SafeScript: what you need to know (and do)

The Victorian real-time prescription monitoring system, SafeScript, is now live, with its use to be mandatory for prescribers and pharmacists from April 2020.
 
Dr Malcolm Hogg (Head of Pain Services, Royal Melbourne Hospital and Member of SafeScript External Advisory Committee) has written a short article with some useful tips for Victorian prescribers.
 
  • The Victorian real-time prescription monitoring system, SafeScript, is now fully functional, with its use to be mandatory for prescribers and pharmacists from April 2020.
     

  • Information regarding prescribing and dispensing of all S8 medicines, and selected S4 medicines, notably codeine, benzodiazepines, the Z drugs and quetiapine, is available via the SafeScript system.
     

  • Integration with prescribing software used in specialist clinics (such as Genie and ZedMed) is available, providing clinicians with notifications within seconds after prescribing a monitored medicine.
     

  • Integration with hospital electronic medical record systems is progressing, so the use of SafeScript in hospitals will be streamlined; in the interim, a web-portal for use on your computer or mobile device is available to assist access within your practice.
     

  • Accessing SafeScript early in a clinical encounter will foster open communication and appropriate decision making and prescribing.
     

  • SafeScript must only be accessed in regards to patients in your care
     

  • Consider a team approach to dealing with patients identified via SafeScript as having prescription medication issues, including dependency.


Following multiple coroner’s inquests and community concern regarding the escalating access and misuse of prescription medicines in the community, the Victorian Government committed to the implementation of a real-time prescription monitoring system, SafeScript.  The system, purpose-designed to optimally document and notify of prescribing and dispensing events, started collecting data in mid 2018, with initial roll out in Western Victoria, then statewide in April 2019.  Its use will become mandatory for prescribers (doctors, nurse practitioners) and pharmacists from April 2020.
 
The use of SafeScript will be monitored via the Medicines and Poisons Regulation branch of the Victorian Department of Health and Human Services to ensure high-risk medicines are prescribed safely in Victoria.  This means there may be regulatory implications for those prescribing high risk medicines without considering the data recorded within SafeScript.  Mostly, any regulatory actions will be in the form of an enquiring letter or phone call to clarify whether the prescriber has checked SafeScript. Where harm, or risk of harm has been identified the department may seek further information to understand the circumstances of the situation.
 
Despite this potential for a “heavy stick”, the premise of SafeScript is actually as a decision support tool, to inform prescribing and promote the safe use of medicines.  The effectiveness of monitoring systems to improve public health lies in its mandatory use; as such, only inpatient hospital prescribing, prescribing in prisons, to residents of aged care residential facilities and patients receiving palliative care are exempt from mandatory use of SafeScript.  Please note, discharge prescribing of high risk medicines from hospitals will require a SafeScript check, which includes prescribing on discharge for post-acute care (such as post surgery or emergency department presentations). 
 
In addition to data on prescribing, SafeScript includes alerts where there are clinical concerns (including multiple prescribers or pharmacies, high doses, potential interactions of opioids with benzodiazepines).  Like the “road rules”, prescribing and dispensing can continue if you consider it is safe and appropriate to do so, and a log is made that you have reviewed the patient’s history; this informs optimal use of medicines and improves patient and community safety.
 
A benefit of the SafeScript system is its ease of use, clear presentation of information and easy access to contact details of prescribers and pharmacists.  It promotes early, open discussion regarding the clinical need for opioid analgesics and sedatives, and subsequently triggers review of symptom management plans.  In the setting of post-acute care, a team approach to management plans, utilising multimodal techniques to limit opioid requirements is encouraged.  Similarly, limiting amounts of medication provision and arrangement of early GP centred follow-up may improve care processes and limit excess S8 medicines in the community.
 
Suggested tips
 
  • Register for SafeScript at www.safescript.vic.gov.au.
     

  • ​Bookmark the SafeScript website, www.safescript.vic.gov.au on your computer, and your mobile device for use “on the run”.
     

  • Integrate the use of SafeScript into your model of care, perhaps as part of history taking, inpatient prescribing, but definitely for outpatient prescribing.
     

  • Consider the implications of SafeScript on your practice; limiting access to appropriate care, including opioid dosing for pain due to concerns or unwillingness to use the system is not an acceptable response; best practice is encouraged, avoid rapid de-prescribing or medication withdrawal.
     

  • Check whether your specialist prescribing software can be integrated with SafeScript; click here for more information.
     

  • Complete the online training for SafeScript at vtphna.org.au/safescript-training-hub; particularly Module One which covers how to use SafeScript and the important regulatory requirements you need to know.


For technical support, contact the SafeScript Technical Support team on 1800 723 379.
 
For further information, visit the SafeScript information website at www.health.vic.gov.au/safescript.

 
Dr Malcolm Hogg
FANZCA, FFPMANZCA
Head of Pain Services, Royal Melbourne Hospital
Member of SafeScript External Advisory Committee
Malcolm.Hogg@mh.org.au
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