The Florida Prescripon Drug Monitoring Program (FDMP) also known as E-FORSCE became operaonal on October 1, 2011. E-FORSCE is a statewide database that collects and stores paent specific dispensed prescripon informaon on schedule II, III, IV controlled substances. All pharmacies in the State of Florida must report controlled substance dispensing informaon for schedule II, III, and IV within 7 days of dispensing.
Although it is not required by law, physicians are encouraged to register and access the state database when prescrib-ing controlled substances. The E-FORSCE database should be ulized as a tool to help improve paent care. Physi-cians will have access to database informaon in the form of a Paent Advisory Report (PAR).
The PAR is a summary of controlled substance prescripon informaon that has been reported to the state for a spe-cific paent for a specified period of me. The PAR is available immediately through E-FORSCE 24/7.
Physicians should use the PAR report to:
1. Supplement their patient assessment
2. Confirm the patient’s prescription history
3. Document compliance with a therapeutic regimen
4. Identify potentially hazardous or fatal interactions
5. Determine if a patient is trying to obtain multiple prescriptions for controlled
sub-stances from multiple practitioners (Pill Shopping).
The TGH Outpaent Pharmacy electronically transmits required informaon daily to the State of Florida reporng agency. Because the data is only required to be sent within 7 days of the dispensing transacon, there is a potenal for a seven day lag me on the availability of reported informaon.
Praconer E-FORSCE Registraon
E-FORSCE grants system access accounts to praconers so that they may look up, view, and print controlled sub-stance dispensing informaon on their specific paents. Praconers may request a user account to access infor-maon in the system. Access is granted to individuals only.
To request an account:
1. Open an internet browser window and type the following URL in the address bar:
www.hidinc.com/flpdmp.
2. Click the Practitioner/Pharmacist link located on the left menu.
3. Click the Terms and Conditions link to open and read.
4. After reading, the terms and conditions, click the Access Request Site link. A logon
win-dow is displayed.
5. Type newacct in the User Name filed.
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Outcomes In Perspective
Outcomes In Perspective
Outcomes In Perspective
Volume 13—Number 6
March 2012
The Florida Prescription Drug Monitoring Program
(FDMP) or E-FORSCE
Page 2 Outcomes In Perspective
6. Type welcome in the Password field.
7. Click OK.
8. Complete the fields on this form.
Information required:
a. Name, Date of Birth, Last 4 digits of SSN, State license number, License type, Date license
ex-pires, DEA number and NPI number, Facility practice name, Mailing address, E-mail address,
Phone number
9. Click Accept & Submit.
If you are approved for an account, you will be nofied via two separate e-mails. The first e-mail will contain a temporary pass-word and instrucons for accessing the system, and the second e-mal will contain your personal idenficaon number (PIN) that you will use to idenfy yourself if you need assistance from the HID Help Desk.
A training guide for E-FORSCE registraon and use can be found at the following internet website:
h"p://www.doh.state.fl.us/mqa/pdmp/Praconer_Info.html
A sample Paent Advisory Report is printed below.
(Continued from page 1)
The Florida Prescription Drug Monitoring Program
(FDMP) or E-FORSCE (cont.)
TGH Pharmacy & Therapeutics (P & T) Committee UPDATE:
December 2011 & January 2012
Earnest Alexander, Pharm.D, Manager, Pharmacy Services
*Please visit Micromedex under the “Hyperlink” tab in EPIC for more details on the latest formulary decisions and access to the TGH
For-mulary.
• Tranexamic Acid injection (Cyklokapron)
A review of published studies using intravenous tranexamic acid was presented to the P & T Committee. The Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) study, a retrospective trial of patients who were seen at a combat hospital in Af-ghanistan was discussed. The study endpoints were mortality at 24 hours, 48 hours and in-hospital mortality. The study showed statistically significant decreases in mortality at 48 hours in tranexamic acid treated patients compared to those who did not receive the agent. These differences in outcomes were only noted in patients who received the agent within 3 hours of injury. Conversely, there was increased risk of death from bleeding noted in patients who re-ceived the agent past the 3-hour cutoff.
Tranexamic acid (Cyclokapron®) was added to the TGH formulary with restriction to the trau-ma trau-massive transfusion protocol to be used within the first three hours following initial injury.
• TGH position statement on pharmaceutical “Gray Market”
As a result of the escalating number of drug shortages and the emergence of alternate sup-plies for products outside of FDA review, TGH has drafted a position statement on purchasing products from the pharmaceutical “Gray Market”:
It is the position of Tampa General Hospital department of pharmacy that pharmaceutical products will not be purchased from non-traditional sources known as the “gray-market”. This position is
taken in order to ensure patient safety and product integrity.
This position statement has been added to the TGH Drug Shortages Policy.
• Ticagrelor (Brilinta®)
Ticagrelor (Brilinta®) is a new anti-platelet agent indicated for secondary prevention of athero-thrombotic events in patients with NSTEMI and STEMI when managed with primary or delayed PCI. Current formulary agents with similar indication include clopidrogel (Plavix®) and prasug-rel (Effient®). Ticagprasug-relor is the first reversible oral P2Y12 ADP receptor inhibitor. A more rap-id onset and offset of platelet inhibition has been noted compared with cloprap-idogrel, likely be-cause it does not require biotransformation to an active metabolite and is not influenced by patient pharmacogenomic differences in enzyme activity. Its quicker offset of antiplatelet activi-ty will allow platelet function to return to baseline more rapidly, possibly resulting in fewer CABG-related bleeding events in patients requiring emergent intervention. However, a shorter half-life of approximately 12 hours necessitates twice-daily dosing compared with once-daily administration of clopidogrel and prasugrel.
Ticagrelor therapy may be associated with fewer thromboembolic events following Acute Coro-nary Syndrome than clopidogrel, but is associated with an increased risk of non–CABG-related
Page 4 Outcomes In Perspective
major bleeding and dyspnea. No comparative studies have been conducted with prasugrel.
It is important to stress that patients should not receive daily aspi-rin in doses greater than 100 mg while on ticagrelor as this has been demonstrated to reduce the antiplatelet effectiveness. Ti-cagrelor could be a viable option for clopidogrel resistant patients and those with contraindications to prasugrel. Ticagrelor
(Brilinta®) has an FDA risk evaluation mitigation strategy (REMS) requirement that includes a medication guide for patients required at each dispense and a communication plan for health care pro-fessionals.
Ticagrelor was added to the TGH formulary with no restrictions.
• 2011 ANNUAL REVIEW
The Committee members reviewed 2011 goals and
accomplish-ments. This document will be posted on the Micromedex Formulary Advisor for all to view.
Please visit “tgh pharmacy” link on any patient care computer or Micromedex through EPIC hyperlink – FORMULARY ADVISOR provides a complete and current list of pharmaceutical shortages
(Continued from page 3)
Just a friendly reminder to make
sure your
Calendars are marked for this
year’s
DOCTOR’S DAY
This newsletter is produced by Tampa General Hospital’s
Quality Improvement Department. All comments, responses or sug-gestions are welcome and should
be directed to: Sally H. Houston, M.D.
Sr. V.P. & Chief Medical Officer Tampa General Hospital,
P.O. Box 1289, Tampa, Florida 33601
~~~~~~~~~~
Editorial Review Board
EXECUTIVE EDITOR EXECUTIVE EDITOREXECUTIVE EDITOR EXECUTIVE EDITOR Sally H Houston, M.D. EDITOR
EDITOREDITOR
EDITOR----ININININ----CHIEFCHIEFCHIEF CHIEF
Charles F. Bombard, RN, MHA LAYOUT & DESIGN
LAYOUT & DESIGNLAYOUT & DESIGN LAYOUT & DESIGN Paul DeLand BOARD MEMBERS BOARD MEMBERSBOARD MEMBERS BOARD MEMBERS Deana Nelson, RN, MHA Thomas Bernasek, M.D.
The physicians below were added to TGH staff: 1/31/2012
Armando N. Guerrez, MD
Obstetrics/Gynecology
Malek Kanama, MD
Surgery/General Surgery
Brian A. Patrick, MD
Internal Medicine/Hospital Medicine
KUDOS TO OUR PHYSICIANS!
Congratulations to the following physicians who were recognized by their patients in the form of personal letters to TGH leadership.
Dr. Peter Chang, Dr. Keely Fischbach Dr. Peter Chang, Dr. Keely Fischbach Dr. Peter Chang, Dr. Keely Fischbach Dr. Peter Chang, Dr. Keely Fischbach
and Dr. Steven Goldin and Dr. Steven Goldin and Dr. Steven Goldin and Dr. Steven Goldin
