Practice policies
Robust and enforced ‘whole of practice’ policies for prescribing drugs of dependence, which give GPs and practice staff permission to say ‘no’, can assist in managing inappropriate requests.
A practice may consider instituting policies, including:
- first presentations of new patients requesting drugs of dependence
- a standard approach/management of patients making inappropriate requests for medicines
- conditions for registrars prescribing drugs of dependence.
Practices may choose to flag some of these policies to patients via a sign in the waiting room.
Further suggested policies and policy templates are available in The Royal Australian College of General Practitioners (RACGP) resource Prescribing drugs of dependence in general practice, Part A – Clinical governance framework (3.7 Practice policies)
Induction
GPs and practice team members should be inducted to all practice policies to ensure consistent understanding and implementation.
Documentation
The quality of patient health records is an important factor in continuity of care and the prescribing of drugs of dependence. Practices should have a mechanism to inform the practice team of patients who demonstrate behaviour consistent with inappropriate use of these medicines and how this is being managed.
Documentation within medical records should be in line with the RACGP resources Improving health record quality in general practice and Standards for general practices (5th edition). The chosen mechanism (for example, placing an asterisk beside certain data in a record) should be documented in a local policy and communicated to all practice members and be clearly visible when a record is opened.
Clinical meetings
Practices should consider discussing these complex presentations at practice clinical review meetings to ensure a practice-wide approach and ongoing education is achieved.
Responding to patient aggression
While it is not typical for a patient to become aggressive, if you or your team feel threatened at any stage, you may consider giving the patient what they want and asking them to leave immediately to avoid an escalation in aggression. Do not confront the patient. In this situation, call the police and your state/territory drugs and poisons unit.
Practices should consider installing a duress alarm system in the practice, for the safety of the practice team and patients. Refer to the RACGP resource Preventing and managing patient aggression and violence for further information, response strategies and templates for communicating with, and discontinuing care for, aggressive patients.