by Kellie Dell'Oro, Prinicipal and Rosemary Blanden, Lawyer | Meridian Lawyers
Before issuing a prescription for a high risk medicine, a prescriber must take ‘all reasonable steps’ to check the SafeScript information for the patient for whom the high risk medicine may be prescribed or supplied.
SafeScript information can alert the prescriber and dispenser to patients at risk of harm or overdose associated with high risk medicines, and assist with deciding whether to prescribe or dispense the high-risk medicine.
SafeScript will be implemented across Victoria, regardless of individual prescriber’s willingness to participate. From April 2020 it will be mandatory to check SafeScript, prior to writing or dispensing a prescription for all high-risk medicines in Victoria. The requirement to check SafeScript will apply to both paper based and electronic prescriptions. Medical practitioners and pharmacists should be aware they must register for SafeScript prior to April 2020, at www.safescript.vic.gov.au, to access the SafeScript system, and comply with legislation.[1]
The monitored high-risk medicines in SafeScript are all Schedule 8 medications and codeine containing medicines, benzodiazepines, zolpidem and zopiclone (z drugs), ketamine and quetiapine, and stimulants for Attention Deficit Hyperactivity Disorder (ADHD) or narcolepsy such as dexamphetamine, lisdexamfetamine, methylphenidate.[2]
Victoria’s SafeScript allows prescription data for high-risk medicines to be transmitted in real-time to a centralised database which is accessible by doctors, nurse practitioners and pharmacists.[3] SafeScript can integrate with existing software systems for medical practitioners using prescribing software. For example, when a medical practitioner is prescribing a high-risk medicine for a patient, a red amber or green notification will pop up on their computer screen to notify the patient’s history of high risk medicine use. Similarly, when a pharmacist is dispensing a high-risk medicine for an individual patient, the colour coded pop up will provide an alert to the patient’s history of high use medicines.
Prescribers are not required to use medical practice software in order to access Safescript. For those prescribers who keep paper files and hand write prescriptions, access to SafeScript will be available via a secure web portal at www.safescript.vic.gov.au, that is also available on tablet devices.
A ‘Red’ alert pops up when there is evidence of multiple prescribers, or prescriptions for combinations of high risk medicines, and when the dose of an opioid medicine is beyond normal range. An ‘Amber’ alert will warn of prescriptions written by more than one prescriber or medical practice over the previous 12 months, or when a daily morphine equivalent dose estimated over the previous 90 days, is too high. A ‘Green’ notification will appear when there has been no prescriptions issued or dispensed for high risk medicines over the last 6 months, or when prescriptions for high risk medicines have been issued by the same prescriber or medical practice over the last 6 months and there are no alerts. When a Green notification appears, the prescriber or dispenser is not required to click to review the patient’s history in SafeScript.
A Red or Amber SafeScript notification will not prevent a prescriber writing a prescription, but will provide context for the prescription and a prompt for further consideration of potential risks, and whether additional steps are warranted.
Prescribers are not required to access SafeScript when prescribing for inpatients in a hospital, an aged care or palliative care facility, or for prisoners in police custody or prison.
Before issuing a prescription for a high risk medicine, a prescriber must take ‘all reasonable steps’ to check the SafeScript information for the patient for whom the high risk medicine may be prescribed or supplied.[4] A pharmacist is required to check the SafeScript database prior to dispensing a high risk medicine.[5] A prescriber or pharmacist who fails to check SafeScript when prescribing high risk medicines, can be fined up to $16,000.
‘All reasonable steps’ takes into consideration what measures have been taken by a medical practitioner or pharmacist to satisfy the requirement. A medical practitioner is unlikely to satisfy the reasonable steps requirement, to access SafeScript, if they had failed to register for SafeScript prior to April 2020, or did not have access to a computer.
Tasmania and Northern Territory have a Real Time Prescribing Monitoring (RTPM) system in place, and Queensland has provided in-principle support for the implementation of a RTPM scheme.
An 18 month introductory period will allow pharmacists and health practitioners to familiarise themselves with the new system and incorporate it into clinical practice.
1. Section 30F, Drugs Poisons and Controlled Substances Act 1981.
2. Vic Health Safescript Medicines-Monitored
3. Deloitte/ Department of Health and Human Services, Regulatory Impact Statement- Proposed drugs, Poisons and Controlled Substances Amendment (Real-time Prescription Monitoring) Regulations 2018, 2.
4. Section 30F Drugs Poisons and Controlled Substances Act 1981.
5. Section 30E Drugs Poisons and Controlled Substances Act 1981.
Disclaimer: This information is current as of June 2019. This article does not constitute legal advice and does not give rise to any solicitor/client relationship between Meridian Lawyers and the reader. Professional legal advice should be sought before acting or relying upon the content of this article.
