The QScript system
QScript is a read-only real-time prescription monitoring system that generates notifications to prompt health practitioners to review a patient’s monitored medicine prescription history at the point of care.
The system conveniently integrates with the everyday workflow of compatible prescribing and dispensing software.
As QScript is an online system, an internet connection is required to access the system. It can be accessed via mobile and tablet devices.
Process flow for QScript
- Patient visits prescriber.
- Prescriber accesses QScript to check the patient’s monitored medicine prescription history.
- Prescriber uses their clinical reasoning to decide whether to prescribe.
- If prescribed, the patient presents the prescription to a pharmacy.
- Pharmacist accesses QScript to check the patient’s monitored medicine prescription history.
- Pharmacist uses their clinical reasoning to decide whether to dispense.
- If dispensed (other than in a public sector hospital) monitored medicine prescription information is automatically uploaded into QScript.
Prescription information in QScript
QScript contains records of monitored medicines that have been dispensed to a patient (provided on prescription) in Queensland community and private hospital pharmacies. All monitored medicines dispensed in these pharmacies are recorded in QScript regardless of whether they are subject to the Pharmaceutical Benefits Scheme (PBS) or Repatriation Schedule of Pharmaceutical Benefits (RPBS) subsidy or are a private prescription.
QScript also contains records of monitored medicines prescribed for patients if the prescription was written by a health practitioner using clinical software connected to a Prescription Exchange Service.
In addition, QScript:
- contains other monitored medicine-related information which may assist clinical decision-making—such as whether a patient is or has been registered on the Queensland Opioid Treatment Program.
- can automatically generate alerts when certain conditions are met which suggest the presence of a ‘high-risk clinical scenario’ (where a health practitioner’s clinical software is integrated with QScript).
QScript is a read-only system; health practitioners are not required to manually enter any information into the system. Prescription data in QScript is collected automatically from Prescription Exchange Services (PESs) which currently support the transfer of electronic prescriptions and prescription information from prescribers to pharmacies.
When a prescription is issued by a prescriber or dispensed at a pharmacy connected to a PES, the PES sends a record of the prescription to QScript in real time.
Patient records not included in QScript
QScript typically does not contain records of:
- monitored medicines:
- dispensed from public sector hospital pharmacies
- supplied in other states/territories
- administered to patients e.g. in health services such as hospitals, prisons, aged care facilities
- given as a treatment dose i.e. not dispensed by a pharmacist
- monitored medicine prescriptions which were handwritten or generated in clinical software systems not integrated with a Prescription Exchange Service (until they have been dispensed at a community or private hospital pharmacy)
- Queensland Opioid Treatment Program records prior to 2015
- Schedule 8 prescribing and dispensing events prior to December 2019
- Schedule 4 monitored medicine prescribing and dispensing events prior to 27 September 2021.
Nationally, all Australian states and territories have either commenced or are working towards implementing real-time prescription monitoring solutions, with the aim of establishing a national system. The intent is that once the necessary technical capabilities and legal and administrative frameworks and arrangements are in place, information about monitored medicine prescribing and dispensing events occurring in all states and territories will be available in each jurisdiction’s real-time prescription monitoring system, to inform clinical decision-making.
Discussing patient care
When a health practitioner views a patient record, their name and organisation contact details are logged. This information is visible to QScript users so health practitioners can contact each other to discuss the patient’s care. Visit the QScript learning portal for information on discussing QScript with patients.
QScript is designed to integrate with existing clinical software. This allows health practitioners to receive notifications when prescribing or dispensing a monitored medicine. When a notification appears, users need to simply click on the link to be taken directly to the relevant QScript patient record, where one exists.
Red notifications mean the prescription has triggered an alert to a high-risk clinical scenario, and careful review of the patient’s QScript record is required.
Amber notifications mean a careful review of the patient’s QScript record is required, but no alert for a high-risk clinical scenario has been triggered.
Green notifications mean no matching patient record has been found in QScript. Green notifications contain a link that directs users to the patient search screen in case the user would like to manually search for a patient record (although there is no legal requirement to do this).
Notifications and legislative requirements
Did the prescription trigger an alert to a high-risk scenario?
Do I have to check the patient’s QScript record?
[Patient name] - Check QScript. Active alerts(s) exist.
[Patient name] - Check QScript. Patient record exists.
[Patient name] - No matching record found.
Visit the QScript learning portal for more information on using the system.
Alerts to a high-risk clinical scenario
Prescribing and dispensing events may trigger an alert within a patient’s QScript record when a high-risk clinical scenario has been identified.
There are six high-risk clinical scenarios:
Patient currently registered on the Queensland Opioid Treatment Program.
Patient previously registered on the Queensland Opioid Treatment Program.
Patient receiving monitored medicines from multiple prescribers: a patient who in the previous 90 days has been dispensed monitored medicine prescriptions written by 4 or more prescribers.
Increased patient overdose risk – average total daily opioids of 100mg oral morphine equivalent (OME) or greater.
A patient whose average total daily opioid dose:
- is currently 100mg OME or greater – based on the amount of opioids dispensed over the previous 90 days; or
- will be 100mg OME or greater – based on the amount of opioids dispensed over the previous 90 days (if any) and the amount of opioids proposed to be prescribed or dispensed.
Increased patient overdose risk – opioid and benzodiazepine/z drug combination.
A patient who in the previous 90 days has been dispensed:
- an opioid and a benzodiazepine/z-drug (zopiclone or zolpidem); or
- an opioid—and it is proposed they are prescribed or dispensed a benzodiazepine/z-drug; or
- a benzodiazepine/z-drug — and it is proposed they are prescribed or dispensed an opioid.
Patient receiving an opioid or benzodiazepine/z drug for the first time in 90 days.
A patient who in the previous 90 days has not been dispensed:
- an opioid – and it is proposed they are prescribed or dispensed an opioid; or
- a benzodiazepine/z-drug – and it is proposed they are prescribed or dispensed a benzodiazepine/z-drug.