Alerts and notifications

This alert is generated when a prescriber prescribes a controlled (Schedule 8) medicine without the necessary Chief Health Officer (CHO) Approval. This alert is only generated at the time of prescribing.

There are three variations of this rule:

• Patient is flagged as drug dependent by a prescriber
  
  Prescriber Not Authorised: [Patient name] has been declared drug dependent by a prescriber. Please obtain CHO approval prior to prescribing the medicine.
   
• Patient has been on the controlled medicine for more than 2 months.
  
  Prescriber Not Authorised: [Patient name] has been on the controlled medicine for more than 2 months. Please obtain CHO approval prior to prescribing the medicine.
   
• Another prescriber holds a current CHO Approval
  
  Prescriber Not Authorised: [Patient name] has a current CHO approval with [prescriber name] to prescribe this medicine. Please co-ordinate treatment with the other prescriber.

This alert is generated when an authorised prescriber prescribes a controlled medicine under Category 1, Category 2A or Category 2B that causes the average daily Morphine Equivalent Dose (MEqD) dispensed to this patient in the past 60 days to exceed the Category limit. The alert is only generated at the time of prescribing. 

There are three variations to this rule, depending on the Category and its associated MEqD limit:

• Category 1 CHO Approval
  
  Opioid Dose Exceeds Approval: Over the last 60 days [patient name] has received a total opioid dose above the approved maximum of 100 morphine equivalent daily dose under your Category 1 CHO approval. Please check you are prescribing within the limits of your CHO approval and whether other opioids have been dispensed from a different prescriber.
   
• Category 2A CHO Approval
  
  Opioid Dose Exceeds Approval: Over the last 60 days [patient name] has received a total opioid dose above the approved maximum of 160 morphine equivalent daily dose under your Category 2A CHO approval. Please check you are prescribing within the limits of your CHO approval and whether other opioids have been dispensed from a different prescriber.
   
• Category 2B CHO Approval
  
  Opioid Dose Exceeds Approval: Over the last 60 days [patient name] has received a total opioid dose above the approved maximum of 300 morphine equivalent daily dose under your Category 2B CHO approval. Please check you are prescribing within the limits of your CHO approval and whether other opioids have been dispensed from a different prescriber.

This alert is generated when a health practitioner prescribes or dispenses a monitored medicine for a patient who has obtained monitored medicine supply/prescription from multiple providers in the last 60 days. While there may be legitimate reasons for the patient to visit multiple providers, the alert will prompt the health practitioner to review the patient’s history prior to prescribing or dispensing.

There are two variations of this rule:

• Patient obtained prescriptions for monitored medicines from at least 3 different prescribers or medical clinics
  
  Multiple Prescribers: [patient name] has obtained prescriptions from at least 3 different prescribers or medical clinics within the last 60 days. Take action to coordinate treatment to ensure patient safety.
   
• Patient obtained supply of monitored medicines from at least 4 different pharmacies
  
  Multiple Pharmacies: [patient name] has obtained prescriptions from at least 4 different pharmacies within the last 60 days. Take action to coordinate treatment to ensure patient safety.

Alert generated at time of prescribing

This alert is generated when in the last 60 days the patient has been dispensed:

an opioid—and they are being prescribed a benzodiazepine/z-drug
— or —
a benzodiazepine/z-drug—and they are being prescribed an opioid.

The risk level of the alert is determined based on whether the prescriptions were written from the same prescriber clinic (medium risk) or different prescriber clinics (high risk).

High risk alert
Concurrent Supply: [patient name]is receiving a combination of Opioids and Benzodiazepine/z drugs and may be at increased risk of harm. Reassess the need for this combination.

Medium risk alert
Concurrent Supply: [patient name] is receiving a combination of Opioids and Benzodiazepine/z drugs and may be at increased risk of harm. Reassess the need for this combination.

Alert generated at time of dispensing

This alert is generated when in the last 60 days the patient has been dispensed:

an opioid—and it is proposed they are dispensed a benzodiazepine/z-drug
— or —
a benzodiazepine/z-drug—and it is proposed they are dispensed an opioid.

The risk level of the alert is determined based on whether the prescriptions were written from the same prescriber clinic (medium risk) or different prescriber clinics (high risk).

High risk alert
Concurrent Supply: [patient name] is receiving a combination of Opioids and Benzodiazepine/z drugs from different prescribers and may be at increased risk of harm. Contact the prescriber to review the combined treatment.

Medium risk alert
Concurrent Supply: [patient name] is receiving a combination of Opioids and Benzodiazepine/z drugs and may be at increased risk of harm. Please review the need for this combination and contact prescriber if required.
 

This alert is generated when a patient with a current or recent Chief Health Officer (CHO) approval for Opioid Maintenance Treatment (OMT) is prescribed or dispensed any of the following

• Schedule 4 benzodiazepines
• Z drugs (zolpidem or zopiclone)
• Other controlled medicines (e.g. oxycodone, morphine)

The alert is not generated if the prescriber has a CHO approval to prescribe other controlled medicines with OMT.

The risk level of the alert is determined based on whether the prescription for the above medicine was written from the same prescriber clinic as the OMT approval holder (medium risk) or a different prescriber clinic (high risk).

Alert generated at time of prescribing

High risk alert
OMT Concurrent Supply: [most recent OMT approved prescriber] has held a CHO approval for Opioid Maintenance Treatment (OMT) for [patient name] within the last 2 months which increases their risk of harm. Reassess the need for this combination.

Medium risk alert
OMT Concurrent Supply: A CHO approval for Opioid Maintenance Treatment (OMT) has been held for [patient name] within the last 2 months which increases their risk of harm. Reassess the need for this combination.

Alert generated at time of dispensing

High risk alert
OMT Concurrent Supply: [most recent OMT approved prescriber] has held a CHO approval for Opioid Maintenance Treatment (OMT) for [patient name] within the last 2 months which increases their risk of harm. Contact the prescriber to review the combined treatment.

Medium risk alert
OMT Concurrent Supply: [most recent OMT approved prescriber] has held a CHO approval for Opioid Maintenance Treatment (OMT) for [patient name] within the last 2 months which increases their risk of harm. Please review the need for this combination and contact prescriber if required.

A Patient Safety Notice may be issued by ACT Health in response to concerns about an individual who has been identified seeking monitored medicines from multiple health practitioners and is at risk of imminent harm.

This alert is generated when a Patient Safety Notice exists in Canberra Script for the patient.

High risk alert
Patient Safety Notice: ACT Health issued a Patient Safety Notice for [Patient name] on [Date of issue]. Review the Notice under the patient correspondence tab and take action to ensure patient safety.