A recent article in Australian Doctor highlighted the legal obligation prescribers to check SafeScript when we are prescribing monitored medicines. The article reported on a recent Coroners Court of Victoria finding into the death of a patient who overdosed on tapentadol and oxycodone. The man had 77 red flags on SafeScript; however, his prescribing history was only checked 6 times.
Coroner Audrey Jamieson criticised almost a dozen doctors for their prescribing, 2 of whom have been referred to the Australian Health Practitioner Regulation Agency. She also criticised the state Department of Health, saying it should have warned prescribers they were breaking the law by not checking SafeScript when required.
What is SafeScript?
SafeScript is software that allows prescription records for certain high-risk medicines to be transmitted to a centralised database in real time. This can be accessed by doctors and pharmacists during a consultation. SafeScript has been available in Victoria since October 2018 and is now available nationwide. It is mandatory to check SafeScript before writing or dispensing a prescription for a monitored medicine.
SafeScript provides prescribers and pharmacists with a clinical tool to make safer decisions about whether to prescribe or dispense a high-risk medicine. It alerts the practitioner that a high-risk circumstance may exist but does not prevent prescribing or dispensing a medicine.
Access to prescription history allows for early identification of misuse and dependence and serves as a prompt for treatment and support needs.
What drugs are monitored?
The system monitors prescription medicines that have the greatest potential to cause harm. These include all Schedule 8 medicines, including opiates such as oxycodone and morphine, alprazolam, stimulants such as methylphenidate, lisdexamfetamine and dexamfetamine and some Schedule 4 medicines including all benzodiazepines, ‘Z-drugs’ such as zolpidem and zopiclone, quetiapine and products containing codeine.
How do I access SafeScript in my practice?
To use the SafeScript tool health professionals must:
- register (providing a unique SafeScript username)
- ensure software is set up and updated
- ensure SafeScript notifications are turned on to receive them while prescribing or dispensing.
Access to SafeScript is available to all registered clinicians through a secure web portal. This can also be accessed when you hand-write prescriptions or practice in a hospital.
Health professionals can also sign in to use SafeScript through a web browser on their computer or phone if they do not have medical software that integrates with it.
What do the notifications mean?
SafeScript patient notifications are red, amber, or green messages that pop up when prescribing or dispensing a monitored medicine. Some software is integrated with the platform and some connect to the online SafeScript portal. Pop-up notifications provide click-through access to the patient’s history.
Notifications provide information to assist clinical decision-making but do not dictate whether a health professional should prescribe or dispense a medicine.
Red notification
High risk circumstances indicating:
- Multiple providers within the last 90 days
- High-risk drug combinations recorded within the last 90 days
- Exceeding opioid dose threshold
Mandatory requirements:
- Click on the notification.
- Review patient history and assess safety and appropriateness to finalise clinical decision.
Amber notification
Patient information available that may impact clinical decision:
- More than one provider within the last 6 months
- Daily morphine equivalent dose (based on an average over the last 90 days) is between 50 mg and 100 mg
- Dispensing from 4 or more pharmacies
Mandatory requirements:
- Click on the notification
- Review patient history and assess safety and appropriateness to finalise clinical decision
Green notification
No cause for concern based on SafeScript record:
- No monitored medicine recorded within the last 6 months, or
- Monitored medicine recorded by the same prescriber within the last 6 months with no red alerts.
Mandatory requirements:
- Not required to click on the notification
- Notification will disappear
What about a patient with no Medicare or using false identities?
Some patients seeking drugs inappropriately provide false identity details, including names and dates of birth. They may also claim they have no Medicare. It is good practice when booking a patient with no Medicare to insist on seeing photo ID to confirm their identity. A Medicare card is not required to monitor drugs on SafeScript. Likewise, if identity cannot be confirmed, as checking SafeScript is mandatory, prescribers should not prescribe monitored drugs. From Vic DOH “Prescribers are reminded of their regulatory responsibility (to take all reasonable steps to confirm a person’s identity) by carefully checking the name and date-of-birth plus photo-identification before issuing a prescription for a drug of dependence for any person who has not previously established their bona fides at the clinic”.
