Maintaining safety
Image based prescribing is a temporary measure to support telehealth and minimise face-to-face contact between patients and their doctors and pharmacists and support people to stay at home.
Some of the more difficult features of managing this temporary prescription format are in place because the protection inherent in the paper-prescription (a medico-legal document) is disrupted. The digital image transmitted to the pharmacy must remain in the pharmacy.
Patients need to be advised by prescribers and pharmacists that repeats, if ordered, must be collected from the pharmacy that holds the digital image. Copies of the digital image cannot be given to patients or transferred to other pharmacies. Problems arise in the pharmacy when patients are unaware of this.
Reducing the Pain:
o Annotate prescriptions with PHEO#4 - the pharmacy will then know your intention.
o Add patient’s contact number – pharmacy may need to contact the patient to discuss availability, delivery, and safety issues.
o Streamlined Authority codes should appear on the digital image or other authority approvals communicated to the pharmacy before supply.
o Avoid faxing prescriptions that are not part of the PHEO #4 unless clearly annotated.
o Include a Cover Sheet with faxed prescriptions to indicate (suggestions):
o The prescription is for PHEO#4 supply
o The patient has nominated your pharmacy to supply this prescription.
o The paper copy will be retained at the practice as required by regulations
o The patient has been informed that any repeats will be held at the pharmacy.
See Public Health Emergency Order under Section 22D – Pharmacist Supply on a Digital Image (PHEO #4)
Prescribing Schedule 8 and Schedule 4 drugs of dependence.
The PHEO#4 interim measures for image based prescribing do not apply to Schedule 8 or Schedule 4 drugs of dependence (benzodiazepines, anabolic steroids and phentermine).
Regulation 25 of the Drugs Poisons and Controlled Substances Regulations allows that:
In an emergency (as exists in the current COVID-19 climate) where a patient cannot be provided with a prescription, the GP may give verbal authorisation to a pharmacist to supply a Schedule 8 poison or Schedule 4 drug of dependence provided written confirmation (usually in the form of the original prescription) is sent to the pharmacist, as soon as practicable.
The phrase ‘as soon as practicable’ means as soon as it is capable of being done, not simply when convenient. By the next post service is the usual guide. (Requesting the pharmacy to collect the original prescription or pay postage is not appropriate for meeting the prescriber’s legal obligation).
SafeScript
The GP is expected to take ‘all reasonable steps’ to check SafeScript when prescribing Schedule 8 or Schedule 4 monitored drugs. SafeScript can be accessed directly from the web portal if you are unable to access via your medical software. If viewing SafeScript is not possible consider other steps to mitigate risk:
o Contacting the pharmacy to enquire about patient history in SafeScript
o Prescribing limited quantities and checking SafeScript at the next available opportunity.
More guidance available here and Criteria for Lawful Prescriptions here.
Compiled from the helpful feedback and suggestions of Practice Managers and Pharmacists across EMPHN catchment. Contact: christine.bellamy@emphn.org.au