Prescription monitoring system flags doctor’s prescribing mistake

The introduction of real-time prescription monitoring has changed the way doctors’ prescribing is being monitored, as this doctor found after prescribing drugs of dependence to help a family member.

In this case, through prescription monitoring, the state’s health department identified that a member had inadvertently self-prescribed drugs of dependence while attempting to prescribe to her husband.

Doctor prescribes to husband

The doctor’s husband had been unwell with COVID and had severe back pain due to repetitive coughing. An orthopaedic surgeon had prescribed a non-steroidal anti-inflammatory medication for his back pain.

However, the medication did not relieve her husband’s pain and the doctor received a call from him while she was at work, saying he was in severe pain. To help alleviate his pain, she wrote him prescriptions for paracetamol and codeine, and tapentadol.

In her haste to quickly write a prescription, the doctor issued the prescriptions from her own record in the practice software (that she used to order medications), rather than creating a new patient record for her husband.

Unfortunately, the doctor’s attempts at altering her own record were only partly successful. As a result, the prescriptions were in her own name, rather than her husband’s. Neither the doctor, nor her husband, nor the pharmacist noticed this at the time and the prescriptions were dispensed to her husband.

Health department alerted to prescribing

Later that month, the doctor received a notice from the health department’s medicines compliance regulatory body asking her to provide information about the prescriptions, including confirming she had issued them.

The regulatory body was alerted to the doctor’s prescribing through the state’s real-time prescription monitoring system. In almost all Australian jurisdictions, it’s an offence punishable by a fine and/or imprisonment to self-prescribe or self-administer certain medicines including Schedule 4 and Schedule 8 medications, without reasonable excuse. Also, all doctors are required to practise in accordance with the Medical Board of Australia’s Good medical practice: a code of conduct for doctors in Australia which prohibits self-prescribing and prescribing Schedule 8, psychotropic medication and/or drugs of dependence for anyone they are close to.

Avant assists doctor

Avant’s medico-legal team helped the doctor submit a response to the regulatory body, clarifying the prescription had been written for her husband, not for herself, and she had not intended to breach the legislation.

The doctor readily acknowledged she shouldn’t have written the prescriptions for her husband and instead, he should have consulted his own treating doctor. She expressed regret that she had prescribed for her husband and completed education on prescribing obligations and treating family and friends provided by Avant.

The regulatory body considered the doctor’s explanation, her remorse, and the insight she had demonstrated by completing further education.

No further action was taken by the regulatory body.

Key lessons

• The introduction of real-time prescription monitoring has enabled greater tracking of prescribing.
• While it can seem expedient to write a prescription for a family member or friend, doctors should avoid treating anyone with whom they have a close personal relationship, except in an emergency. Doctors are prohibited from prescribing Schedule 8 medication and drugs of dependence for anyone they are close to.
• Never self-prescribe. It is prohibited by the Medical Board’s code of conduct for any medication, and self-prescribing certain drugs, including Schedule 4 and Schedule 8 medications is illegal in most Australian jurisdictions.

Avant resource

Factsheet: Treating family members, friends, or staff

Opioid prescribing insights

Our data reveals 1 in 17 claims and complaints* involved opioid prescribing practices.

Overprescribing was the most common issue raised in 56% of these claims and complaints. In more than half of these cases the doctor did not meet the standard of care, emphasising the need to take care when treating patients for pain which is neither acute nor cancer related.

Prescribing without authority was an issue in 17% of opioid prescribing claims and complaints. In more than three-quarters of these cases the standard of care was not met, highlighting how important it is to know and comply with legislation in your state or territory. Other issues included self-prescribing and prescribing that was not clinically indicated.

The data sends a clear message to doctors to be confident about refusing to prescribe opioids, or deprescribing when clinically appropriate.

Opioid prescribing issues (some cases had more than one issue)

Assessment of claims and complaints involving opioid prescribing issues

A doctor’s perspective

Dr Patrick Clancy, MBBS, FRACGP, MHlth&MedLaw, Senior Medical Adviser, Avant

This case highlights some unique challenges when considering prescribing for family members, friends, or staff.

The Medical Board’s code of conduct says that wherever possible, doctors should avoid providing medical care to anyone with whom they have a close personal relationship. It specifically prohibits prescribing Schedule 8 and psychotropic medications, and drugs of dependence in those situations, as well as self-prescribing.

Prescribing in these situations can be unsafe and inappropriate. While it may be unavoidable in some rare urgent or acute situations, always ensure you have considered all other alternatives. For example, in the case here, the doctor could have assisted her husband to contact his treating doctor to provide further prescriptions via a telehealth consultation.

If you do find yourself in a genuinely unavoidable situation, the following actions are important:

• Only provide a limited prescription to address the acute or urgent situation, in relation to dose and amount, and avoid including repeats on the prescription.
• Document the prescription you provide and the reasons for it, including the circumstances of the acute or urgent need.
• Consider contacting the pharmacy where the prescription will be dispensed so they are aware of the situation.
• Communicate with the person’s usual treating doctors about the steps taken.
• Avoid prescribing drugs of dependence at all.

This article was originally published in Connect  magazine issue 21.