JHQ 4911: Improving Hospitalist Prescription Drug Monitoring Program Review for Safer Opioid Prescribing: A Quality Improvement Initiative-Improving Hospitalist Prescription Drug Monitoring Program

Improving Hospitalist Prescription Drug Monitoring Program

Pdf Summary

This quality improvement initiative addressed inconsistent hospitalist review of Florida’s prescription drug monitoring program (PDMP/E-FORCSE) before discharge opioid prescribing. At baseline, only 67.6% of opioid-prescribing discharges in the Hospital Internal Medicine Department documented PDMP review, despite legal and safety expectations.<br /><br />Using the DMAIC framework, the team identified barriers such as limited awareness of requirements, unfamiliarity with E-FORCSE access and documentation, workflow inefficiencies, and weak prompting systems. Interventions targeted hospitalist physicians, advanced practice providers, and pharmacists and included: stakeholder education, standardized documentation smart phrases, pharmacist secure-chat reminders at discharge, workflow algorithms, weekly dashboard monitoring, and targeted feedback to noncompliant prescribers.<br /><br />Over the 3-month intervention period, 336 opioid-prescribing discharges were reviewed. PDMP documentation increased from 67.6% at baseline to 84.8%, with a peak of 100% in the final week, representing a statistically significant improvement (p < .001). The largest gains occurred after workflow algorithms and targeted feedback were introduced, suggesting that embedding PDMP checks into routine workflow was more effective than education alone.<br /><br />Importantly, the balancing measure showed no meaningful harm to operational efficiency: discharge-before-noon rates remained stable (11.67% during the intervention vs. 13.47% baseline; p = .27).<br /><br />The authors conclude that a multidisciplinary, workflow-based QI approach can substantially improve PDMP review adherence without delaying discharge processes. They suggest this model is scalable and may support safer opioid prescribing, stronger regulatory compliance, and broader opioid stewardship efforts in other hospital settings.

Keywords

quality improvement

PDMP

E-FORCSE

opioid prescribing

hospitalist

discharge

workflow

DMAIC

documentation

opioid stewardship