Real-time prescription monitoring and medicine safety


Real-time prescription monitoring systems such as SafeScript are empowering pharmacists to improve medicine safety – a key insight gleaned from PSA’s recent VIC/TAS Annual Therapeutic Update (ATU).

Laura Mulligan, pharmacist and senior policy officer rom the SafeScript team at the Department of Health and Human Services (DHHS), led a session about the value and application of SafeScript, which is being rolled out across Victoria.

SafeScript was developed in part by understanding the behaviours that cause people to fall into prescription drug use through interviewing the family members who have lost loved ones due to overdoses. This aspect of co-design provided the developers important insight into timing and factors contributing to opioid harm and was significant in helping design algorithms and alerts in a way which empowers pharmacists and doctors to take meaningful steps to reduce this risk.

While the system alerts clinicians to certain high-risk circumstances, it doesn’t tell pharmacists or doctors whether they should prescribe or dispense. The information is there as an informative mechanism and for healthcare professionals to address with patients, should they see fit. The decision to supply rests with the pharmacist, and SafeScript supports them to be more accountable and responsible for medicine safety.

Over 11,000 clinicians have currently registered for SafeScript, which includes over 50% of Victoria’s pharmacists. So far, there have been 7,432 alerts generated by the SafeScript system through analysis conducted in the Western Victoria area.

From April 2020, the use of SafeScript will be mandatory in Victoria. Ms Mulligan said that the DHHS’s decision to make the system compulsory was based on US data, which showed that in the states where real-time prescription monitoring is mandatory (such as New York), the number of multiple provider episodes dropped dramatically.

Extra support

Ms Mulligan emphasised that SafeScript is not just an IT system, and that there are a number of supporting initiatives for patients and clinicians available. There are numerous training opportunities for pharmacists, such as face-to-face sessions, webinars (where pharmacists can gain up to six CPD points for completing three modules) and online training conducted by NPS MedicineWise.

There is also the new SafeScript Pharmaceutical Helpline, run through Turning Point, that pharmacists can direct patients to. The Helpline is available 24 hours a day, and is staffed by nurses with specific training in how to talk to people with prescription medicine dependence issues. If pharmacists sense that the patients they suspect of having a prescription medicine dependence are not open to having a discussion in the pharmacy, they can suggest contacting the helpline.

With the rollout of SafeScript, the DHHS has also expanded Reconnexion – a specialised, Victoria-based benzodiazepine support service. Reconnexion offers extra support through counselling, training and resources for prescribers, pharmacists and patients that have benzodiazepine dependence issues.

Patient-centred approach to medicine safety

When discussing monitored prescription medicines with patients, Ms Mulligan said that a patient-centred approach is crucial. It’s important to explain the risks of prescription medicines use to patients in a non-judgemental way and to use supporting evidence where possible. Even if the patient displays resistance, pharmacists should repeat the same message about the importance of safety.

‘It will get through to them eventually’, she said, reflecting on insights provided during patient and family consultation.

There are a range of steps pharmacists can take to support opioid safety with patients. For example, pharmacists can consider initiating a one-prescriber one-pharmacy arrangement with patients via agreement, or initiating staged supply where appropriate.

If pharmacists have serious concerns about a patient or they are worried that they may be trafficking prescription medicines, Ms Mulligan recommended notifying the Medicines and Poisons Regulation team within the DHHS.