363 Characterization and Impact of a State Prescription Drug Monitoring Program by Emergency Department Providers

Abstract

The Minnesota Prescription Monitoring Program (RxSentry) collects prescription data on all schedule II-IV controlled substances as well as federal schedule V substances. Reporting is from all in-state pharmacies and other dispensers as well as those out of state pharmacies that ship controlled substances to Minnesota residents. To determine if this program is used and its effect on controlled substance prescribing as perceived by emergency department (ED) providers. This was a prospective observational study conducted at an urban, Level 1 Trauma Center with 99,000 annual visits. Data collection was performed using trained research associates. We screened all adult patients in the ED during a randomized distribution of 10 8-hour shifts totaling 80 hours in November 2013. ED providers were approached to complete a survey if their patient received pain medication either in the ED or upon discharge, or if the provider used the RxSentry system. Data were analyzed using descriptive statistics. A total of 673 patients were screened and 235 were enrolled. Of 235 patients, 187 were prescribed a pain medication at discharge (80%), 137 were prescribed a controlled substance at discharge (58%). The RxSentry program was used in 37 patients (16%). Providers reported the RxSentry changed the decision to prescribe a controlled substance in 13 cases. In 3 cases, the provider did not prescribe a controlled substance and in 10 cases the provider did prescribe a controlled substance. Providers reported the RxSentry program changed their decision regarding quantity of controlled substances in 9 cases, in 4 of these cases the quantity of controlled substance was increased and in 5 cases it was decreased. In the majority of cases (30/34, 88%), the provider did not discuss the use of the program with the patient if it was used. The RxSentry system was only used 16% of the time a patient was given a pain medication. Of these, the provider reported the use of the system had an effect on prescription or quantity dispensed of controlled substance prescribed in 29% of these cases. It appears the system is under-utilized, and could potentially have a larger impact if it were used in more patients who were prescribed controlled substances.