Quality Improvement Proposal: PDMP for Opiate Prescription Reduction

This report presents a quality improvement proposal aimed at addressing the opiate crisis through the implementation of Prescription Drug Monitoring Programs (PDMP). The introduction highlights the significance of evidence-based practice in driving quality improvement initiatives and identifies the misuse of prescription drugs as a primary concern. The proposal outlines the rationale for selecting this issue, emphasizing the need for nurse practitioners to have adequate tools to manage pain and limit the opiate crisis. The report provides supportive evidence, referencing the use of PDMP in the US and describing its function in tracking controlled substances. The methodology involves a non-experimental correlational design to explore the relationship between PDMP usage and opiate prescription reduction. The steps of implementation include standardization of data fields, reduction in data collection intervals, instituting prescription forms, integration of electronic prescribing, and improving data quality. Each step is supported by rationale and evidence. The evaluation plan includes satisfaction surveys, system audits, and the analysis of outcome measures. The conclusion reiterates the importance of the proposal and the use of evidence-based practice to improve patient care. References to relevant studies are also provided.

Quality Improvement Proposal
Quality Improvement Proposal
Student’s Name:
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Quality Improvement Proposal
Table of Contents
Introduction 3
The requirement of quality improvement initiative and expected outcome 4
Supportive evidence 4
Steps of implementation: 5
A. Standardization of data fields 5
B. Reduction in data collection interval 5
C. Instituting prescription forms 6
D. Integration of electronic prescribing 6
E. Improving data quality 6
Evaluation: 6
Conclusion 7
References 7
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Quality Improvement Proposal
Introduction
Evidence-based practice (also referred to as EBP) is considered as the regulatory force which
drives several initiatives of quality improvement in an organization or the standardization of
practices. Several factors have been recognized which motivates the use of EBP to improve the
quality of health care provided for increasing the positive outcomes with the help of constant
utilization of the knowledge-based research. The research-based evidence provides a base that
helps in propelling my nursing project. The problem selected in the present paper is for exploring
the relationship which occurs when the PDMP (also referred to as Prescription Drug Monitoring
Programs) is used by the prescribers for a time duration as well as for determining the total
reduction in the number of opiate prescriptions after use and if the program is also being referred
to other disciplines of pain management. The rationale to select this issue is at par due to the
crisis of opiate experienced by several countries as well as the way regular and adequate training
including the tools to manage people who seek pain control could be provided assistance and
care. The study initially explains about the evidence-based practice while identifying the issue
and the requirement of quality improvement proposal in the area as well as its expected
outcomes.
The requirement of quality improvement initiative and
expected outcome
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Quality Improvement Proposal
The growth of misuse of the prescription drugs within the primary care setting is recognized as
an issue hence increasing the urge to initiate quality improvement planning and initiation. Hence,
it is required that nurse practitioners should be provided with adequate training tools to manage
pain while taking part in limiting the crisis of opiate. The initiation of quality improvement will
help to reduce the opiate crisis while having some unprecedented effect on well being,
community, patient’s safety, growth and well being. There are several limitless benefits that
could be possible with the active participation of nurse practitioners in their practice area and
organization. The expected outcome could be a reduction in the misuse of prescription drugs
while providing quantifiable data which will help in guiding prescribers while prompting
explorations of alternate treatment which will depict the effect of opiate while assessing patients
daily. The initiative would help in operating within in real-time while collaborating with
interstate along with the incorporation of e-health records for identification of such patients and
recognizing appropriate prescription drug abusers (Ali, Dowd, Classen, Mutter & Novak, 2017).
Supportive evidence
In the US, the PDMP has been utilized in some settings for addressing the problem of misuse of
prescription drug. It is a type of database that helps in tracking controlled substances that are
prescribed by the providers of healthcare. Providers could help in reporting the concerns to
several agencies that deal with law enforcement (Grecu, Dave & Saffer, 2018). It was initially
designed and used for collecting, analyzing and reporting the prescription along with the
dispensing of various controlled substances. The initiative will make use of a non-experimental
correlational design, that helps in exploring the association of variables with the help of
statistical analysis. The variables will be obtained from the previous documents as well as
medical history while including the nature of pain, its intensity any past treatments, present
condition, its impact on physical functions of the body and any history of misuse of prescription
drugs. Variables for the implementation includes access to PDMP, any agreement with the
patient, prescription of opioid, opioid dose, etc (Grecu, Dave & Saffer, 2018).
Adaptation and implementation of the regular use of PDMP based on evidence-based practice
would consist of obtaining a complete history as well as a physical assessment of the patient
along with the assessment of their functioning at times when patients are present in the primary
healthcare setting for complaints related to pain. Supporting the statements various research-
based literature have been recognized such as a study conducted by Khalid et al., (2015) which
ought to make a comparison of adherence with the guidelines of opioid adherence as well as the
misuse of prescription drugs on resident’s and other physicians which depicted the level of
monitoring which was found to be potentially higher as compared to other studies. A similar
study was recognized related to prescribing pressures conducted by Patrick, Fry, Jones & Buntin,
(2016), examining various opinions of ER physicians on the impact of economic as well as
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Quality Improvement Proposal
regulatory factors on the patient’s management displaying behaviors of drug misuse with the
help of PDMP. Another study on complementary therapies has been recognized to be helpful to
manage chronic pain (Simpson, 2015). The results depicted the grounded approach of PDMP
within the nociceptive perception (Simpson, 2015).
Steps of implementation:
The steps of initiating quality improvement program have been discussed below with supporting
evidence and rationale which will help in complete, adequate, updated analysis of data as well as
reports of end users (Ali, Dowd, Classen, Mutter & Novak, 2017).
A. Standardization of data fields
Rationale: The prescribers should examine every drug class which is being scheduled for
making adequate prescribing decisions. The classes would be subjected to misuse. Collection of
all the planned permits would help in improving the detection of the questionable misuse of the
activity. Maintaining a uniform standard of data standard might help in facilitating data sharing
interstate, analyzing the interorganizational collaborations. The use of recent standards of PDMP
would help in providing finished data fields while improving the correction of error as well as
providing more functionalities.
Evidence: It includes all the unpublished PDMP analysis of data while taking expert opinion.
B. Reduction in data collection interval
Rationale: Timely data are considered to be causing potential prescribing which should be
informed along with enhanced detection of any questionable activity.
Evidence: Requirement of any professional opinion.
C. Instituting prescription forms
Rationale: Instituting of serialized prescription forms might tend to decrease in prescription
fraud and might be higher to unserialized forms which are tamper-proof.
Evidence: It was depicted in various published studies.
D. Integration of electronic prescribing
Rationale: Integration of PDMP along with e prescribing might result in highly reliable, whole
as well as time bound monitoring of prescription.
Evidence: The perceptions of key stakeholders towards PDMP initiation.
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Quality Improvement Proposal
E. Improving data quality
Rationale: Total as well as particular data could help to enhance reporting, and is essential for
drug prescribers as well as healthcare providers to make decisions related to patient care while
detection of any type of questionable activity.
Evidence: Attained field experience and the perceptions of key stakeholder on quality
improvement.
Evaluation:
Evaluation practices related to PDMP initiation might cover the response towards the regularly
changing demands as well as the conditions while making sure that the systems, as well as the
policies, should permit the highest adequate use of PDMP data. The evaluation process includes
conducting satisfaction as well as several utilization surveys on the point of end-users.
Conducting audits of the PDMP system and its proper use. Utilization of PDMP data in the form
of outcome measures to evaluate the program as well as any changes in the policy. Analyzing
different outcomes and their data such as overdoses, visit ER, admission to hospitals, etc. for
evaluating the impact of the quality improvement system (Ali, Dowd, Classen, Mutter & Novak,
2017).
Conclusion
The present study identifies a quality improvement opportunity with the help of evidence-based
research. The research-based evidence provides a base that helps in propelling my nursing
project. Adaptation and implementation of the regular use of PDMP based on evidence-based
practice would consist of obtaining a complete history as well as a physical assessment of the
patient along with the assessment of their functioning at times when patients are present in the
primary healthcare setting for complaints related to pain. The evaluation process includes
conducting satisfaction as well as several utilization surveys on the point of end-users.
Conducting audits of the PDMP system and its proper use.
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Quality Improvement Proposal
References
Ali, M., Dowd, W., Classen, T., Mutter, R., & Novak, S. (2017). Prescription drug monitoring
programs, nonmedical use of prescription drugs, and heroin use: Evidence from the
National Survey of Drug Use and Health. Addictive Behaviors, 69, 65-77. doi:
10.1016/j.addbeh.2017.01.011
Grecu, A., Dave, D., & Saffer, H. (2018). Mandatory Access Prescription Drug Monitoring
Programs and Prescription Drug Abuse. Journal Of Policy Analysis And Management,
38(1), 181-209. doi: 10.1002/pam.22098
Khalid, L., Liebschutz, J., Xuan, Z., Dossabhoy, S., Kim, Y., & Crooks, D. et al. (2015).
Adherence to Prescription Opioid Monitoring Guidelines among Residents and
Attending Physicians in the Primary Care Setting. Pain Medicine, 16(3), 480-487. doi:
10.1111/pme.12602
Patrick, S., Fry, C., Jones, T., & Buntin, M. (2016). Implementation Of Prescription Drug
Monitoring Programs Associated With Reductions In Opioid-Related Death Rates.
Health Affairs, 35(7), 1324-1332. doi: 10.1377/hlthaff.2015.1496
Simpson, C. (2015). Complementary Medicine in Chronic Pain Treatment. Physical
Medicine And Rehabilitation Clinics Of North America, 26(2), 321-347. doi:
10.1016/j.pmr.2014.12.005
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