Florida’s House Bill 21 goes into effect July 1, 2018. The new law limits prescriptions for Schedule II opioids to treat acute pain to three days. This requires changes in prescribing practices, including setting a January 31, 2019 deadline for completing a two-hour continuing medical education course (CME).
An Overview of the Law
- Prescribing practitioners must consult the prescription drug monitoring program (PDMP) before prescribing controlled substances (opioids and non-opioids). This does not apply to patients under age 16.
- The three-day limit may be increased to seven days if determined to be medically necessary with proper documentation and “Acute Pain Exception” written on the face of the prescription.
- Defines “acute pain” as the normal, predicted, physiological, and time-limited response to an adverse chemical, thermal, or mechanical stimulus associated with surgery, trauma, or acute illness. The term specifically does not include pain related to:
- A terminal condition;
- Palliative care to provide relief of symptoms related to an incurable, progressive illness or injury; or
- A serious traumatic injury with an Injury Severity Score of 9 or greater.
- Physician must prescribe an opioid antagonist when using a Schedule II opioid to treat pain related to traumatic injury with an injury severity score of 9 or greater.
- Must indicate “non-acute pain” on the face of the prescription.
What Physicians Can Do Now
- Register with E-FORCSE (Electronic-Florida Online Reporting of Controlled Substances Evaluation Program) https://florida.pmpaware.net (Note that E-FORCSE recently updated their system, including this new URL.)
- If you visited the above URL prior to May 9 and updated your login information, you should be all set.
- If you didn’t visit this new URL before May 9, you’ll have to re-register.
- Starting July 1, 2018 the “Prescription Monitoring” shortcut in Cerner now points to this URL.
- For technical assistance, please contact the help desk at email@example.com or (877) 719-3120.
- For program policy questions, please contact program staff at firstname.lastname@example.org or (850) 245-4797.
- Assign designees within the E-FORCSE system (there is no limit on the number of designees a prescriber may have in the E-FORCSE system.) Learn more about designees here.
- Complete board-approved two-hour CME. There are currently several groups that qualify to offer the course right now.
Florida Osteopathic Medical Association
- Florida Medical Association -
Florida Academy of Family PhysiciansFlorida College of Emergency PhysiciansBaptist Health of South Florida
Learn more about the law, including standards of practice, prescription limits, examples of controlled substances and their schedules, and designee requirements in the following documents (Doctor Connect login required):
The Prescription Drug Monitoring Program (PDMP) and Cerner
Beginning July 1, 2018, prescribing practitioners must adhere to the law and consult the PDMP before prescribing controlled substances. There is currently no transition period planned for adherence to the law. BayCare is working closely with governing bodies to ensure as smooth a transition as possible, and we will be integrating the PDMP tool (E-FORCSE) within the MPage of our EMR (Cerner). We expect this functionality to be ready sometime in the fall. Until then, click the “Prescription Monitoring” tab within Cerner.
For help with the E-FORCSE shortcut in Cerner, click here: https://secure.doctorconnect.org/Resources/training/Documents/auth/ise/isedu_Cerner%20EMR_COM_E-FORCSE%20Link%20on%20Cerner%20Toolbar.pdf
(7/26/18) See the updated FAQ from the FMA here: http://www.doctorconnect.org/Resources/news/Pages/ABOUTUS/E-FORCSE-Consultation-Requirement-FAQ.aspx
Q: Does accessing E-FORCSE through the Cerner banner bar link (“Prescription Monitoring”) suffice for documentation that E-FORCSE was checked or should it be specifically documented in a physician’s note or discharge summary?
A: Going into PDMP by any method gets recorded into their system. Specific documentation wouldn’t be required in the note.
Q: If the hospital pharmacist has checked E-FORCSE, would that count as a delegate or would the physician need to check E-FORCSE him or herself?
A: The pharmacist would only count as a delegate if they have linked themselves to that specific prescriber and checked E-FORCSE prior to the prescriber writing the Rx.
Q: Does E-FORCSE need to be checked on day of discharge or would it suffice if it were checked on day of admission or during the hospital stay?
A: There are no specific provisions related to that timing in the statute. It states that the PDMP must be checked by prescriber or delegate prior to prescribing. Until more clearly designated, checking during hospitalization or on admission should fulfill requirements.
For a full FAQ, click here: http://www.flhealthsource.gov/FloridaTakeControl/faqs