‘It’s already making a big difference.’

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Mandatory use of SafeScript will commence from 1 April, with a transition to the national system scheduled for mid 2020 and other jurisdictions in the works

In April 2020, the Victorian Drugs, Poisons and Controlled Substances Regulations 2017 will make using SafeScript a mandatory requirement prior to prescribing or dispensing a monitored medication.

These monitored medications include all S8 medications, and selected S4 medications including benzodiazepines, z-drugs, quetiapine and all products containing codeine.

The Victorian Pharmacy Authority (VPA) reminds pharmacists who have yet to sign up to SafeScript of their professional obligation to do so in time for 1 April 2020.

“Pharmacists should also allow ample opportunity to use and become familiar with the SafeScript system before the deadline,” says the VPA.

There are some exceptions to mandatory use, including treating patients in hospital, prison and aged care.

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Pharmacists will be legally obliged to check SafeScript before making a clinical decision.

It will be mandatory for hospital pharmacists to check SafeScript when supplying monitored medicines to patients for use outside of hospital – such as on discharged or outpatients.

However it won’t be mandatory to check the system when supply of a monitored medicine is for use within hospital – such as inpatients and treatment within the emergency department.

At the current time, prescribers will also not be required by law to access SafeScript when prescribing monitored medicines in any hospital setting.

Since April 2019, when SafeScript rolled out state-wide, results show the system is already making a big difference in clinical care, says Justin Lam, Principal Advisor for Real-Time Prescription Monitoring Implementation Regulation with the Department of Health and Human Services (DHHS).

“Just within the first six months of going state-wide, we saw a 25% reduction in the proportion of patients who are taking a high-risk opioid,” Mr Lam told delegates at the recent eMedication Management Conference held in Sydney and organised by Informa Australia.

“Another positive sign, the state coroner has given us an indication that it’s looking likely that the number of deaths this year from prescription medicines is likely to be lower than it has been for many years,” he says.

The system works by alerting pharmacists and doctors to high-risk circumstances, for example, if a patient goes to more than four pharmacies in a certain period of time, if the morphine equivalents dose exceeds a certain threshold or when there are high-risk drug combinations.

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The majority of doctors and pharmacists are signed up to SafeScript.

Over 23,000 doctors and pharmacists are now registered for SafeScript in Victoria, representing just under 80% of GPs and also 80% of pharmacists – and this is before the mandatory period has commenced, Mr Lam told eMM Conference delegates.

David Freemantle, General Manager eHealth at Fred IT Group – the organisation that was selected to build SafeScript as well as the Commonwealth’s national real time monitoring system – tells AJP the high uptake during the non-mandatory phase has been a “great sign”.

He adds that the reduction in patients taking high-risk opioids shows how important the system has been so far.

“The statistics say it all really. It’s been hugely successful,” says Mr Freemantle.

“The beauty of SafeScript is it gives a real-time notification on the screen which then indicates to the practitioner whether they should go look [at the patient record] or not.”

He recommends that pharmacists comply with mandatory use of the system.

“The legislation prescribes significant penalties” if not complied with, he says.

‘Hoping to have as many jurisdictions as possible’

Shortly after mandatory use of SafeScript commences, the system is set to be integrated into the national data exchange by mid-2020, says Mr Freemantle.

Queensland’s QScript is also lined up to be adopted into the national system at the same time.

Fred IT Group is engaged with “pretty much every jurisdiction”, says Mr Freemantle.

“We’re hoping to have as many jurisdictions as possible [integrated into the national system] by the end of the year,” he adds.

David Heffernan has been heavily advocating for real time monitoring to be implemented in NSW.

However NSW pharmacists have expressed frustration at the lack of a similar system being introduced in their own state.

Pharmacy Guild NSW President David Heffernan has been in constant talks with the state government over real time monitoring.

“The PSA and the Guild have been meeting face to face with the government, heavily advocating for its implementation,” he tells AJP.

“The RACGP would like to have the SafeScript system implemented in NSW as soon as possible, and the Pharmacy Guild would like it 100%.”

Mr Heffernan describes the reason for the delayed uptake as one mainly of bureaucracy.

“Victoria has done the heavy lifting with regards to its development, I don’t believe NSW should try to recreate the wheel. I think they should look at policy borrowing from our neighbours, to look and learn from their experience,” says Mr Heffernan.

“We know it’ll save lives, and we really look forward to its implementation.”

PSA NSW President Professor Peter Carroll also emphasises his support for the introduction of a real time monitoring system in NSW.

“At present it is possible for people to doctor shop, get prescriptions for opioids and other drugs of misuse and go to numerous pharmacies and there is little chance of this being detected,” says Professor Carroll.

“We see real time monitoring as a public health initiative which will help pharmacists and GPs identify those that may be misusing opioid and other products, with the view to getting them the appropriate help and counselling.

“Pharmacists can’t identify these people, doctors can’t identify them, and without this system it will just continue. We believe the sooner it’s introduced into NSW, the better. And its introduction will be a really positive move.”

A pharmacist’s experience

Carlene McMaugh says SafeScript provides confidence to pharmacists.

Leading Victorian pharmacist Carlene McMaugh says her workplace activated SafeScript as soon as it became available to opt in.

“It became a standard piece of our workflow – it’s actually very easy to use,” she tells AJP.

“So long as you spend the few moments needed to look at a profile when you receive a red or orange warning, then it adds a lot of context to your work too,” says Ms McMaugh.

“The main thing it provides is confidence that you are making a decision with much more information available than you previously had, which then empowers you to have discussions with people that are actually helpful.

“You aren’t trying to find out background histories as often because you’ve already got access to it – you can focus on really useful counselling and advice.”

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