drug Addiction Treatment Act of
2000 permitted "qualifying physicians" to treat opioid use disorder in an office-based
setting. The FDA approved medication buprenorphine, a partial opioid agonist, is used in
the treatment of opioid use disorder in an office-based setting. Despite its efficacy, there
is significant concern about the potential misuse and diversion of buprenorphine
(Federation of State Medical Boards, 2013 ).
The purpose of the Quality Improvement project was to increase drug screens and
prescription drug monitoring program assessments (PDMP) for patients enrolled in ORT.
Drug screens and PDMP assessments are commonly used to mitigate the potential risk of
misuse and diversion associated with ORT. Quarterly random drug screens and PDMP
assessments were implemented for patients enrolled in ORT in an office-based setting in
Dallas, Texas. In this setting there are three clinicians. Data collected included the
number of drug screens and PDMP assessments. Retrospective data included 60 chart
reviews for data before intervention, and 64 charts after intervention. The frequency of
drug screenings and PDMP assessments were measured using a Monitoring Score. The
six-month study period was April 1, 2015 to September 30, 2015. Charts met criteria for
inclusion if the patient enrolled in ORT was in maintenance treatment, diagnosed with opioid
use disorder, and at least 18 years of age or older. Charts were excluded if the
patient was enrolled in induction ORT, hospitalized during the study period, or under the
age of 18 years old.
Clinicians demonstrated a significant increase in the number of drug screens and
PDMP assessments post protocol implementation. Prior to implementing the protocol,
68% of patient charts showed a Monitoring Score of 0, indicating no record of drug
screens or PDMP assessments. Post implementation, there were no charts reviewed that
reflected a Monitoring Score of O reflecting a significant increase in drug screens and
PDMP assessments. In fact 80% of the charts had a Monitoring Score of 3 or higher,
with 4 being maximum assessment possible.
The Opioid Use Disorder Protocol served as a tool to engage clinicians in a
comprehensive ORT treatment plan that promotes safe prescribing. The QI project
suggests that implementing a guideline for the frequency of drug screenings and PDMP
assessments is an effective way to reinforce clinician behavioral change in managing the
potential risk of ORT. DNP scholarly projects using quality improvement initiatives are
significant contributions to nursing practice and improving health outcomes. This
protocol has made a positive impact on clinician practice; clinicians report that the
protocol improved the quality of care provided at Live Oak Counseling.