SafeScript NSW is a new tool which gives doctors and pharmacists real-time data about their patient’s prescribing and dispensing history for monitored medicines and helps them make more informed and safer prescribing decisions.
SafeScript NSW was initially introduced to Hunter New England and Central Coast areas in November 2021, as part of a phased statewide rollout. It will be available from this week to doctors and pharmacists in Northern Sydney and Nepean Blue Mountains, with those in all NSW areas to have access from May.
Prescribers will receive an invitation to register for SafeScript NSW when it becomes available in their area.
While participation is not mandatory, the program allows for safer clinical decisions at the point of care and aims to improve patient safety. It can also help doctors and pharmacists identify “doctor shoppers”.
The increasing harm from monitored medicines such as opioids and benzodiazepines are a major public health concern. In 2019, there were 1,865 drug-induced deaths in Australia. Significantly, drug-induced deaths were more likely to be due to pharmaceuticals than illegal substances, with benzodiazepines being the most commonly involved. Opioids were found to be present in more than 60 per cent of drug induced deaths, with more than half (56 per cent) attributed to pharmaceutical opioids.
Unsafe prescribing is also reflected in complaints to us. Last financial year, prescribing, including inappropriate prescribing, inappropriate medication counselling and inappropriate administration was the third most complained about area of practice.
Recently a complaint from a health professional concerned about the prescribing practices of a doctor. The notifier and the doctor were both aware that the patient had a history of mental illness and polysubstance abuse, yet despite this, the treating doctor prescribed high doses of unauthorised methadone and co-prescribed diazepam. This placed the patient at an increased risk of overdose and respiratory depression. Had the doctor been using SafeScript NSW, the doctor would have been alerted to the high usage of monitored medicines and the potential for substance abuse.
Designed to be easy to use and integrated into a doctor or pharmacist’s clinical software, SafeScript NSW will provide a pop-up notification when a high-risk scenario is detected. This could include scenarios such as:
- multiple prescribers - where a patient has received prescriptions for monitored medicines from four or more prescribers within the last 90 days
- use of high doses of opioids - where the average daily dose exceeds 100mg oral morphine equivalent over a 90 day period, excluding medicines used for opioid replacement therapy
- concurrent prescribing of potentially harmful substances - for example certain long acting opioids (fentanyl and methadone) and benzodiazepines.
Prescribers who have registered and are not using integrated software are still able to view a patients’ monitored medicine history by logging into the SafeScript NSW portal.
Dr Natalie Cordowiner, a GP already using SafeScript NSW says, “It is integrated really well and easy to use. I have a lot more insight and information about what is going on with patients now.”
“SafeScript has actively helped by reassuring me I am doing the correct thing by both myself, my patients and the community. It has increased my confidence in not prescribing in an after hours setting with evidence to back up medication seeking behaviour and also to be more reassured on the odd occasion when I do prescribe strong pain relief, for example, that there are not multiple other prescribers involved,” says Dr Cordowiner.
If you receive an alert from SafeScript NSW, this does not prevent you from prescribing or dispensing the medicine. It simply draws your attention to the clinical risk, meaning that the final decision rests with the prescriber or pharmacist. Steps should be taken to manage the risk, assess whether this is the most appropriate medication for the patient and ensure their safety. This includes developing a plan that does not involve abruptly stopping treatment for patients who have been taking monitored medicines over a long period of time.
Doctors and pharmacists can access the 24/7 SafeScript NSW Clinical Advice Line (1800 434 155) for clinical management on safe and appropriate prescribing and dispensing of monitored medicines.
SafeScript NSW website