What is Real Time Prescription Monitoring?
Real Time Prescription Monitoring is computer software that allows prescription records for some high-risk medicines to be transmitted in real-time to a centralised database which can then be accessed by doctors and pharmacists during a consultation. Real Time Prescription Monitoring provided prescribers and pharmacists with a clinical tool to make safer decisions about whether to prescribe or dispense a high-risk medicine. It will facilitate the early identification, treatment and support for patients who are developing signs of dependence.
Prescription medicines causing greatest harm to the community will be monitored through Real Time Prescription Monitoring. This includes all Schedule 8 medicines and other high risk medicines such as benzodiazepines, zolpidem or zopiclone, quetiapine and codeine.
Detailed information for prescribers is available from https://www.health.gov.au/initiatives-and-programs/national-real-time-prescription-monitoring-rtpm
It is important to note that Real Time Prescription Monitoring is referred to differently by each State/Territory, for example 'Safescript', 'QScript' and 'ScriptCheckSA'.
How to Enable Real Time Prescription Monitoring in Clinical
Ensure all practitioners have completed their individual Real Time Prescription Monitoring registration before they enable the feature in MedicalDirector Clinical.
1. From the Clinical front screen, select User > Setup Users and open [edit] each practitioner.
2. Tick
the Participate in Real Time
Prescription Monitoring check box.
Other Requirements for Using Real Time Prescription Monitoring in Clinical
o Your practice must be registered for MDExchange. In the MDExchange settings, you must ensure each user who wishes to use Real Time Prescription Monitoring has a Participation of either 'Public' or 'Private'. See Step 7 of the Registering MDExchange instructions.
You must have ePrescribing enabled for each practitioner who wishes to participate in Real Time Prescription Monitoring.
Using Real Time Prescription Monitoring
Once Real Time Prescription Monitoring is enabled, the practitioner will be prompted with the Real Time Prescription Monitoring warning when S8 drugs and other high risk medicines such as benzodiazepines, zolpidem or zopiclone, quetiapine and codeine are prescribed.
Real Time Prescription Monitoring Notifications
The practitioner will get a Real Time Prescription Monitoring prompt after performing the following on any S8 drugs and other high risk medicines such as benzodiazepines, zolpidem or zopiclone, quetiapine and codeine.
o When adding drugs to the Current Rx tab.
o When Changing ‘Dose’ in Current Rx tab
o When Changing ‘Quantity’ in Current Rx tab
o When Changing ‘Strength’ in Current Rx tab
o When re-prescribing a current high-risk medication via the patient's Old Scripts Tab
See Managing and Modifying Current Prescriptions
A GREEN notification will appear in the following situations:
o When there has not been a prescription issued/dispensed for a monitored medicine in the last 6 months or
o 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 Real Time Prescription Monitoring becomes mandatory, prescribers/pharmacists will not be required to click on the notification to review the patient history.
An AMBER notification will appear in the following situations:
o When prescriptions for a monitored medicine in the last 6 months have been issued by more than one prescriber/medical practice or
o 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 Real Time Prescription Monitoring 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 RED notification will appear in the following situations:
o Patient has active alerts within the last 3 month (90 days)
A RED notification will appear when there is a current alert relating to the prescribing/dispensing history of a patient.
These alerts are:
o Multiple provider episodes: When prescriptions from 4 or more prescribers/medical practices or 4 or more pharmacies have been recorded in Real Time Prescription Monitoring within the last 90 days.
o High-risk drug combinations: When prescriptions for certain drug combinations have been recorded in Real Time Prescription Monitoring within the last 90 days.
• Methadone + a benzodiazepine
• Methadone + a long-acting opioid
• Fentanyl + a benzodiazepine
• Fentanyl + a long-acting opioid
o 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 Real Time Prescription Monitoring 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.
Amber and Red Notification include a URL that allows the user to link into the Health Professional Portal and view the patient's profile.