DEA and prescribing provider

TheLastStatetoGrantNursePractitionersDEALicensure_AnEducationImprovementInitiativeontheFloridaPrescriptionDrugMonitoringProgram.pdf

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The Last State to Grant Nurse Practitioners DEA Licensure An Education Improvement Initiative on the Florida Prescription Drug Monitoring Program

Joni R. Kellams, DNP, ARNP, FNP-BC m John P. Maye, PhD, CRNA

Abstract Nurse practitioners (NPs) now have prescriptive authority

for controlled substances in all 50 states in the United

States. Florida, the last state to grant NPs DEA licensure,

has been wrought with prescription diversion practices for a

number of years as pill mills, doctor shopping, and

overprescribing proliferated. Prescription Drug Monitoring

Programs (PDMPs) help curb drug diversion activity and

play a key role in reducing the abuse of controlled

substances. The primary objective of this education

improvement initiative was to increase knowledge of

actively licensed NPs in the state of Florida regarding the

state’s PDMP. The main themes included the drug abuse

problem, description and progression of the PDMP, and

how to use the Florida PDMP. Upon approval from the

institutional review board, this education improvement

initiative gauged NP knowledge of the PDMP and main

themes before and after an educational PowerPoint

intervention. A pretest/posttest questionnaire was

administered for assessment of all knowledge questions.

One hundred forty-five NPs with active advanced registered

NP licenses in Florida completed both the pretest and

posttest questionnaires. Descriptive statistics and paired

t tests were used for statistical significance testing. Knowledge of the PDMP and the main themes of the

education improvement initiative significantly increased

(p G .001) from pretest to posttest results. This education improvement initiative had positive effects for NPs on the

knowledge of the Florida PDMP and the main themes. This

indicated that Florida NPs are able to acquire greater

comprehension of the PDMP by an education intervention.

Keywords: controlled substances, drug diversion, education

initiative, Florida, nurse practitioner, Prescription Drug

Monitoring Program

INTRODUCTION Addiction to substances continues to be a global epidemic

with more than 200 million people reportedly abusing illegal

substances worldwide (United Nations, 2014). In the United

States, 25 million people were abusing substances in 2012

(U.S. Department of Health and Human Services [HHS],

2013). Currently, drug overdose has surpassed motor vehicle

accidents as the number one cause of injury deaths in the

United States (Centers for Disease Control and Prevention,

2014). Correlating to the large numbers of prescription

abusers, the supply for pharmaceutical substances also in-

creased. Opioid sales soared dramatically, seeing a 627%

increase in sales from 1997 to 2007 in America (U.S. Depart-

ment of HHS, 2013). Thus, higher numbers of opioid-related

deaths occurred as well, from 3,000 deaths in 1999 to over

15,000 deaths in 2008 (U.S. Department of HHS, 2013).

The cost of illicit drug abuse was in excess of $193 billion in

2007 due to crime, health, and diminished work productivity

(U.S. Department of Justice National Drug Intelligence Center,

2011). Moreover, the U.S. Department of Justice Drug En-

forcement Administration (2015) estimated that healthcare

costs due to prescription drug abuse exceeded $3 trillion in 2014.

Drug Abuse in Florida Florida has been the focus of the addiction crisis for a number

of years and was once the highest state with opioid purchases

with almost 41 million purchases in dosage units from January

to June 2010 (Office of National Drug Control Policy, 2011). In

contrast, and in a distant second, Ohio reached almost one

million opioid dosage unit purchases during that same time

(Office of National Drug Control Policy, 2011). Florida

prescribers being one of the highest purchasers of opioids

eventually led to a proliferation of drug diversion activity,

such as pill mills, doctor shopping, and prescriptions from

multiple sources and multiple pharmacies (Florida Board of

Medicine, 2014).

At the height of the battle, prescription-related deaths in

Florida reached a staggering 2,710 deaths in 2010 (Florida

Office of the Attorney General, 2014). The following year,

Florida implemented legislation targeted at decreasing con-

trolled substance abuse from a prescriber and dispenser

perspective. Florida Statute 893.055, the PDMP statute, out-

lined the creation of an electronic database to monitor

Joni R. Kellams, DNP, ARNP, FNP-BC, and John P. Maye, PhD, CRNA, University of South Florida, Tampa.

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Correspondence related to content to: Joni R. Kellams, 15810 Briarcliff Lane, Fort Myers, FL 33912.

E-mail: [email protected]

DOI: 10.1097/JAN.0000000000000177

Journal of Addictions Nursing www.journalofaddictionsnursing.com 135

Original Article Journal of Addictions Nursing & Volume 28 & Number 3, 135Y142 & Copyright B 2017 International Nurses Society on Addictions

controlled substance prescription activity for patients. After

this legislation passed, the number of prescription-related

deaths decreased to 2,539 in 2011 and 2,090 in 2012 (Florida

Office of the Attorney General, 2014).

Legislation in Florida In January 2017, Florida joined the rest of the states to give

nurse practitioners (NPs) prescriptive authority for con-

trolled substances by implementing Florida HB 423, also

named the Barbara Lumpkin Prescribing Act (The Florida

Senate, 2016). NPs are now able to prescribe Schedule IIYIV controlled substances throughout the state (The Florida

Senate, 2016) and are required by the Florida Board of Nurs-

ing to finish 3 hours of continuing education on safe, effective

controlled substance prescribing with each advanced regis-

tered NP (ARNP) license renewal (Florida Board of Nursing,

2016). NPs in Florida must complete this same continuing

education biennially. The legislation change does not affect

the current ability of Florida NPs to access the Prescription

Drug Monitoring Program (PDMP), as DEA licensure is not

required to retrieve information from the electronic data-

base (Health Information Designs, 2015). NPs in Florida,

along with other healthcare providers, have the ability to avoid

compounding the prescription drug abuse issue, and utiliza-

tion of the PDMP can be a powerful tool to thwart further

addiction. Research indicated that NPs value PDMPs as a ben-

eficial tool to prevent drug diversion activity in their practice

(LeMire, Martner, & Rising, 2012). It would behoove NPs in

Florida to understand the PDMP and incorporate it into their

controlled substance prescribing practices.

Prescription Drug Monitoring Program The PDMP is a tool used to electronically collect and store in-

formation on controlled substance disbursement at the state

level (U.S. Department of Justice Drug Enforcement Adminis-

tration, 2015.). Florida’s PDMP is known as Electronic-Florida

Online Reporting of Controlled Substance Evaluation Pro-

gram (E-FORCSE). Research showed that, in states that have

implemented PDMPs, the implementation resulted in success-

ful reductions in prescription opioid-related deaths (Delcher,

Wagenaar, Goldberger, Cook, & Maldonado-Molina, 2015), de-

crease in the supply and abuse of highly addictive controlled

substances (Worley, 2012), and decline in opioid dispensation

(Brady et al., 2014). The PDMP legislation, as well as legislation

to curb pill mill activity in Florida, resulted in substantial reduc-

tions in drug diversion activity in Florida (Surratt et al., 2014).

A 25% reduction in oxycodone-related deaths in the state of

Florida was observed after implementation of the PDMP (Delcher

et al., 2015). Furthermore, Florida recognized a steady decline in

prescription-related deaths each year after implementation of the

PDMP (Florida Office of the Attorney General, 2014), whereas

the trend for prescription-related deaths before implementation

had revealed a steady increase each year (Florida Office of the

Attorney General, 2014).

A nationwide study on states with active PDMPs showed

that there was also a downward trend in opioid dispensation

(which was converted to morphine milligram equivalents

for the study) by approximately 3% (Brady et al., 2014).

The most impressive decrease in opioid prescription and

use has been observed where baseline opioid use and pre-

scribing practices were highest (Rutkow et al., 2015).

PDMPs are crucial tools used to reduce the supply and

abuse of controlled substances specifically targeted as

highly addictive, such as opioids and benzodiazepines

(Worley, 2012).

The National All Schedules Prescription Electronic

Reporting Act was enacted in 2005 at the federal level to

encourage states to adopt PDMPs. Subsequently, all states,

except Missouri, have passed some form of legislation for

a PDMP. The PDMP in Florida was signed into state leg-

islation in June 2009 and implemented into practice in

September 2011 (Florida Department of Health, 2015).

In 2013, Florida prescription-related deaths fell under

2,000 to 1,916 for the first time since 2006 (Florida Depart-

ment of Health, 2015).

Likewise, PDMPs have been effective tools to decrease

drug diversion behavior in other states. Since Kentucky

adopted an electronic monitoring program in 1999, they have

fallen from the second highest state for nonmedical use of

prescription painkillers to the 31st (Substance Abuse and

Mental Health Services Administration, 2013). In Oregon,

accessing the PDMP changed certain ways in which pre-

scribers practice healthcare. When prescription abuse was

suspected because of PDMP data, prescribers discussed con-

cerns and reviewed data with patients, prescribed alternative

medications, referred patients to specialists, required patients

to enter into a prescription contract, and even discharged

some patients from their practices (Irvine et al., 2014). In

discussing concerns about the PDMP data, several patients

subsequently inquired about addiction treatment options as

well (Irvine et al., 2014).

Current research indicated that many prescribers were

reluctant to utilize the PDMP for various reasons. Barriers

to prescriber use of the database varied from information

retrieval being too time consuming to lack of ease in accessing

and utilizing databases (Rutkow et al., 2015). Education

on the PDMP and how to use it is vital therefore, and this

education initiative strove to reduce barriers due to lack

of knowledge affecting potential use of the PDMP by NPs.

Evidence was also clear that prescriber and dispenser par-

ticipation is necessary for PDMPs to succeed (Rutkow et al.,

2015). In accessing the PDMP, clinicians are able to safely

prescribe controlled substances for patients, oppose doctor

shopping, and openly discuss treatment options for addicts

(Haffajee, Jena, & Weiner, 2015). To be proponents for safe,

responsible, controlled substance prescribing, NPs should be

aware of the PDMP, created as a safeguard against prescrip-

tion misuse and overprescribing. Florida addiction and

overdose rates have decreased since implementation of the

PDMP, yet prescribers need to use the electronic database

for the PDMP to work as intended and for those rates to lower

even further.

136 www.journalofaddictionsnursing.com July/September 2017

Purpose The purpose of this education improvement initiative was to

increase knowledge of the PDMP by actively licensed NPs in

Florida. The major themes of the education improvement ini-

tiative were (a) the prescription drug abuse problem, (b) the

description and progression of the PDMP, and (c) how to use

Florida’s PDMP, E-FORCSE.

METHODS This education improvement initiative was designed for ac-

tively licensed NPs in Florida to increase knowledge of

Florida’s PDMP and the main themes of the education im-

provement initiative. The conceptual framework used for

this education initiative was the Stetler Model of Research

Utilization, as a model for knowledge translation. The Stetler

Model of Research Utilization assisted in the critical thinking

process relating research findings on the PDMP to practical

application by NPs (National Collaborating Centre for

Methods and Tools, 2011).

Sample The sampling strategy was on a voluntary basis and included a

study participant group made up of NPs with active ARNP

licenses in Florida. This was the only inclusion criterion to

participate. Exclusion criteria included non-NP providers

(doctor, physicians assistant, nurse, certified registered nurse

anesthetist without an NP license, certified nurse midwife

without an NP license), and current NP students who were

not actively licensed to practice as NPs in Florida.

Data Collection The Florida Department of Health Public Data Portal was

used to identify 16,892 potential participants who met par-

ticipation requirements. After institutional review board

approval for the education improvement initiative, weekly

recruitment emails were sent for 4 consecutive weeks to

potential participants. The recruitment email included a cover

letter, consent to participate in the education improvement

initiative, and directions on how to successfully complete the

education initiative and explained the voluntary nature of

participation. Implementation of the education improve-

ment initiative was done completely online and included all

the tools to fulfill the objective of the education improvement

initiative.

Education Improvement Instrument This education initiative utilized an electronic pretest question-

naire to be completed before study participants accessed the

educational PowerPoint and an electronic posttest question-

naire to be completed after study participants finished the

educational PowerPoint. The PowerPoint presentation was

developed to increase participants’ knowledge of the education

improvement’s main themes and provided all the educational

components to correctly answer all knowledge questions in the

pretest/posttest. The pretest consisted of a response to the in-

formed consent to participate in the education improvement

initiative, 3 simple and nonidentifiable sociodemographic

questions, and 18 questions gauging the participants’ current

knowledge of the education initiative’s themes. The three

sociodemographic questions included (a) confirmation of

active Florida ARNP license status, (b) age, and (c) years of

experience as an NP. The posttest consisted of the same

18 questions about the major themes of the education initiative

that were included in the pretest yet excluded the consent ques-

tion and the three initial sociodemographic questions. The

18 identical knowledge questions were broken down as follows:

(a) Section 1 was composed of Questions 1Y5 on the drug abuse problem, totaling five questions; (b) Section 2 was com-

posed of Questions 6Y13 on the description and progression of the PDMP, totaling eight questions; and (c) Section 3 was com-

posed of Questions 14Y18 on how to use E-FORCSE, totaling five questions. After completing the posttest questionnaire,

participants were directed to an answer key where correct an-

swers to the 18 knowledge questions were revealed. The pretest/

posttest questionnaire remained open for participation for

2 months.

Data Analysis Data were analyzed using Intellectus Statistics software.

The metrics used to gauge the success of this education im-

provement initiative included comparison of the pretest

knowledge questions to specific corresponding posttest

knowledge questions after participants completed the educa-

tional PowerPoint. Summary statistics were calculated for

each ratio variable, and frequencies and percentages were cal-

culated for each ordinal variable. A paired samples t test was

conducted to examine whether the difference between com-

posite pretest and posttest scores, Section 1 (Questions 1Y5) pretest and posttest scores, Section 2 (Questions 6Y13) pretest and posttest scores, and Section 3 (Questions 14Y18) pretest and posttest scores was significantly different from zero.

RESULTS Three hundred nineteen NPs finished the online pretest ques-

tionnaire. Of those 319 NPs, 145 NPs also finished the

online posttest questionnaire, thereby providing completed

responses and inclusion in this education improvement ini-

tiative. All of the 145 education improvement initiative

participants gave consent to participate and had an active

ARNP license in Florida. The most frequently observed cate-

gory of age was 50Y64 years (n = 69, 48%). The most frequently observed category of years of experience was

G5 years (n = 62, 43%). Demographic frequencies and per- centages are presented in Table 1.

The observations for composite pretest score ranged from

3.00 to 13.00, with an average of 7.18 (SD = 2.14). The obser-

vations for composite posttest score ranged from 1.00 to

18.00, with an average of 14.06 (SD = 2.77). The observations

for Section 1 (Questions 1Y5) pretest score ranged from 1.00 to 5.00, with an average of 2.63 (SD = 0.94). The observations

for Section 1 posttest score ranged from 0.00 to 5.00, with an

average of 4.53 (SD = 0.79). The observations for Section 2

Journal of Addictions Nursing www.journalofaddictionsnursing.com 137

(Questions 6Y13) pretest score ranged from 1.00 to 7.00, with an average of 3.11 (SD = 1.48). The observations for Section 2

posttest score ranged from 1.00 to 8.00, with an average of

6.14 (SD = 1.38). The observations for Section 3 (Questions

14Y18) pretest score ranged from 0.00 to 4.00, with an average of 1.43 (SD = 1.03). The observations for Section 3 posttest

score ranged from 0.00 to 5.00, with an average of 3.37 (SD =

1.36; see Table 2 for minimum and maximum pretest and

posttest scores).

For the composite scores, the result of the paired samples

t test was significant, p G .001, suggesting that the true differ- ence in the means of composite pretest and posttest scores

was significantly different from zero. The mean of composite

pretest score (7.18) was significantly lower than the mean of

composite posttest score (14.06). For Section 1 scores, the

result of the paired samples t test was significant, p G .001, suggesting that the true difference in the means of Section

1 pretest and posttest scores was significantly different from

zero. The mean of Section 1 pretest score (2.63) was signifi-

cantly lower than the mean of Section 1 posttest score (4.53).

For Section 2 scores, the result of the paired samples t test was

significant, p G .001, suggesting that the true difference in the means of Section 2 pretest and posttest scores was signifi-

cantly different from zero. The mean of Section 2 pretest

score (3.11) was significantly lower than the mean of Section

2 posttest score (6.14). For Section 3 scores, the result of the

paired samples t test was significant, p G .001, suggesting that the true difference in the means of Section 3 pretest and post-

test scores was significantly different from zero. The mean of

Section 3 pretest score (1.43) was significantly lower than the

mean of Section 3 posttest score (3.37). There was a gain of

6.88 in the mean of composite score, a gain of 1.9 in the mean

of Section 1 score, a gain of 3.03 in the mean of Section 2 score,

and a gain of 1.94 in the mean of Section 3 score (see Table 3 for

paired samples t test differences between pretest and posttest

scores). Figure 1 presents the mean of composite scores and

each section scores.

DISCUSSION The outcomes of this education improvement initiative re-

vealed the value of the education intervention as a strategy

to increase knowledge of the Florida PDMP by NPs actively

licensed in Florida. The findings indicated that participants

generally had insufficient knowledge of the PDMP and major

themes of the education improvement initiative before the

education intervention. Pretest score means for composite

and each separate section scores were significantly lower than

posttest score means for composite and each separate section

scores. Posttest score means were higher for composite and all

sections, indicating a better understanding of the PDMP and

the education improvement initiative’s themes. Thus, the

education improvement initiative may be effective in improv-

ing NPs’ knowledge of the PDMP.

The knowledge questions where the highest actual gains in

correct answers from pretest to posttest were noted in the fol-

lowing: (a) Question 1 (75.17% gain and 109 participant

increase from pretest to posttest), which educated on poison-

ing (which included overdose deaths) as the primary cause of

accidental deaths in the United States; (b) Question 8 (69.65%

TABLE 1 Frequency Table for Demographic Variables

Variable n %

Age

18Y29 6 4

30Y49 59 41

50Y64 69 48

965 11 8

Missing 0 0

Years of experience

G5 62 43

6Y10 24 17

11Y15 19 13

916 40 28

Missing 0 0

Note. Because of rounding errors, percentages may not equal 100%.

TABLE 2 Minimum and Maximum Scores of Pretest and Posttest Scores

Scores Total Min Max

Composite score, pretest 18 3.00 13.00

Composite score, posttest 18 1.00 18.00

Section 1, pretest 5 1.00 5.00

Section 1, posttest 5 0.00 5.00

Section 2, pretest 8 1.00 7.00

Section 2, posttest 8 1.00 8.00

Section 3, pretest 5 0.00 4.00

Section 3, posttest 5 0.00 5.00

TABLE 3 Paired Samples t Test for the Differences Between Pretest and Posttest Scores

Variable Pretest, M (SD)

Posttest, M (SD) n t Test p Value

Composite 7.18 (2.14)

14.06 (2.77)

145 j29.31 G.001

Section 1 2.63 (0.94)

4.53 (0.79)

145 j19.82 G.001

Section 2 3.11 (1.48)

6.14 (1.38)

145 j21.48 G.001

Section 3 1.43 (1.03)

3.37 (1.36)

145 j16.40 G.001

138 www.journalofaddictionsnursing.com July/September 2017

gain and 101 participant increase from pretest to posttest),

which identified Missouri as the only state without enactment

of PDMP legislation; and (c) Question 18 (63.45% gain and 92

participant increase from pretest to posttest), which associated

a physician’s name, address, and number of controlled sub-

stance prescriptions for a patient by using the doctor bag

symbol in the map results section of E-FORCSE (see Table 4

for all knowledge questions and frequency of correct answers).

In the posttest, the knowledge questions that participants

scored the highest on included the following: (a) one selection

from Question 16 (100% [145 participants] answered correctly),

which included the first and last name as a required field

in the Report Query search; Question 3 (99.31% [144 par-

ticipants] answered correctly), which distinguished Florida

as the state that purchased 10 times the national average of oxy-

codone pills; and Question 10 (98.62% [143 participants]

answered correctly), which acknowledged that individual prac-

titioners or pharmacists were granted access to E-FORCSE.

The knowledge questions in the posttest that participants

scored the lowest on were the following: (a) Question 11

(44.83% [65 participants] answered correctly), which dealt

with understanding that Florida does not mandate prescriber

participation in the PDMP; (b) Question 15 (59.31% [86 par-

ticipants] answered correctly), which asked which query

generated dispensed prescriptions history attributed to DEA

number; and (c) Question 17 (65.52% [95 participants] an-

swered correctly), which inquired what a patient advisory

report generated in E-FORCSE.

The item participants struggled with the most was Ques-

tion 11 on Florida’s lack of prescriber mandates for the PDMP.

This important educational point was missed by most par-

ticipants in the pretest and posttest and was particularly vital

for participants to understand. It was a far reaching aim of

this education improvement initiative to potentially gar-

ner support for prescriber-mandated legislation in Florida

by increasing understanding of and participation in the

PDMP. Again, participation in the PDMP by dispensers and

prescribers encourages not only the success of the PDMP

(Rutkow et al., 2015) but also the ability for a PDMP to work

as intended to decrease drug diversion behaviors. Prescriber

mandates to use the state’s respective PDMP exist in only 22

states before prescribing controlled substances in situations

where abuse is evident (Haffajee et al., 2015). The PDMP in

Florida requires dispensers of controlled substance to access

the database, yet prescribers are exempt from this mandated

accountability.

The lowest mean pretest and posttest scores between

the three sectional scores were in Section 3 (how to use

E-FORCSE), which suggested that participants had a greater

knowledge deficit on how to use E-FORCSE, the questions

were most challenging in this section, and/or participants

gained the least knowledge within this section, among other

possible explanations. The highest gain in mean scores from

pretest to posttest sections occurred in Section 3 as well,

which indicated that participants could have had the most

to learn on how to use E-FORCSE. The highest mean pretest

and posttest scores between the three sectional scores were in

Section 1 (the drug abuse problem), which indicated that par-

ticipants knew the most about this section, questions were

more easily answered in this section, participants more easily

understood the educational information relevant to this sec-

tion, and/or participants had prior knowledge of this section’s

concepts, among other possible explanations. Overall, there

were significant knowledge improvements observed on com-

posite and all sectional scores, which strengthened the

argument for educational advancements on the PDMP.

This was the first educational improvement initiative to

focus on the Florida PDMP for NPs, yet there were limitations

as well. Participation was open to any NP with an active

ARNP license in Florida; therefore, a voluntary self-selection

bias was conceivable. Participants were not observed while

taking the pretest and posttest to ensure integrity of testing

standards. Participants were also personally responsible to

view the educational PowerPoint on their own and in their

own time frame. The instruments used were not validated,

and there was no determination of current utilization of the

Figure 1. Mean of pretest and posttest scores.

Journal of Addictions Nursing www.journalofaddictionsnursing.com 139

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e c t)

1 . H

e lp

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d ru

g -s

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g b e h a vi

o r.

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fy c li n ic

ia n s

w it

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a p p ro

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sc ri

b in

g a n d

d is

p e n si

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p a tt

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3 .

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. 4

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(6 8

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h a t

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a P

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h a t

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g a n d

d is

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in fo

rm a ti o n

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IV m

e d ic

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in F lo

ri d a ?

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8 %

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to E

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(c o n ti n u es )

140 www.journalofaddictionsnursing.com July/September 2017

T A B L E

4 K n o w le d g e

Q u e s ti o n s a n d

F re

q u e n c y

a n d

P e rc

e n ta

g e s o f C o rr e c t A n s w e rs

a n d

G a in s F ro

m P re

te s t to

P o s tt e s t,

C o n ti n u e d

N o .

K n o w

le d g e

Q u e st

io n

C o rr

e c t

A n sw

e r

P re

te st

, %

(N u m

b e r

o f

P a rt

ic ip

a n ts

) C o rr

e c t

P o st

te st

, %

(N u m

b e r

o f

P a rt

ic ip

a n ts

) C o rr

e c t

G a in

s Fr

o m

E d u c a ti o n

In te

rv e n ti o n ,%

(N u m

b e r

o f P a rt ic

ip a n ts

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1 2

W h ic

h o f th

e fo

ll o w

in g

d o

n o t re

q u ir

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p o rt

in g

to E -F

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C S E

w h e n

a d m

in is

te ri n g

o r d is

p e n si

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a ry

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ra n s

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a ir

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it a ls

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to ry

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o n e -t

im e

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re su

p p ly

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% (3

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9 )

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% (6

7 )

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m a n d a to

ry fo

r d is

p e n se

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re p o rt

C II Y C IV

w it h in

_ _ _ _ _ _ _

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ti o n :

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(4 6

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3 %

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% (8

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h o f th

e fo

ll o w

in g

a re

re q u ir e d

to c o m

p le

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a c c e ss

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fo rm

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e le

c t a ll

th a t a p p ly

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th a n

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c h o ic

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a y b e

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a il

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ss 1

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1 %

(1 2

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4 3

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3 )

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n u m

b e r

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1 .3

8 %

(2 )

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li c e n su

re e xp

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% (7

9 )

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8 0

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1 7

) 3

. 2

6 .2

1 %

(3 8

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1 5

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q u e ry

c a n

b e

u se

d b y

p ra

c ti

ti o n e rs

to vi

e w

a h is

to ry

o f

a ll

d is

p e n se

d p re

sc ri

p ti

o n s

a tt

ri b u te

d to

th e ir

D E

A n u m

b e r?

P ra

c ti

ti o n e r

D E

A q u e ry

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% (6

9 )

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% (8

6 )

1 1

.7 2

% (1

7 )

1 6

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a re

th e

re q u ir

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fi e ld

s in

th e

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2 %

(1 4

3 )

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1 0

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(1 4

5 )

1 .

1 .3

8 %

(2 )

2 .

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o f

b ir

th 2

. 8

4 .8

3 %

(1 2

3 )

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9 7

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% (1

4 2

) 2

. 1

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0 %

(1 9

)

3 .

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p e n se

d st

a rt

a n d

e n d

d a te

s 3

. 5

7 .2

4 %

(8 3

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. 8

4 .1

4 %

(1 2

2 )

3 .

2 6

.9 0

% (3

9 )

1 7

A R

e c ip

ie n t

Q u e ry

w il l

g e n e ra

te w

h ic

h o f

th e

fo ll o w

in g :

P a ti

e n t

a d vi

so ry

re p o rt

(P A

R ),

w h ic

h c h e c k s

c o n tr

o ll e d

su b st

a n c e

d is

p e n si

n g

in fo

rm a ti

o n

fo r

a sp

e c if

ic p a ti

e n t.

4 0

.6 9

% (5

9 )

6 5

.5 2

% (9

5 )

2 4

.8 3

% (3

6 )

1 8

In th

e M

a p

R e su

lt s

se c ti

o n ,

w h a t

re p re

se n ts

th e

p h ys

ic ia

n ’s

a d d re

ss a n d

w il l

d is

p la

y th

e p h ys

ic ia

n ’s

n a m

e a n d

n u m

b e r o f p re

sc ri

p ti

o n s

w ri

tt e n

fo r

th e

p a ti

e n t.

D o c to

r b a g

2 4

.1 4

% (3

5 )

8 7

.5 9

% (1

2 7

) 6

3 .4

5 %

(9 2

)

Journal of Addictions Nursing www.journalofaddictionsnursing.com 141

PDMP by participants. There were no benefits to participants

for continuing education credits as well.

Future research should focus on how an education im-

provement initiative affects use of the PDMP and ease of

use by clinicians. In addition, research should emphasize

how an education intervention affects implementation of

the PDMP for improvement in patient care when controlled

substances are prescribed. Studies have found that active use

of the PDMP may refine controlled substance prescribing by

clinicians. In Ohio, 61% of emergency room providers who

were given PDMP data on patients did not prescribe or lim-

ited the original intended amount of narcotics when abuse

was apparent, whereas 39% altered prescription actions by

increasing narcotic amounts as the PDMP indicated no pre-

scription abuse (Baehren et al., 2010). From a legislative

perspective, research should be directed at whether par-

ticipation in an education improvement initiative increases

support for healthcare policy changes, namely, encouraging

PDMP prescriber-mandated participation.

CONCLUSION This education improvement initiative resulted in significant

positive impacts for NPs on the knowledge of the Florida

PDMP and the other themes of the education initiative. The

competency gained by Florida NPs indicated that an educa-

tion intervention would encourage greater comprehension of

the PDMP. In addition, recurrent evaluation of NPs’ knowl-

edge of the PDMP could distinguish when supplementary

education is warranted. It is imperative for NPs to understand

the PDMP and the implications of safe prescribing practices

since gaining DEA privileges in Florida. It is possible that the

downward trend in prescription-related deaths in Florida will

continue despite a lack of prescriber mandates; nevertheless,

close to 2,000 deaths due to prescriptions are still far beyond

acceptable. Therefore, knowledge of the PDMP is critical for

Florida NPs to provide safe patient care and be in line with

state-mandated controlled substance prescribing laws.

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http://floridasnursing.gov/latest-news/new-legislation-impacting-your-profession/

http://myfloridalegal.com/webfiles.nsf/WF/RMAS-9GUKBJ/$file/Progress-Report-Online-2014.pdf

http://www.hidesigns.com/assets/files/flpdms/2016/FL_PDMP_Training_Guide_for_Practitioners_and_Pharmacists.pdf

http://www.nccmt.ca/resources/search/83

https://obamawhitehouse.archives.gov/sites/default/files/ondcp/ndcs2011.pdf

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