A NSW Government website

What is SafeScript NSW

What is SafeScript NSW

SafeScript NSW is a real time prescription monitoring system. It allows prescribers and pharmacists to access real-time information about their patient’s prescription history for certain high-risk medicines, known as monitored medicines. This information helps prescribers and pharmacists to make safer clinical decisions and reduces the incidence of harm, including death, from the unsafe use of monitored medicines.

The increasing harm from unsafe use of monitored medicines is a major public health concern. In 2019, there were 1,644 unintentional deaths due to drug overdoses in Australia. 429 (26%) deaths were due to pharmaceutical opioids and 582 (35%) deaths involved benzodiazepines. To learn more about these statistics, view the Penington Institute Australia's Annual Overdose Report 2021.

SafeScript NSW is part of NSW Health’s commitment to reduce harm from monitored medicines and help save lives.

Improved safety of monitored medicines

More informed clinical decision making tailored to patient circumstances

Decreased harm from monitored medicines

List of monitored medicines

An expert panel of academics, pharmacologists and experts in addiction medicine and pain management was established to provide advice to NSW Health when determining the medicines that will be monitored in SafeScript NSW. The panel also considered approaches in other states and territories when determining the monitored medicines list for NSW. To learn more about the criteria used to select the list of monitored medicines view the FAQ section.

Monitored medicines include:

Category

Medicine

Opioids

Including but not limited to buprenorphine, codeine, fentanyl, hydromorphone, methadone, morphine, oxycodone, pethidine, tapentadol, tramadol

Benzodiazepines (prescribed for anxiety or sleep)

Including but not limited to alprazolam, bromazepam, clobazam, clonazepam, diazepam, flunitrazepam, lorazepam, midazolam, nitrazepam, oxazepam, temazepam

Other sleeping aids

Zolpidem, zopiclone

Psychostimulants (prescribed for ADHD and narcolepsy)

Dexamfetamine, lisdexamfetamine, methylphenidate

Other

Ketamine, pregabalin, quetiapine, cannabis based medicines in Schedule 8
All other Schedule 8 medicines not listed above

A full list of monitored medicines is included in the Poisons and Therapeutic Goods Regulation 2008 (Appendix E).

Future inclusions in the monitored medicines list

NSW Health will monitor usage trends of medicines that were considered but ultimately not included in the monitored medicines list, and any emerging evidence may warrant reconsideration of their inclusion in the SafeScript NSW system.

How SafeScript NSW works

SafeScript NSW is a computer software system that provides prescribers and pharmacists with real-time information about a patient’s prescription history for certain high-risk medicines, so they can make safer clinical decisions at the point of care.

The SafeScript NSW system collects prescribing and dispensing information about monitored medicines via the electronic prescription exchange services (PES) that are already connected to most prescribing and dispensing systems.

Using SafeScript NSW with integrated software

Prescribers or pharmacists who have registered for the SafeScript NSW system and using integrated clinical software will receive a pop-up notification on their desktop warning them when a high-risk scenario is detected within the database. These scenarios include:

  • multiple prescribers involved - where a patient has received prescriptions for monitored medicines from four or more prescribers within the last 90 days
  • use of high doses of opioids - where the average daily dose exceeds 100mg oral morphine equivalent over a 90 day period, excluding medicines used for opioid replacement therapy
  • concurrent prescribing of potentially harmful substances - for example certain long acting opioids (fentanyl and methadone) and benzodiazepines.

Prescribers and pharmacists can click on the notification to access the SafeScript NSW portal to view the patient’s full monitored medicine history.

Using SafeScript NSW without integrated software

Prescribers and pharmacists who are not using integrated software are still able to access SafeScript NSW to view their patient’s monitored medicine history by logging into the SafeScript NSW portal directly.

Frequently asked questions

General

Who has access to SafeScript NSW?

Eligible prescribers (medical practitioners and nurse practitioners) and pharmacists registered with Ahpra will be able to access SafeScript NSW.

When was SafeScript NSW rolled out?

SafeScript NSW was made available to prescribers and pharmacists in all NSW areas in May 2022. It was rolled out in a phased approach starting in Hunter New England and Central Coast in November 2021, followed by Nepean Blue Mountains and Northern Sydney areas in March 2022.

Is the use of SafeScript NSW mandatory?

SafeScript NSW has the potential to help save lives and reduce unsafe use of monitored medicines in the community. While the use of SafeScript NSW is not mandatory, all prescribers and pharmacists in NSW are encouraged to use the system once it becomes available in their region.

How does SafeScript NSW fit into the Commonwealth Real Time Prescription Monitoring program?

NSW is committed to national real time prescription monitoring (RTPM), which will reduce unsafe prescribing of monitored medicines and use of these medications that is likely to result in harm. RTPM will also support increased regulatory efficiency and monitoring across jurisdictions.

SafeScript NSW, along with RTPM solutions of other states and territories, interacts with the National Data Exchange provided by the Australian Government Department of Health.

To learn more about the national RTPM program visit the Australian Government Department of Health website.

How was the list of medicines monitored by SafeScript NSW decided?

An expert panel of academics, pharmacologists and experts in addiction medicine and pain management was established to provide advice to NSW Health when determining the medicines that will be monitored in SafeScript NSW. The panel also considered approaches in other states and territories when determining the monitored medicines list for NSW.

The following criteria were used to guide decision making when considering the inclusion of Schedule 4 medicines in the SafeScript NSW system:

  1. Evidence of harm – for a medicine to be included there should be evidence of a pattern of harm in NSW, including non-prescribed use, dependence and fatal and non-fatal overdoses.
  2. Trends in prescribing – for a medicine to be included there should be evidence of an increasing trend in prescribing rates, as well as non-prescribed use or abuse in an Australian or global context.
  3. Substitution effect – a medicine or group of medicines should be included if there is a risk that regulation of another medicine may result in a displacement of use to other medicines or illicit substances
  4. Chilling effect – inclusion of medicines for monitoring in SafeScript NSW may discourage prescribing of monitored medicines when they are otherwise clinically appropriate, resulting in negative patient outcomes.
  5. Regulatory burden – care must be taken to ensure that the information collected in SafeScript NSW should be sufficiently inclusive as to adequately perform its purpose in mitigating harm without adding to the significant regulatory burden that prescribers and pharmacists already face or diluting the impact of SafeScript NSW on the actions of prescribers and pharmacists.
  6. Utility of information for clinical care - medicines should be considered for inclusion where the added visibility will provide clinicians greater confidence in assessing and managing the patient, leading to improved patient care. Vulnerable and complex patients in particular are at a higher risk of harm from these high-risk medicines due to polypharmacy and the multiplying effect of being on numerous medicines. This criterion provides for the monitoring of medicines that aren’t inherently high-risk in their own right but may be meaningful to the health practitioner and assist them to form a more accurate overall picture of medicines use.
  7. Consistency with other jurisdictions – consideration is given to the approaches of other states and territories in determining their lists of monitored medicines, so as to ensure co-ordinated approaches and minimise cross-border issues

Will OTP Information be visible in SafeScript NSW?

Many of the prescribers and pharmacists registered for or participating in the Opioid Treatment Program (OTP) in NSW are either not using integrated software systems or are not using such systems when recording OTP prescribing and dispensing. ​

This is particularly the case with OTP provided in public and private clinics in NSW. This means that the methadone or buprenorphine medicine prescribed and supplied by them to a patient as part of the OTP may not be included in the patient’s SafeScript NSW patient history.

OTP prescribers and pharmacists will be able to view monitored medicines transactions performed by other health practitioners when these transactions have been conducted electronically using software integrated with Prescription Exchange Services.

Will a registered pharmacy be able to see dispensing and prescribing from clinics and pharmacies that are not registered with SafeScript NSW?

Yes. The collection of prescribing and dispensing information about monitored medicines is authorised under the Poisons and Therapeutic Goods Regulation 2008. All prescribing and dispensing transactions for monitored medicines that are generated using a Prescription Exchange Service (PES) will be collected by SafeScript NSW even if the individual prescriber or pharmacist is not registered to access SafeScript NSW.

Are NSW Health Systems going to be integrated with SafeScript NSW?

NSW Health hospitals and outpatient clinic information systems will not be integrated with the SafeScript NSW system at this stage because NSW Health prescribing and dispensing systems are not currently integrated with electronic prescribing infrastructure. Exploratory work is currently underway to implement ePrescribing in NSW Health facilities. NSW Health public hospital and clinic prescribers and pharmacists can log into the SafeScript NSW system using their StaffLink ID and password to view a history of their patient’s high-risk medicines prescribed or dispensed in the community.

Access

How do I access SafeScript NSW?

You must be registered with SafeScript NSW to access it. If you are using integrated clinical software (such as Best Practice or Z Dispense) you can login and access SafeScript NSW through your software. You can also access SafeScript NSW via the portal.

Do we need patient consent to access SafeScript NSW?

While a prescriber or pharmacist does not need patient consent to view their SafeScript NSW records, it is good clinical practice to talk to the patient about what information is being accessed and how the information is being used to inform decisions about their treatment.

A prescriber or pharmacist is permitted to view a patient record in SafeScript NSW in the following circumstances:

  • when prescribing or supplying a monitored medicine to the patient
  • when reviewing the patient’s monitored medicine history as part of a patient consultation (e.g., when a prescriber takes a patient history, or a pharmacist conducts a medication review)
  • when discussing the patient’s monitored medicine history with other registered health practitioners who are involved in that patient’s care.

Can I access SafeScript NSW if I also work in other states and territories?

SafeScript NSW is accessible to health practitioners who practice in NSW. Where a health practitioner works in NSW occasionally, they will be eligible to register for and access SafeScript NSW, but only for enquiries relating to their practice in NSW. This is because the enabling regulation that provides for health practitioner access to the SafeScript NSW system only permits access relating to prescribing or dispensing that occurs in NSW. For more information, click here: SafeScript NSW Factsheet for Other States and Territories

The Commonwealth is currently working on a data sharing framework that will facilitate the sharing of information between the jurisdictional systems. The intent is for health practitioners to be able to access the information they need to inform their practice, wherever they are in Australia. There is not an established timeframe for this work, but health practitioners will be notified when there is further progress in this space.

Do you need to be logged into SafeScript NSW to be able to receive notifications?

No. So long as your software is configured to enable SafeScript NSW then the system will operate in the background and only send you a pop-up notification when you are in the process of prescribing or dispensing a monitored medicine. If you are not registered, the pop-up notification will not take you to the patient profile. If you are registered but not logged in, a prompt to login into SafeScript NSW will be displayed. Some information on configuring your software can be found here:
https://www.safescript.health.nsw.gov.au/health-practitioners/registration-and-technical-support/access-using-clinical-software

How do locums access SafeScript NSW if they are working between different pharmacies?

Locum pharmacists can register with SafeScript NSW. The registration process is no different to that of other eligible practitioners. Once registered, the locum pharmacist can then view patient profiles by logging into the SafeScript NSW portal directly (https://hp.safescript.health.nsw.gov.au). When logged into the portal, the locum pharmacist can enter the pharmacy approval number and view the 20 most recent notifications that have been generated at that pharmacy.

Where the pharmacy at which they are working on any individual day is using integrated software, the locum pharmacist will receive pop-up notifications and will be able to access the SafeScript NSW portal by clicking on selected notifications to view information about the associated alerts and the patient’s monitored medicines history.

Using SafeScript NSW

How far back does SafeScript NSW provide prescribing and dispensing history for monitored medicines?

The prescribing and dispensing event data feed for monitored medicines in NSW commenced 7 April 2021.

Do we have to log into SafeScript NSW every day?

It depends on your clinical practice. Most practitioners will log into SafeScript NSW in response to an amber or red pop-up notification. However other practitioners may want to log in once at the beginning of the day and set a daily PIN to streamline their ongoing access throughout the day.

How does SafeScript NSW match patient records?

SafeScript NSW uses first name, last name, and date of birth to match patient records. If the patient provides false or inaccurate details, then you may not be able to locate matched records.

Is it still possible to prescribe or dispense monitored medicines if a warning is received in the system?

Yes. Prescribers and pharmacists may still prescribe and dispense monitored medicines even if there is a warning if they believe it is clinically safe and appropriate to do so. The SafeScript NSW system provides health practitioners with improved quality of information at the point of care that is intended to aid clinical decision making and ensure appropriate use of monitored medicines.

If deciding that a medicine is no longer the safest treatment, it’s important to remember good clinical practice involves ensuring that appropriate continuity of care is provided for the patient.  Abruptly discharging the patient or suddenly stopping treatment of patients who have been taking high-risk medicines over a long period of time is contrary to patient safety.

Is there the potential for an increase in calls from pharmacists to GPs about scripts that trigger amber or red notifications?

Pharmacists may want to contact prescribers when a prescription is issued following a red or amber notification. This is good clinical practice for a pharmacist and would happen now if they have concerns about dispensing a particular medicine.

We have not seen or heard of reports from Phase 1 or 2 of a significant increase in the number of calls to GPs in this regard.

Pharmacists are encouraged to view the Access History in the patient record to see if the prescriber has viewed the corresponding alert.  This would help inform any conversation with the prescriber about the alert and/or decision to dispense.

SafeScript NSW supports a co-ordinated approach to patient care which involves the prescriber and the pharmacist.

Are private prescriptions included in SafeScript NSW?

Yes. Records of private prescriptions are included in the SafeScript NSW system when they are either prescribed electronically or dispensed in a community pharmacy.

SafeScript NSW collects prescribing and dispensing information about monitored medicines via the electronic prescription exchange service (PES) that are already connected to most primary care prescribing and dispensing systems.

SafeScript NSW collects information for any monitored medicines that are sent to the PES regardless of whether it was supplied on a Pharmaceutical Benefits Scheme (PBS) subsidy or private prescription.

Does SafeScript NSW include scripts accessed without a Medicare card?

Yes. People who access prescriptions privately without a Medicare card will also be captured on the system.

Will handwritten and non-PBS prescriptions appear on SafeScript NSW?

Yes. Non-PBS prescriptions will be captured in SafeScript NSW, provided that the prescribing and/or dispensing system are connected to the Prescription Exchange Service (PES).

Prescribing events for handwritten prescriptions will not be captured in SafeScript NSW, however where the associated dispensing event is conducted electronically with software integrated with the PES, the information about the prescription will be captured in SafeScript NSW as a dispensing event.

If pharmacy assistants or dispensary technicians are dispensing, will SafeScript NSW notifications still work?

If the pharmacy is using integrated dispensing software, pop-up notifications will be generated during the dispensing process. Pop-up notifications will be generated for dispensing by both assistants/technicians and pharmacists. However, pharmacy technicians and assistants are not eligible to register for SafeScript NSW and therefore will not be able to log into the system when the notification is triggered. Only prescribers and pharmacists registered with Ahpra are legally authorised to access SafeScript NSW and are responsible for ensuring that it is for their use only.

Do we need to register patients for opioid prescriptions even though we are getting an authority script?

There are two kinds of authority:

  1. PBS authority – this is national requirement for all items prescribed on PBS under authority indications – this is the case for opioids. Pharmaceutical Benefits Scheme
  2. NSW state authority – this may be needed as well as the PBS authority https://www.health.nsw.gov.au/pharmaceutical/doctors/Pages/prescribe-s8-opioid.aspx
    1. For a person using drugs of dependence
    2. For a non-drug dependent person prescribed high risk medicines with addiction potential continuously for more than 2 months:
      1. any injectable form of any drug of addiction
      2. any drug of addiction for intranasal use, or for spray or application to mucous membranes
      3. alprazolam
      4. buprenorphine (except transdermal preparations)
      5. flunitrazepam
      6. hydromorphone
      7. methadone

Support

What support is there for prescribers and pharmacists?

Prescribers and pharmacists are being supported during the rollout of SafeScript NSW and will have ongoing access to education and training, including accredited eLearning modules, facilitated learning sessions and recorded webinars.

In addition to education and training, prescribers and pharmacists are being supported with tailored enhancements to local HealthPathways and a dedicated 24/7 clinical advice line (1800 434 155). The telephone service is now available and provides point in time support and advice to prescribers and pharmacists when responding to the needs of patients using monitored medicines.

What do the education and training resources cover?

Education and training resources explain: ​​

  • how and when to use the SafeScript NSW system​​
  • information about high-risk medicines and clinical practice ​​
  • how to support patients who may be at risk of harm. ​

Technical

Is SafeScript NSW connected to My Health Record?

SafeScript NSW only contains information about monitored medicines that are prescribed for and supplied to patients. SafeScript NSW is not integrated with My Health Record in any way and does not add any information to My Health Record. A patient does not need to have My Health Record for a health practitioner to access information held about them in SafeScript NSW.

Why are health practitioners being prompted to reauthenticate despite having already set up a daily PIN?

When health practitioners close their browser and attempt to log back into SafeScript NSW, they are being prompted to go through the multi-factor authentication process rather than being able to enter the portal using their daily PIN. This additional authentication step only occurs when the web browser is closed. The SafeScript NSW team is working to resolve this issue so only the daily PIN is required.

For More Information

For more information visit www.safescript.health.nsw.gov.au. You can also send enquiries to safescript@health.nsw.gov.au.