2026 Eastern States Conference

Title: Characterizing Urine Drug Screening Utilization in Patients with Medication Use Agreements within a Learning Health System
Authors: Julia Iskra, PharmD, Donielle Beiler, BS, Antoinette Dicriscio, PhD, Vanessa Troiani, PhD
Learning Objective:
At the conclusion of this presentation, audience members will be able to describe medication use agreement (MUA) adherence and urine drug screen (UDS) ordering habits for patients seen by an MTDM pain management clinic.
Background/Objective: Patients prescribed controlled substances sign a medication use agreement (MUA), allowing for routine urine drug screening (UDS) monitoring. Examining UDS and clinical actions in MUA patients may highlight ways pharmacists can improve patient care.
Methods: We conducted an observational quality improvement analysis to document current clinical processes and outcomes related to UDS compliance and standard practices within the context of MUAs. We began by documenting initial clinical observations from interactions with patients with MUAs in the context of standard clinical care. We are in the process of auditing a subset of patients with MUAs, referred to a medication drug therapy management (MTDM) pain management pharmacist in January and February of 2026. Patients were only included if they completed an intake visit. Extracted data on each patient will include demographics, details of the MUA, UDS order history, panel components, and confirmatory testing. Using the data extracted from patient records, we will assess MUA policy adherence and UDS ordering heterogeneity as the primary outcomes.
Results: Initial observational analysis demonstrated practice variability in UDS ordering, with inconsistent panel composition, underutilization of confirmatory testing, and the absence of standardized protocols, suggesting opportunities for process improvement. For the audit phase, 23 patient charts were identified as relevant for review based on referral and MUA data. A standardized chart review extraction tool was developed to operationalize UDS-related process and outcome measures within pain pharmacist referral workflows, allowing for systematic assessment of current practice variation and identification of quality improvement opportunities. Chart review is currently ongoing; results will be shared at the conference.
Conclusions: This quality improvement study evaluates UDS ordering compliance and result monitoring for patients with an active MUA referred to an MDTM pharmacist. Our chart review aims to standardize UDS documentation, identify deviations from MUAs, and improve pharmacist-led monitoring to support safer prescribing and controlled substance management.
Self-assessment question: What role can pharmacists play in ensuring MUA adherence and consistent UDS monitoring?