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

BACKGROUND: Safe opioid prescribing remains a national priority amid rising overdose-related morbidity and mortality. Prescription drug monitoring programs (PDMPs) aim to improve prescribing safety by identifying high-risk medication patterns; however, clinician engagement remains inconsistent despite legal requirements. Internal audits at our institution demonstrated PDMP review in only 67.6% of opioid-prescribing discharges within the Hospital Internal Medicine Department, identifying a clear quality improvement (QI) opportunity. PURPOSE: This QI project aimed to increase PDMP review during opioid-prescribing discharges at our Hospital Internal Medicine Department by 20% over a 3-month period. METHODS: Using the DMAIC framework, interventions targeted hospitalist physicians, advanced practice providers, and pharmacists. Strategies included stakeholder education, standardized documentation templates, pharmacist secure-chat reminders at discharge, workflow algorithms, and weekly dashboard monitoring with targeted feedback. The primary outcome was the proportion of opioid-prescribing encounters with documented PDMP review. The balancing measure was the percentage of patients discharged before noon to ensure operational efficiency was preserved. Chi-square and two-sample t tests were performed. RESULTS: Among 336 eligible discharges, PDMP review increased from 67.6% at baseline to 84.8% by March 2025, with a peak of 100% observed during the final measurement week (p < .001). Review rates increased steadily, with the largest gains after dissemination of workflow algorithms and targeted feedback. Discharge-before-noon rates remained stable (11.67% vs. 13.47%; p = .27), with no effect on operational efficiency. CONCLUSIONS: This QI initiative significantly improved PDMP review adherence without affecting discharge efficiency. IMPLICATIONS: This scalable, multidisciplinary model supports regulatory compliance and strengthens system-level opioid stewardship across health care settings.