For prescribers and pharmacists

Safer patient care is only a click of a button away. More Victorians lose their lives from prescription medicines then on our roads each year - this is an opportunity for us to do something to make a real difference.

SafeScript, a Victorian Government initiative, is a new system to help health practitioners provide better care to patients on high-risk prescription medicines. It offers comprehensive information on the prescription history of a patient including helpful alerts to prompt clinical intervention when the patient may be at risk of harm.

It’s quick and easy to use and updated in real time allowing health practitioners to work together to better treat their patients. In conjunction with additional training focussed on improving clinical and counselling skills, SafeScript will help health practitioners to co-ordinate care and identify patients who may need additional support to manage their medicines.

Using SafeScript is easy and secure. After a once off registration which includes important security settings to protect patient health information, you will be able to log in and refer to a list of monitored medicines prescribed and dispensed to your patient.

As health practitioners, this is your opportunity to be at the forefront of change.

SafeScript is easy to use, safe & secure, but more importantly it will save lives. 

Go to safescript.vic.gov.au to sign up today.

Patient records in SafeScript may only be lawfully accessed when you are involved in that patient’s medical care and in the context of the medicines which are monitored.  

If you do access a patient's record in SafeScript, you will need to make sure you can substantiate this access in your capacity as their registered health practitioner.  

The following is a non-exhaustive list of circumstances where accessing patient records in SafeScript would be permitted in law:

• when prescribing or supplying a medicine to the patient,
• when reviewing the patient’s medication history as part of a patient consultation (e.g. when a doctor takes a patient history or a pharmacist conducts a medication review), or
• when discussing the patient’s medication history with other registered health practitioners who are involved in that patient’s care.

The legislation does not permit you to view a patient’s record if you are not involved in that patient's medical care.

For patients whom you are involved in their care, you are only authorised to use the information in SafeScript for the purposes of ensuring the safe prescribing and supply of prescription medicines to your patients.

You must not use the information for any other purpose. Any other purpose may include (but is not limited to) marketing or commercial purposes.

SafeScript is quick and easy to use with minimal interruption to clinical workflow. If you use software that is connected to a Prescription Exchange Service (PES), you receive pop-up notifications whenever you issue or dispense a prescription, which prompts you to review the patient record in SafeScript, if necessary. By clicking on the notification you are taken directly to the patient’s record.

When using SafeScript, it is important to differentiate between notifications and alerts.

Notifications are the red, amber or green messages that pop-up on a prescriber or pharmacist’s screen when they are prescribing or dispensing a medicine monitored in SafeScript. These notifications are designed to quickly and clearly signal to the prescriber or pharmacist if checking the patient’s record in SafeScript is required.

Alerts exist within the SafeScript portal, and indicate that the dispensing history for a patient has met certain criteria for high-risk circumstances. Clinicians will be prompted to consider this information as part of their clinical decision-making.

A RED notification will appear when there is a current alert relating to the prescribing/dispensing history of a patient.

These alerts are:

• Multiple provider episodes: When prescriptions from 4 or more prescribers/medical practices or 4 or more pharmacies have been recorded in SafeScript within the last 90 days.
• High-risk drug combinations: When prescriptions for certain drug combinations have been recorded in SafeScript within the last 90 days.
  • Methadone + a benzodiazepine
  • Methadone + a long-acting opioid
  • Fentanyl  + a benzodiazepine
  • Fentanyl  + a long-acting opioid
• Opioid dose threshold: When the daily morphine equivalent dose (calculated based on an  average over the last 90 days) exceeds 100mg MED daily (i.e. a high risk dose).

When use of SafeScript becomes mandatory, prescribers/pharmacists will be required to click on the notification to review the patient history to assess whether it is safe or appropriate to prescribe/dispense a medicine.

An AMBER notification will appear in the following situations:

• When prescriptions for a monitored medicine in the last 6 months have been issued by more than one prescriber/medical practice,

or

• When the daily morphine equivalent dose (calculated based on an  average over the last 90 days) is between 50mg and 100mg MED daily (i.e. a medium risk dose)

When use of SafeScript becomes mandatory, prescribers/pharmacists will be required to click on the notification to review the patient history to assess whether it is safe or appropriate to prescribe/dispense a medicine.

A GREEN notification will appear in the following situations:

• When there has not been a prescription issued/dispensed for a monitored medicine in the last 6 months,

or

• When prescriptions for a monitored medicine in the last 6 months have been issued by the same prescriber/medical practice, and there are no alerts

When use of SafeScript becomes mandatory, prescribers/pharmacists will not be required to click on the notification to review the patient history.

The data required for SafeScript is collected automatically from Prescription Exchange Services (PES) that support the electronic transfer of prescriptions from medical clinics to pharmacies.

When a prescription is issued at a medical clinic or dispensed at a pharmacy, the PES will send a record of the prescription in real time to SafeScript. No direct data entry will be necessary.

SafeScript is a clinical tool which provides information about high-risk circumstances and assists you in making more informed and safer clinical decisions. It does not prevent you from prescribing or dispensing a medicine you believe is clinically necessary.

Clinicians are strongly encouraged to complete SafeScript training, which has a focus on enhancing clinical and counselling skills. When you identify a high-risk circumstance in SafeScript, this training will give you the confidence to continue to provide safe and appropriate ongoing care to your patient.

From April 2020, it will be mandatory for you to check SafeScript when writing or dispensing a prescription for certain high-risk medicines. There will be some exceptions to this requirement, such as when you are treating a patient in a prison, a police gaol or an aged care facility, as an inpatient at a hospital or in palliative care.

The system is quick and easy to use so that checking SafeScript will not interrupt your clinical workflow and you will be able to focus on patient care.

Mandatory use of SafeScript was endorsed by the project expert advisory group and is supported by key organisations including Pharmacy Guild of Australia, Royal Australian College of General Practitioners and ScriptWise. Prescription monitoring systems adopted in other countries have been more effective in reducing harms from high-risk prescription medicines when the use of these systems has been mandatory.

Provided that you take reasonable steps to use SafeScript, you will not be penalised for one-off occasions where you do not, or are not able to, check a patient record. The legislation enables specific penalties to be applied but the department will focus on circumstances that pose a significant risk of harm to patients or where practitioners have repeatedly failed to comply with mandatory requirements.

The penalties of 100 penalty units are the same as current penalties for failing to apply for a treatment permit when prescribing Schedule 8 medicines.

As SafeScript now provides clinicians direct access to prescription histories of their patients for high-risk medicines, there is reduced reliance on the Schedule 8 permit system to assist in the co-ordination of care. This means that some of the Schedule 8 permit requirements for prescribers may be reduced when they check SafeScript before prescribing a Schedule 8 medicine.

Further information on permit requirements is available on the Medicines and Poisons Regulation website.