Real-Time Prescription Monitoring
August 28, 2017
How will real-time prescription monitoring affect your practice?
In August 2017 the Victorian Government introduced a Bill to enact real-time prescription monitoring for medications that are considered to put patients at risk of drug related harm. Victorian Coroners had called for a real-time prescription monitoring regime for some time as recommendations from numerous coronial inquests.
The monitoring regime is intended to cover all Schedule 8 drugs and some Schedule 4 drugs such as benzodiazepines, z-drugs (zolpidem and zoplicone), the antipsychotic quetiapine and eventually codeine. Other drugs can be included in the list of “monitored poisons.”
The monitoring regime will be implemented in phases commencing in 2018 and the Department of Health and Human Services, DHHS, will provide training in its use.
Real-time prescription monitoring is software that takes prescribing information from pharmacists and stores it in a central database which prescribers and suppliers can then access at the time of a consultation, or at the time a drug is supplied.
The legislation imposes requirements on prescribers and provides significant penalties in the form of fines, up to 100 penalty units (at the current rate this amounts to $15,857), for breaches of the law.
From a prescriber’s perspective, you will need to have access to an internet-connected device to access the secure website to view the patient’s dispensing history. It will be mandatory to take all reasonable steps to check the patient’s dispensing history before prescribing a medication that is subject to monitoring. The intention is that over time the checking requirement will be linked to practices’ prescribing systems.
It will be an offence to access the information unless you are authorised to do so. For medical practices, this means the prescriber, be they a medical practitioner or a registered nurse practitioner, will be required to access the site. This is not an administrative task that can be delegated to another person. It is also an offence to use the information accessed for purposes other than treatment. You can, however, disclose the information to other treating registered practitioners if it is relevant to the patient’s care.
The database is intended to record all medications supplied to a person, and may record all permits that apply to the person and any notifications that the person is a drug-dependent person. The decision to prescribe remains that of the practitioner. However, it would be prudent to record that you have accessed the database in the clinical records and provide a rationale for the prescription.
There is a protection in the law for anything done in good faith in carrying out the requirements of the legislation. For example, if a practitioner has complaints made that the practitioner refused to supply a medication, reliance on the database will be a defence to the complaint. It would be prudent to ensure that your records provide evidence of the reasonable steps you have taken to check the database and the information recorded to justify the decision to prescribe one of the monitored drugs.
Finally, you should also consider what approach you might take if you decide not to prescribe one of the monitored drugs, how that is to be communicated to the patient and how you may deal with any response that puts you or your practice at risk.
At this stage, the Bill has not been passed by Parliament. When it has and becomes law, practitioners will need to be aware of the new regime and ensure they comply with it.
If you require any advice on this or any other topic contact Ball+Partners and we will be pleased to assist you.
For more information about Real-Time Prescription Monitoring, follow this link to the health.vic website.