It’s now mandatory for all prescribers in Queensland to check QScript to view a patient’s prescription history of monitored medicines when prescribing these medications.
All prescribers must register with QScript to be able to use it. QScript is a read-only real-time prescription monitoring system which provides monitored medicine prescription history. If your prescribing software is integrated with the electronic prescription exchange services, pop-up notifications will alert you to the information held in QScript. Prescribers without an integrated system must access QScript through a web portal.
Doctors are not required to enter any information into QScript. It is recommended by Queensland Health that you sight photographic identification to confirm your patient’s identity.
Which medications are monitored?
- all schedule 8 medicines e.g. opioids, alprazolam, dexamphetamine, nabiximols (cannabis extracts)
- all benzodiazepines
How should you use the information in QScript?
The information can help you decide whether it is appropriate to provide a prescription and how to manage patients’ medication use.
Every time you prescribe a monitored medicine, you should document that you have checked QScript, along with your clinical assessment, and any interventions, and that you have given consideration to the information available.
Does QScript decide whether you can prescribe?
No. It is a clinical tool which purely provides information about the monitored medicines prescribed to a patient. Pre-set algorithms create red alerts which identify high-risk clinical scenarios for patients, for you to then consider.
What should you do if you receive a red alert?
A red alert is not a barrier to prescribing. However, it is a prompt for you to determine if the ongoing prescribing is appropriate.
Remember, stopping a patient’s monitored medicines may cause more harm than good. There will be circumstances where ongoing prescribing may be more clinically appropriate.
Can you terminate the relationship if you’re concerned about a patient’s prescription history?
Patients may display drug-seeking behaviour for many reasons, including poorly managed pain, an undiagnosed medical condition or a substance use disorder.
If you decide to terminate the relationship, ensure there is appropriate continuity of care and no immediate risk to the patient's health.
Are you liable for any adverse events if you prescribe to a patient displaying drug-seeking behaviour?
The processes of determining whether you have prescribed appropriately have not changed. However, a court or regulator may now also consider whether your prescribing was clinically appropriate based on the information available to you in QScript.
Are there any exceptions to the requirement to check QScript before prescribing monitored medicines?
You do not need to check QScript if you are directly administering a monitored medicine yourself.
You do, however, need to check QScript if you are prescribing a monitored medicine, including when you give a verbal order for another person to administer it, unless there is an exemption or reasonable excuse.
No exemptions have been granted, and “reasonable excuse” has not been defined.
Therefore, it is uncertain whether QScript must be checked where monitored medicines are routinely administered by another person under the orders of a doctor, including acute emergencies, anaesthesia, intensive care management and post-operative care.
As a result, Avant is unable to provide advice about this at present. Avant has urged Queensland Health to provide further clarity about this.
If you need advice around prescribing monitored medicines, email us on firstname.lastname@example.org or call 1800 128 268, available 24/7 in emergencies.