Since at least 2012 there has been an increasing push in Australia for the implementation of a national real-time prescription monitoring system that alerts doctors and pharmacists to people who are misusing prescription drugs.
More than 20 Coronial Inquests in New South Wales, Victoria and Western Australia alone have recommended a real-time prescription monitoring system in an attempt to reduce the number of lives that are lost as a result of overdosing on prescription medications. Peak industry bodies have been strong supporters of such a system and have been urging its implementation for several years.
The question for health practitioners, and in particular allied health practitioners such as pharmacists, is to what extent it will impact on their professional responsibilities and obligations.
Status of Australia’s system
In 2008, Tasmania implemented the Drugs and Poisons Information System Online Remote Access system (known as ‘DORA’) in response to the state’s higher use of oxycontin per capita than any other state – it now has the lowest. In 2013, the Australian Government developed and funded an Electronic Recording and Reporting of Controlled Drugs system (‘ERRCD’) and licensed the system to each state and territory in Australia. The ERRCD is based upon the DORA system.
The EERCD aims to provide immediate access to data relating to dispensing by pharmacists of certain controlled drugs, and online access to authorised health professionals of up-to-date information relating to patient dispensing histories. It is believed that an effective nationwide EERCD will provide practitioners with a clinical tool to minimise the number of patients who are doctor and pharmacy shopping and help practitioners make informed clinical decisions, including early identification of patients who have, or are at risk of, addiction. The difficulty in implementing the system Australia-wide has been due to the technical, legal and financial hurdles that have to be overcome.
NSW and ACT have been actively trialing a real-time prescription monitoring system and over the past year other states are taking steps in the same direction.
In April 2016 Victoria announced it was allocating approximately $30 million over 4 years to implement its ERRCD system and anticipates it starting in 2018. Whilst the ERRCD system is currently restricted to Schedule 8 medications, such as oxycodone, Victoria is considering expanding the model to include certain other drugs such as to the system, including ongoing training and support to pharmacists and doctors, is expected to be completed by late 2018.
What will it mean for health and allied health practitioners?
In addition to the changes that will need to be made to a practitioner’s administrative and technological systems (for which further training and presumably funding will be provided), evidence of a practitioner’s knowledge and use of ERRCD is likely to have particular significance in coronial, civil and disciplinary proceedings.
A common feature in many of the recent coronial inquests in relation to deaths arising from overdoses of prescription medication, and the disciplinary cases for professional misconduct involving doctors and pharmacists, is the lack of education about the legal and clinical aspects of drugs of dependence and the regulations application in each state. There are often differences between each state and territory as to the regulations applicable to prescribing (and consequently dispensing) drugs of dependence. Both health practitioners and pharmacists need to ensure they are well educated on both the current regulations, and any changes to regulations and practice guidelines, that are made as the ERRCD is implemented in their state or territory.
Prescribers will also no doubt be expected to have a system in place whereby regular checking of a patient’s dispensing history on the ERRCD is undertaken prior to writing a prescription for a drug of dependence and to turn their mind to whether the patient is addicted, or at risk of developing an addition, to the medication. Many practitioners regularly have such a thought at the forefront of their minds, however once an ERRCD system is in place, one would anticipate that evidence of performing such a check will be expected of the practitioner in civil and disciplinary proceedings.
Pharmacists will need to be equally vigilant. As pharmacists must make an independent judgment as to whether a prescription presented is valid, the medication safe and appropriate for a patient, and whether it is consistent with the prescriber’s intention, pharmacists will need to ensure that personal dispensing guidelines are updated to include checking any ERRCD system, and recording and acting upon the results. That may require further enquiries with the prescriber or previous dispensers and/or refusing to dispense medications.
While the additional step in a health, and allied health, practitioner’s practise is adding to the workload of already busy professionals, most would welcome and support the additional step. The potential benefits to the community in assisting professionals provide their patients the care they require far outweighs the inconvenience. As a whole the profession is actively embracing a nationwide ERRCD system. However, as every good lawyer and insurer will say, just make sure you keep a record of your knowledge and use of it.
For more information, contact Julie Somerville, Principal.
“While this initiative certainly is in the community interest, it will have an impact on pharmacists and has the potential to bring with it an increased legal liability exposure.” – Paul Baker, Managing Principal, Meridian Lawyers