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SWEP Communique - Prescriber Communication

10 July 2018

Feedback from the Chief Allied Health Officer re: Failed Scripts and New Prescription Forms
 
Dear Prescribers,

Thank you for your feedback over the last week regarding my communique on Prescriber accountabilities and failed scripts, as well as your feedback regarding the new prescription forms.
SWEP remains committed to continuous improvement based on the experiences and feedback of our Prescribers. Please see below for an update and the immediate changes we have made.
 
New Prescription Forms
With the introduction of the new database we have also introduced revised prescription forms.
The intention in making this change was to condense the prescription form and clinical justification form into one, reduce duplicated questions, auto populate information wherever possible, provide clear prompts and descriptions for questions, and to ensure consistency across scripts for all AT categories.

We are thrilled that last week alone, we had 239 scripts successfully submitted into the new database - congratulations to all Prescribers who were a part of this.

Whilst we have reduced the overall number of questions asked of Prescribers we have received some very useful and constructive feedback about the length of the script and potential further improvements that could be made.

Responding to this feedback immediately we have already undertaken the following;
  • removed the "mandatory" requirement for clinical justification questions (Prescribers should note that this information is still required for all NDIS scripts)
  • created a "copy application" function so that if you need to complete a script across more than one AT category it will populate client details across
  • adjusted the Oxygen Prescriber and LCGP prescription forms so that it is more streamlined and focused on oxygen or LCGP requirements 
 
We are also working with the database developers to consider the following improvements;

  • a simplified application process for low cost items (for example items under $150)
  • exploring how we might streamline applications for highly experienced red Prescribers
 
Failed Scripts
Last week we communicated information related to "failed scripts". Since then we have had feedback and concerns raised by Prescribers around the implications this might have if SWEP were to pursue Prescribers to take responsibility for resolving any errors.
 
I 'd like to provide some further detail as to why we have put this process in place but please be assured that our first approach is always to resolve unforeseen errors collaboratively. This process is not to pursue Prescribers who have undertaken thorough assessments and robust clinical reasoning or where the circumstances involve clients with highly complex needs and unforeseen changes occur.

Our definition of a "failed script" relates to the event where assistive technology has been supplied based on the advice and recommendation of the prescribing therapist that has subsequently been considered not fit for purpose.
 
Examples of failed scripts that have occurred in the past include;
  • Prescribers submitting a script based on client and / or family demands rather than clinical need, only to have the item rejected by the client as it was never fit for purpose
  • equipment ordered based on incorrect or inappropriate assessments and then rejected by the client as not fit for purpose
  • Prescribers signing off that they have completed a final check of the item and that up to date assessments are complete only to find this has not occurred and the clients rejects the item as not fit for purpose
                             SWEP certainly acknowledges that there are specific challenges when there are waiting periods for supply, or
                             staffing changes occurring between the original prescription and supply. Where clients wait longer than 6 months
                             since the application was lodged, or have a rapidly changing condition, SWEP staff should always ask the
                             Prescriber to confirm suitability of the recommended item.
 
SWEP aims to ensure accountability for the appropriate use of finite resources. We would only consider looking into a matter further; where it was felt that there was unprofessional conduct (conduct that is of a lesser standard than that which might reasonably be expected of the health practitioner by the public or professional standards); when misleading or falsified information had been provided to SWEP; or significant concerns are identified related to a Prescriber " ôs clinical reasoning (for their appropriate Prescriber level).

For our clients, this is about ensuring they have the confidence the items being prescribed are fit for purpose and will meet their needs. It also means that SWEP does not have to reinstate a subsidy and order a second item which then effects the resources available and wait times for other clients who may be waiting. We encourage Prescribers to utilise the Imprest stores to trial items with their clients.

If there are concerns about a failed script the review process includes a thorough evaluation undertaken by 1-2 of our expert Clinical Advisors who would then provide a formal opinion to myself as the Chief Allied Health Officer to determine if further action is required. We are hoping this will be a very rare occurrence.

The intention of this communique is to ensure that Prescribers are aware of their responsibility in the assessment process, and that equipment is appropriately prescribed in the first instance. Therefore, this will ensure that best possible outcomes are delivered to our clients and mitigates the occurrence of unnecessary resources from all parties.

Please remember that in the first instance we are always here to work collaboratively with you. If you have questions regarding a specific prescription please contact the SWEP team on swepimt@bhs.org.au or for any general questions regarding this communique please contact myself at swepcaho@bhs.org.au

Kind regards,
Donna Markham
SWEP Chief Allied Health Officer

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