Fact Sheet - Tasmanian Opioid Pharmacotherapy Program - Dosing Sheets for Community Pharmacists - July 2016

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This Fact Sheet provides Community Pharmacists with information about how to complete monthly dosing sheets (medication administration charts) for clients receiving opioid pharmacotherapy treatment.

General Requirements

  • Three formats of the dosing sheets are available for use. These include PDF, Word and Excel formats. Choose a format which best suits your needs.
  • All dosing sheets can be printed as a blank form and then completed manually.
  • When completing the dosing sheets manually, please ensure all details are written clearly so they are legible and easy to read. If an error is made when completing the dosing sheets, simply rule a line through the incorrect text and clearly re-write the correct details.
  • Alternatively certain areas of the dosing sheets can be completed electronically prior to printing. Only those fields that require information are able to be edited – the remainder of the dosing sheet is locked and cannot be changed.
  • Dosing sheets and the monthly summary sheet must be submitted to the Pharmaceutical Services Branch within ten (10) days of the start of each new month.
  • Fax to (03 6173 0820 or scan and emailed to pharm.services@dhhs.tas.gov.au

Using the dosing Sheets Electronically:

The following table describes how parts of the dosing sheets can be completed electronically.

  • The PDF file format cannot be saved when data has been electronically entered.
  • Navigation around the form can be achieved by using the “Tab” key on the keyboard to move from field to field or the mouse can be used to select any field.
  • There are two types of fields contained in the form – text fields and fields with menu options.
  • The text field can be completed electronically by typing text into each field.
  • The fields with menu options have a drop down menu which can be accessed by clicking on the button at the end of the field which will reveal options to choose from – select an option from the menu to complete the field.
  • Contents of a text field can be removed by selecting the field and pressing the delete key on your key board.
PDF File Types
  • The PDF file format cannot be saved when data has been electronically entered.
  • Navigation around the form can be achieved by using the “Tab” key on the keyboard to move from field to field or the mouse can be used to select any field.
  • There are two types of fields contained in the form – text fields and fields with menu options.
  • The text field can be completed electronically by typing text into each field.
  • The fields with menu options have a drop down menu which can be accessed by clicking on the button at the end of the field which will reveal options to choose from – select an option from the menu to complete the field.
  • Contents of a text field can be removed by selecting the field and pressing the delete key on your key board.
Word File Types
  • The Word version of the forms can be saved when data is entered electronically.
  • Navigation around the form can be achieved by using the “Up” and “Down” arrows on the keyboard to move from field to field or the mouse can be used to select any field.
  • There are two types of fields contained in the form – text fields and fields with menu options.
  • The text field can be completed electronically by typing text into each field.
  • The fields with menu options have a drop down menu which can be accessed by clicking on the button at the end of the field which will reveal options to choose from – select an option from the menu to complete the field.
  • Contents of a text field can be removed by selecting the field and pressing the delete key on your key board.
Excel File Types
  • The Excel version of the forms can be saved when data is entered electronically.
  • Navigation around the form can be achieved by using the “Tab” key or the arrow keys on the keyboard to move from field to field or the mouse can be used to select any field.
  • There are three types of fields contained in the form – text fields, fields with menu options and fields that require data to be entered in a particular format.
  • The text field can be completed electronically by typing text into each field.
  • The fields with menu options have a drop down menu which can be accessed by clicking on the button at the end of the field which will reveal options to choose from – select an option from the menu to complete the field.
  • The fields which require data to be entered in a particular format when selected will display a note describing what format to enter the data (for example the Month/Year field requires data to entered in the format mm/yy).
  • The Dosing Day field only requires the date to be enteredin the first row (ie in cell B16). The remaining Day fields will be populated automatically once the first date is entered.
  • Contents of a text field can be removed by selecting the field and pressing the delete key on your key board.
  • Please ensure that you have the contents scaled to fit on one page before printing (found under the print menu).


Individual Patient Dosing Sheets (Medication Administration Charts)

  • A separate dosing sheet must be used for each individual patient every month. Please ensure you fill out all required fields of information on each dosing sheet.
  • You may use pharmacy dispensing labels for pharmacy and patient details fields in the header of each dosing sheet. All required information must be present.
  • TOPP #: The TOPP number is assigned to persons/clients who are registered on the Tasmanian Opioid Pharmacotherapy Program. It is available from the prescriber, or via the Drugs and Poisons Information System Online Remote Access (DORA) website or by calling the Pharmaceutical Services Branch on telephone 03 6166 0400 (who can arrange online access to DORA for you)
  • Each dosing sheet has an end of month summary table for completion and sign off by the pharmacist. The end of month summary table is slightly different for each opioid pharmacotherapy as follows:

Suboxone®/Subutex® Summary

END OF MONTH SUMMARY (for payment)

Total no. Bupe. Doses:Last daily dose of month: (mg)Total no. TAD:Total no. missed doses:Pharmacist signature:
  • Total no. of Bupe. doses: If the patient is dosed every second day (and therefore receives 15 doses for a 30 day month) the total number of buprenorphine doses received for the month is 15. If the patient is given five (5) take away doses and ten (10) observed doses, this equates to a total of 15 buprenorphine doses for the month.
  • Last daily dose of month: This is recorded as the last equivalent daily dose i.e. if the patient is given 16mg of buprenorphine every second day (double dose), this equates to a dose of 8mg per day and should be entered in the summary as 8mg per day.
  • Total no. TAD: This is the total number of takeaway doses given to the patient for the month.
  • Total no. of missed doses: This is the total number of doses the patient missed for the month.

Methadone Syrup/Liquid (Biodone) Summary

END OF MONTH SUMMARY (for payment)

 Last daily dose of month: (mg)Total no. TAD:Total no. missed doses:Pharmacist signature:
  • Last dose of the month: The last methadone dose given to the patient for the month.
  • Total no. TAD: This is the total number of takeaway doses given to the patient for the month.
  • Total no. of missed doses: This is the total number of doses the patient missed for the month.

Monthly Summary Report and Cover Sheet

  • The Monthly Summary Report and Cover Sheet is to be completed each month and submitted to the Pharmaceutical Services Branch along with all client dosing sheets.
  • Complete the Report by listing the name of each patient/client who has dosed at your Community Pharmacy for the month.
  • Use the drug key (M = Methadone Syrup; ML= Methadone Liquid – Biodone Forte; S = Suboxone; B = Subutex) to identify what drug each patient is supplied each month.
  • Copy over the matching dosing information from each individual patient’s dosing sheet from the end of month summary section located at the base of each sheet.
  • If there is a change from one agent to another during the month, please enter both pieces of information on the summary sheet.

For more information

Download the dosing sheets (relevant to each pharmacotherapy medication)

If you have any queries in relation to the submission of dosing forms, please contacts Pharmaceutical Services Branch on telephone (03) 6166 0400 or email pharm.services@dhhs.tas.gov.au

Queries in relation to the Tasmanian Opioid Pharmacotherapy Program Policy, incentive payment issues or suggested changes to the forms can be directed to the Alcohol and Drug Service on phone (03) 6166 0825 or email mhs.executiveassistant@ths.tas.gov.au