Do you look patients up on your state’s controlled substance monitoring database before writing prescriptions for these medications? I’ve long been aware of this resource available to nurse practitioners and other prescribers, however I recently learned that there’s a lot more to using these databases than most providers are aware of. Did you know that it may be illegal for you to print out the results of an inquiry into the system? Or, for example, that you may be legally obligated to look a patient up in your state’s database before writing certain prescriptions?
It can be difficult for nurse practitioners to keep up with the rules and regulations that guide our practice. Like me, you may not have even been aware of the kinds of guidelines that govern the use of your state’s prescription drug monitoring program (PDMP).
PDMPs are statewide databases that collect information about controlled substances dispensed in the state. Nurse practitioners may access this information to help prescribe these potentially dangerous and addictive medications responsibly. Because PDMPs are state resources rather than federal, guidelines for use vary by geographic location. Nurse practitioners must be aware of the regulations for using their state’s PDMP to practice in compliance with the law. Here are the practical questions you need to ask about your state’s prescription drug monitoring database.
1. Am I required to have access to my state’s PDMP?
Believe it or not, some states mandate that nurse practitioners maintain access to the state’s prescribing databank. This means you are required to sign up for an account and maintain an active username and password.
2. Am I required to use my state’s prescription drug monitoring program?
Checking prescribing stats for patients takes time. So, it’s natural that many nurse practitioners skip this step when writing for controlled substances. Many states, however, require that providers check the PDMP before writing prescriptions for certain substances or before prescribing medications beyond a specific timeframe. For example, in Tennessee, providers must check the state’s database before prescribing an opioid or benzo as a new course of treatment lasting more than seven days.
3. Who else can check a patient’s prescriptive status on my behalf?
Policymakers recognize that use of a PDMP takes precious time. In an increasingly strapped healthcare environment, the last thing we as nurse practitioners need is more paperwork, right?! Fortunately, in all but four states, law allows NPs to designate additional individuals in their practice to access the system. This way, a medical assistant, for example can verify the prescriptions a patient has received and notify the NP before the patient encounter. Typically, delegates must create their own account. They should not access the system using your credentials. Don’t forget…if an employee leaves your practice, you must also revoke their access to the database.
Apologies to nurse practitioners working in Michigan, Missouri, Nevada, Mississippi and Oklahoma – appointing a delegate is not permitted where you practice.
4. What can I do with information from the PDMP?
Once you suspect a patient of drug-seeking behavior, it can be tempting to print out the results from your PDMP inquiry, stride into the exam room, and authoritatively toss the results down in front of the malingering patient. But, not so fast. States regulate what prescribers are permitted to do with this information. In fact, in some states it may be illegal to print this information at all. In other states, you may not be permitted to include inquiry results in the patient’s chart or other permanent record. Avoid getting yourself into a legal tangle by understanding how your state expects nurse practitioners to handle this sensitive patient data.
5. Can I access information from neighboring states?
Practicing near the Tennessee border, many of my patients reside in nearby Kentucky. So, these two states allow healthcare providers to access one another’s prescription monitoring databases. While accessing information from neighboring states can be helpful for nurse practitioners, NPs must be aware of the regulations for use of each database they access. Neighboring states will have different rules for accessing, handling and distributing PDMP data.
6. How up to date is the information in my state’s PDMP?
Like any technology platform, some state’s prescription monitoring systems are better than others. In Alaska, for example, the PDMP is updated only monthly so providers can’t be sure what prescriptions their patients have recently filled. Pennsylvania’s PDMP in contrast, is updated in real time. Most states fall somewhere in between, updating prescribing information somewhere between 24 hours and one week after a prescription for a monitored substance is filled.
7. Which substances are monitored?
In a similar manner, states differ on which substances are monitored in the PDMP. Some states require reporting of schedule II – IV controlled substances. Other states require the inclusion of certain non-controlled substances in their systems. Nurse practitioners can expect information in the database to vary depending on where they practice.
Overall, it’s essential to familiarize yourself with state guidelines for use of this resource to keep your NP license in good standing. Misuse or neglecting to use your state’s prescription drug monitoring database could mean facing disciplinary action from the board or nursing or board of medicine where you practice.
If you aren’t aware of the guidelines for use of your state’s PDMP, the National Association of State Controlled Substances Authorities website contains helpful links to state profiles outlining terms of use.
Were you surprised by any of the guidelines for prescribers in your state?
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