Disclaimer: I am not a lawyer or a medical malpractice/ risk management expert. The content on this page is provided for general guidance only. I am only sharing what I currently understand based on what I have read or heard from experts. Clinicians are responsible for obtaining guidance on these issues from their malpractice insurance provider and/ or attorney.
I am not giving credit to the sources from which I learned the tips below because I did not ask for permission to do so.
What is the PDMP?
In almost all states in the US, prescribing clinicians can check a database called the Prescription Drug Monitoring Program (PDMP; also called PMP) to see exactly what prescriptions for controlled substances a patient has filled.
PDMP programs vary by state. For example, here is the website for the PDMP program in Pennsylvania where I practice:
https://www.health.pa.gov/topics/programs/PDMP/Pages/PDMP.aspx
Note:
– We get this information even if the medication was prescribed by another clinician.
– Increasingly, the PDMPs for different states are getting connected and, to some extent, we can also check controlled substance precriptions that a patient may have filled in some other states.
– Prescribing clinicians are allowed to delegate to someone else, e.g., an assistant, the task of checking the PDMP.
– Pharmacies are also required to check the PDMP before filling a prescription for a controlled substance.
When do we need to check the PDMP?
PDMP laws in the United States vary by state. For those not in the US, yes, it is strange that the laws in the US differ from state to state. Clinicians practicing in the US must become familiar with the PDMP laws in their state.
Just to give you an idea, prescribing clinicians in Pennsylvania (as of November 2018) must check the PDMP:
– The first time they prescribe a controlled substance to the patient
– If they suspect abuse or diversion of the medication
– EVERY single time a prescription for an opioid or a benzodiazepine is written. Yes, every single time. That’s the law.
– While this is not required, checking the PDMP before each prescription for ANY controlled substance is recommended.
Do’s
While the PDMP keeps track of when we check on entries about a patient, it may be best that we document briefly in the patient’s chart that PDMP was checked. We don’t have to do this but if there is a problem in the future, we may not want to depend on a government agency to provide us information and proof about when we checked the PDMP.
Don’ts
– If we find any evidence on the PDMP of inappropriate behavior by the patient, this does NOT mean that we can immediately stop providing care to the patient. We must provide appropriate notice and referrals. Otherwise, we could be accused of “abandonment” of the patient.
– If we find any evidence on the PDMP of inappropriate behavior by the patient, this does not mean that we can or should share this information with law enforcement authorities or others. Prescribing clinicians should check and be aware of laws of in the state where they practice. But, due to strict laws about confidentiality, only under special circumstances are we allowed to disclose wrongdoing by patients to others. Typically, these relate to preventable danger to specific other people.
A handout from PRMS, a major provider of risk management insurance that has kindly provided free resources on this website recommends that clinicians NOT report problems found through PDMP to law enforcement.
Also, the information provided to us in the PDMP is protected by special rules of confidentiality. So, it was suggested to me that the information in the PDMP about a particular patient should NOT be put in our chart (records) about the patient. Why? Because if our records may be sent to someone in the future, either with the patient’s consent or under subpoena or court order.
As noted above, we are NOT allowed to disclose PDMP information to others and if a printout from PDMP is in the chart, we may be forced to send it along with the records in response to a subpoena or court order.
Related Pages
Prescribing controlled substances: Managing the risks
Myths and Misconceptions: Patients who obtain multiple prescriptions
Risk management in mental health practice
Risk management tips from Professional Risk Management Services (PRMS)
What are the BEST books on each topic related to psychiatry/ mental health?
References
Pennsylvania PDMP: Tutorials and Policies
Pennsylvania PDMP: Questions and Answers
Copyright © 2018 to 2021, Simple and Practical Medical Education, LLC. All rights reserved. May not be reproduced in any form without express written permission.
Disclaimer: The content on this website is provided as general education for medical professionals. It is not intended or recommended for patients or other laypersons or as a substitute for medical advice, diagnosis, or treatment. Patients must always consult a qualified health care professional regarding their diagnosis and treatment. Healthcare professionals should always check this website for the most recently updated information.
The PDMP in my state also monitors provider statistics. I believe as an NP my prescribing practices are compared to other NPs. So if you are an ADHD specialist and prescribe lots of stimulants, you would have a high percentage of stimulant prescriptions. Or if you are a pain specialist and have a high percentage of pain med. This implies you are doing something wrong. How does one protect oneself from DEA judgment that may not have all the facts?
Obviously we don’t report patients to law enforcement. I think the bigger question is do you contact other prescribers to discuss what is going on and make sure everyone is on the same page both in terms of helping the patient and not endangering anyone.
Dear Dr. Raj,
One additional reason not to put a copy of a PDMP search in a pt’s chart pertains to the disclaimer contained in any search. The disclaimer (this is not the exact wording of it) states “The information is not guaranteed to be accurate”.
I have found major errors in closely examining several PDMP’s. A medication I do not prescribe has been attributed to me (my name) or the date the script was issued is not accurate or it is listed more than once along with other odd errors.
I also have found most clinicians overlook the disclaimer and take the information as gospel.
The word to the wise is suppose here is “Read the small print”.
Best,
Mary Miller MSN., MPH., CS., APRN
M
Thanks, Mary, for your comment!