PDL Professional Officers have observed an increase in formal requests for information regarding dispensed medicines from the Real Time Prescription Monitoring (RTPM) sections of health departments.
In most cases, the request for information is regarding the following issues:
- Large quantities of monitored medicine dispensed to a single patient over a short period
- Doses and quantities of monitored medicines that are not supported by current therapeutic guidelines
- Self-prescribing of monitored medicines (check your local legislation as self-prescribing of S8s and monitored S4s varies across jurisdictions)
- Dispensing from fraudulent prescriptions
What is RTPM?
It is a decision-making tool that enables prescribers and pharmacists to view a patient’s history and use of monitored medicines. RTPM information needs to be incorporated with all other available information to make the best decision possible at the time of an interaction with a patient.
RTPM is now available in all jurisdictions except Western Australia and is mandatory in Victoria, Queensland, South Australia and the Northern Territory.
RTPM integrates with your dispensing software to alert you of potential high-risk situations. Most RTPM systems use a traffic light system with pop-up warnings.
- Red warnings = High risk e.g. multiple prescribers, high doses, large quantities
- Orange warnings = Moderate risk e.g. multiple prescribers with moderate doses and/or quantities
- Green warnings = Low/no risk e.g. one prescriber and seemingly appropriate doses and quantities
The pop-up warnings act as a guide only. Pharmacists must use their own clinical judgement.
PDL insights into dispensing monitored medicines
1. Conduct a risk assessment before dispensing
An individual risk assessment of all medications should be performed prior to supply. This is especially important with high-risk medicines. Pharmacists are expected to consider and assess the following points:
- Is the medicine and dose appropriate and within usual prescribing guidelines?
- Has there been specialist involvement?
- Has an appropriate time elapsed between dispensing?
- Could there be misuse or diversion?
- Is the prescription legitimate and correct as per state legislation?
- Is the dosing measurement and formulation appropriate e.g. mLs vs mgs, IR vs SR?
2. Supply using your own clinical judgement
Trust your instincts. If you are concerned that the medication, strength, quantity, dosage or interval are inappropriate:
- Speak with the prescriber to discuss your concern(s).
- Decline supply or supply a smaller quantity, such as staged supply (or verification supply if legislated), with appropriate counselling and guidance.
PDL reminds pharmacists that it is their responsibility to make the final clinical decision to supply. Pharmacists have been penalised for supplying S8 medicines outside current therapeutic guidelines, even after they have checked with the prescriber.
3. Document high-risk interactions
PDL recommends documenting:
- Clinical reasoning for declining supply
- Clinical reasoning for supplying despite a warning from RTPM
- Communication with the prescriber or other HCP
- Any interaction that may give rise to a complaint or regulatory action
4. Other PDL insights
- Interns are encouraged and, in some jurisdictions, required to register with RTPM.
- State and territory RTPM systems are not linked. The patient address determines which system their history is captured in. E.g. the data for a patient presenting a prescription in Qld with a NSW residential address will be captured in the NSW RTPM system.
- Pharmacists who plan to practice interstate or who work in border towns may need to register for multiple RTPM systems.
- Pharmacists should keep up to date with current guidelines for high risk medications.
- Some RTPM systems have associated 24/7 clinical advice lines to support pharmacists in clinical decision making.
How can I register/access RTPM?
You can register and/or access your state’s RTPM using the links below:
- Victoria- SafeScript
- Queensland- QScript
- New South Wales- SafeScript NSW
- Australian Capital Territory- Canberra Script
- South Australia- ScriptCheckSA
- Northern Territory- NTScript
- Tasmania- DORA
For immediate advice and incident support, call PDL on 1300 854 838 to speak with one of our Professional Officers. We are here to support our pharmacist members 24/7, Australia-wide.