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

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

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.

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.

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.

When was SafeScript NSW rolled out? 

SafeScript NSW was made available to prescribers and pharmacists in all NSW areas in late 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.

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. ​

Who has access to SafeScript NSW?

Prescribers (medical practitioners and nurse practitioners) and pharmacists registered with Ahpra will be eligible to access SafeScript NSW, when it becomes available in their area.

What does SafeScript NSW mean for public hospitals? 

NSW Health prescribers and pharmacists will be able to 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. ​

However, NSW Health hospitals and outpatient clinic information systems will not be integrated with the SafeScript NSW system. This means that prescribing and dispensing information from public hospitals and clinics will not be included in the SafeScript NSW system and NSW Health prescribers and pharmacists will not receive a notification directly into the Electronic Medical Record (eMR) to warn them of a high-risk scenario.​

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’s available in their region.

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 services (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.

For more information

For enquiries about SafeScript NSW, contact safescript@health.nsw.gov.au.