How many coroners does it take to change a lightbulb? One to change the lightbulb and another to pronounce the old lightbulb dead from natural causes.Unfortunately it seems it also takes more than one coroner to change a systemic issue with the monitoring of medication prescriptions within Victoria, Australia.
When a 38 year old Victorian man’s death in 2012 was attributed to the combined toxic effects of prescription medication you could be forgiven for asking why a doctor would prescribe these conflicting medications concurrently. But one doctor did not prescribe all of the medications. In this case it was two doctors working at different clinics who were unaware of the other’s prescriptions for their patient. Essentially they were prescribing blind.
The process of attending more than one doctor for prescription medication is known as ‘doctor shopping’ and without a real-time prescription monitoring program Victorian doctors will continue to be in the dark. Doctor shopping is used to obtain restricted medications in quantities exceeding therapeutic doses from multiple doctors for personal use or on-selling. A real-time prescription monitoring program has already been implemented in Tasmania and is currently being investigated in Western Australiafollowing similar deaths. While there is some debate about the optimal program to prevent the prescribing of conflicting medications by different doctors (some have suggested a real-time dispensing monitoring program run by pharmacists would be most efficient) it is clear that a system is not only required, but urgently needed.
In February 2012 Victorian Coroner John Olle cited universal support for a real-time prescription monitoring program and was not surprised by the community frustration at the lack of progress. Coroner Olle then made the recommendation that a real-time prescription monitoring program be implemented in Victoria “within 12 months” to prevent further harm and deaths caused by doctor shopping.
The same recommendation regarding the implementation of a real-time prescription monitoring program has been made in response to five separate deaths investigated by four Victorian coroners in 2014 alone. Each time their choice of words revealing increasing frustration with the inaction in this area.
Recently in December 2014 Victorian Coroner Jacinta Heffey summarised the state of play with the real-time prescription monitoring program. The former Victorian Health Minister David Davis made an election promise in 2014 to implement a real-time prescription monitoring program should his party be re-elected. The result of the election saw a change of government in Victoria and the position of the new Health Minister Jill Hennessy is unknown.
The author Elia Petzierides is a Victorian based Advanced Life Support Paramedic and a Registered Nurse with a Graduate Diploma in Advanced Clinical Nursing.
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