Patient Alerts (also referred to as Clinical Alerts) are an optional PDMP enabled enhancement that provides notifications and/or alerts to prescribers to indicate that one of their patients has met or exceeded a threshold determined by the PDMP. These alerts are meant to serve as a tool to help healthcare providers identify patients who may have higher or unexpected exposure to controlled substances and consider a supportive conversation between the provider and patient. Patient Alerts are not meant to indicate illegal or inappropriate behavior and are not meant to replace provider decision-making.
There are 6 different types of Patient Alerts the PDMP may have enabled for their providers.
- Prescriber & Dispenser Thresholds
When a patient receives controlled substance prescriptions from multiple prescribers, drug interactions can occur, especially if providers are unaware of the other medications the patient has received. The Prescriber & Dispenser Threshold alert occurs when a patient fills controlled substance prescriptions written by a specified number of prescribers, filled at a specified number of pharmacies, within a specified amount of time. The number of prescribers, pharmacies, and timeframe are determined by the PDMP.
- Daily Active MME Threshold
Prescribing the lowest effective dose of opioids can be an effective strategy to reduce the risk of overdose or development of opioid use disorder, and providers should use caution when increasing a patient’s daily opioid dose above the recommended daily morphine milligram equivalent (MME) dosage unless there are specific extenuating circumstances. The Daily Active MME Threshold alert occurs when a patient a receives a cumulative daily opioid dosage greater than the limit set by the PDMP.
- Opioid & Benzodiazepine Threshold
Patients taking opioids who receive an additional prescription for an opioid, benzodiazepine, muscle relaxant, or hypnotic are at increased risk of overdose, thus, special consideration and medication management should be used. The Opioid & Benzodiazepine Threshold alert occurs when a patient has filled both an opioid and a benzodiazepine prescription that overlap for at least 1 day.
- Daily Active Methadone Threshold
Prescribing the lowest effective dose of Methadone can be an effective strategy to reduce the risk of overdose or development of substance use disorder. Providers should use caution when increasing a patient’s daily Methadone dose above the recommended daily Methadone dosage unless there are specific extenuating circumstances. The Daily Active Methadone Threshold alert occurs when a patient a receives a cumulative daily Methadone dosage greater than the limit set by the PDMP.
- Opioid Consecutive Days Threshold
The CDC recommends that providers limit the duration of prescribed opioids to 3 days or less for acute pain (including most post-surgical pain). Limiting initial prescriptions to 3 days reduces the patient’s risk for dependence and limits misuse of leftover medication. If a patient’s circumstances require more than 3 days of opioids, it is recommended to limit to 7 days and re-assess the patient’s condition at that time. The Opioid Consecutive Days Threshold alert occurs when opioids have been received daily by the patient for longer than 3 days.
- Deceased Patient Alert
The Deceased Patient Alert presents when a patient has been reported to the PDMP as deceased, typically by way of public records or direct reporting received from the jurisdiction’s Medical Examiner’s Office. Depending on the functionality enabled by the PDMP, the Deceased Patient Alert may come with additional notification regarding patient-controlled substance toxicology. This alert serves as a tool for provider awareness and prevention of drug diversion/misuse.
The Patient Alert User Experience
As determined and enabled by the PDMP, there are four interactions where a provider may encounter or receive information regarding a Patient Alert.
PMP AWARxE My Dashboard
If enabled by the PDMP, Patient Alerts is viewable to providers within their PMP AWARxE My Dashboard. To access My Dashboard, go to the PMP AWARxE menu and select Dashboard from the Home section.
| The report accessed from My Dashboard is a historic Patient Alert Patient Report designed to show the Patient Alert occurring during the identified timeframe and may not be representative of the patient's current/active Patient Alert status. To review the patient's most recent report, click Refine Search to run a current report. |
PMP AWARxE Patient Alerts
If enabled by the PDMP, Patient Alerts is viewable to providers within their PMP AWARxE Patient Alerts. To access Patient Alerts, go to the PMP AWARxE menu and select Patient Alerts from the RxSearch section.
| The report accessed from My Dashboard is a historic Patient Alert Patient Report designed to show the Patient Alert occurring during the identified timeframe and may not be representative of the patient's current/active Patient Alert status. To review the patient's most recent report, click Refine Search to run a current report. |
When viewing a Patient Alert, a banner will display on all Patient Alert patient reports accessed via the Patient Alerts View All Alerts table or the My Dashboard Patient Alerts table in PMP AWARxE. This banner will inform providers they are viewing a historical Patient Alert patient report, as well as provide instructions for using "Refine Search" to review the patient's most recent dispensation information. The banner messaging will also include reference to the specific Patient Alert triggered and the alert date for improved transparency and understanding.
For additional information on performing Patient Requests, please refer to the Performing a Patient Request (Patient Search) help article.
PMP AWARxE & PMP Gateway Patient Report Flags
If enabled by the PDMP, authorized roles may find Patient Alert flags in the State Indicators tile of the patient report if the patient has met or exceeded an identified threshold. The patient report accessed via Rx Search Patient Request will only show Patient Alerts that are actively occurring during the timeframe of the search. To view historical Patient Alerts, please see My Dashboard and/or Patient Alerts.
Email Notification
If enabled and on a cadence determined by the PDMP (daily or monthly), providers may receive an email notification if they have a patient that has met or exceeded an identified threshold. This email notification will contain an aggregate overview of any actively occurring Patient Alerts. These notifications will not contain PHI. To view further details for the Patient Alert(s), providers should login to their PMP AWARxE account and visit My Dashboard and/or Patient Alerts.
For more information on understanding a user’s My Dashboard or viewing a Patient Alert, please refer to the My Dashboard Overview or the Patient Alert help articles.