SafeScript NSW contains clinical alerts which are displayed where a high-risk situation has been detected in a patient’s prescription or dispensing record for monitored medicines. The alerts are generated in real time, as the events are recorded in the system. Alerts are red or amber, depending on the potential for harm. This fact sheet contains information about how each of the alerts works, and the clinical evidence that supports each alert.
It is critical to note that the alert in SafeScript NSW does not instruct clinicians on what to do or whether a medicine should or should not be provided. This decision remains with the clinicians involved in the care of the patient. SafeScript NSW provides additional information and context to help inform this decision.
The clinicians involved in the care of the patient remain best placed to consult with the patient and determine whether these medicines remain the safest and best option based on the individual’s health needs and circumstances.
This alert is triggered when prescribing and/or dispensing events for certain opioid and benzodiazepine receptor agonist (benzodiazepines, zolpidem, zopiclone) combinations are identified within the last 30 days.
The opioid and benzodiazepines receptor agonists included in this alert are:
A red notification will appear for prescribing and dispensing events for patients in this situation. Checking the corresponding alert in SafeScript NSW is then required to progress.
*Methadone products that are commonly prescribed as opioid substitution therapy as part of the NSW Opioid Treatment Program are not included in this alert category.
This alert rule will trigger for prescribing and dispensing events for patients whose average total daily opioid dose is currently 100mg morphine equivalent or greater for any dispensed monitored medicines. The alert is generated based on a rolling average over the previous 90 days.
A red notification will appear in this situation. Checking the corresponding alert in SafeScript NSW is then required to progress.
The average 90-day morphine equivalent dose (MED) is determined by calculating the MED associated with each transaction (Transaction MED) and adding these together to form a cumulative total for all dispense events in the last 90 days.
The Transaction MED value is determined using the following formula:
Medicine Strength x MED conversion factor x Dispense Qty
˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗˗
90 days
= Dispense Transaction MED
When a new transaction enters the database, its transaction MED value is added to the rolling 90-day total. If this addition means that the rolling 90-day total reaches or exceeds 100mg, a red alert is generated.
The morphine equivalent dose calculated by the SafeScript NSW system is not the same as an Oral Morphine Equivalent Daily Dose (OMEDD). An OMEDD is calculated based on the prescribed dose, whereas the morphine equivalent dose calculated by SafeScript NSW is based on an average of the medicines supplied to the patient.
Care needs to be taken with calculating the oral morphine equivalence. There is often variability in conversion factors and the patient may not be taking all the opioid medication being dispensed to them. An Opioid calculator has been developed by the Faculty of Pain Medicine, Australian and New Zealand College of Anaesthetists (FPM ANZCA) to assist practitioners in conducting these calculations. The conversion factors used by SafeScript NSW align to the FPM Calculator, with the exception of Methadone, which uses a conversion factor of 3.
A multiple provider alert will be triggered when the patient is receiving monitored medicines from multiple prescribers from different clinics. It is common for patients to see more than one prescriber at the same clinic. For this reason, prescribe events from prescribers in the same clinic are only counted as a single prescriber when this alert is calculated.
A red alert will trigger when prescribing events for monitored medicines from four or more prescribers from different medical practices in the last 90 days are identified in a patient’s SafeScript NSW record.
An amber alert will be triggered when a patient has had prescriptions for monitored medicines dispensed at four or more pharmacies in the past 90 days. While there are many circumstances where this may be considered appropriate, health practitioners should be aware this behaviour, when associated with the use of monitored medicines, can be linked to oversupply of medicines and an increased risk of harm.10
This alert rule will trigger for prescribing events where the medicine is a CNS depressant or sedating medicine, if the patient is currently enrolled in the Opioid Treatment Program (OTP).
An amber alert is triggered if the prescriber is the approval holder or authorised under the approval*.
A red alert is triggered if the prescriber is not the approval-holder, nor authorised under the approval*.
* Authorised under the approval:
The approval holder or the medical practitioner or nurse practitioner is practising at the same premises that the holder of the authority was practising at when the approval was issued
A red or amber 'medicine requires approval' alert may be visible on a patient record. This alert was triggered to notify prescribers that:
This alert was introduced to prevent multiple prescribing events that can result in duplication of treatment and increased risk of harm. However, it has become evident that the presence of this alert hasled to misinterpretation by prescribers and pharmacists as to its intended purpose, which has resultedin treatment being withheld from patients. Therefore,from 18 June 2024 this alert will no longer trigger.
As these alerts were triggered at a point in time, they cannot be removed from the system. Any alerts triggered prior to this date will remain visible on the patient record.
Do not take this alert into account when prescribing or dispensing the medicine. If a patient has a red or amber 'medicine requires approval’ alert on their record:
Please note prescriptions for psychostimulant medicines must be endorsed with a NSW Health approval number. Prescribers are responsible for ensuring that prescriptions are correctlyendorsed with a valid approval number. When dispensing, pharmacists are responsible forensuring that the number is present on the prescription. Pharmacists are not expected to verify the validity of the approval number endorsed on the prescription.
