The National ResidentialMedication Chart (NRMC)

For use in AustralianResidential Aged Care Facilities

✔Introduction module for nursing and care staff

Learning outcomes

Through this module you will learn about:

✔ The characteristics of the NRMC

✔ The different sections of the NRMC

✔ Communicating changes to pharmacy

✔ Accurate documentation

✔ The essential fields for supply of medicines

✔ Available resources and support materials

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Introduction

To successfully complete this module you will need to:

The NRMC team can be contacted on 02 912 63514 or email NRMC@safeyandquality.gov.au

√ Score 80% in the assessments at the end of this module

√ Complete this Learning module

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Lets get started

NRMC: Safety and chart design

The NRMC has been developed by the Australian Commission on Safety and Quality in Health Care (ACSQHC).

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Research shows that many adverse events reported in Australian residential aged care facilities (RACFs) are associated with medications.

Research also demonstrates that improvements to medication chart design can improve the safety of medication processes.

The NRMC was overseen by a reference group of aged care industry experts, health care professionals and subject matter experts (including nursing, medical, pharmacy and care staff) from States and Territories across Australia.

NRMC: Evidence based practice and quality aged care

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The NRMC is intended to reflect:evidence based practice;

the aged care Accreditation Standards;the Aged Care Act 1997; and

It also is intended to minimise the risk of adverse medication events for residents by safer :

legislative requirements.

administering of medicines.

dispensing; and

prescribing,

Characteristics of the NRMC

The NRMC has been designed to enable:

✔ The medication chart as a prescription

✔ A central point for information

✔ Standard duration of a maximum of four months

✔ Different sections for different types of medicines

✔ Evidence based National standard medication chart for use in Residential Aged Care Facilities (RACFs)

NRMC: General requirements

All prescribers must order medicines for residents in accord with legislative requirements as required by State/Territory Health (Drugs and Poisons) Regulations;

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.

The NRMC is to be completed for all residents and to be available for prescribing, dispensing, administering and reviewing; and

All medications should be reviewed regularly to identify potential drug interactions and to discontinue medicines that are no longer required

Changes to residential aged care prescriptions

The NRMC enables the supply of most medicines, and most PBS/RPBS claiming, directly from the NRMC without the need for a separate written PBS/RPBS prescription

When are prescriptions are still required?

Authority Required items requiring prior approval including PBS/RPBS items with increased

quantities

Items only available under Section 100 e.g. Highly Specialised Drugs

Controlled drugs (‘Schedule 8’ medicines)

Medicines depending on state and territory law

Schedule 4 medicines which are not Australian Register of Therapeutic Goods (ARTG) registered

General requirements for using the NRMC

• Available for the prescribing, supply, administering and review of a resident’s medicines.

• Original NRMC is retained at the RACF • Pharmacists must keep a copy of the NRMC for at

least two years for Medicare audit purposes • If more than one NRMC is in use:

• Chart 1 of 2; • Chart 2 of 2

• Paperless claiming does not require pharmacists to provide a copy to Medicare as evidence of supply

Essential fields for supply and claim from the NRMC

Essential fields in accordance with legislation

1. Resident identification

2. Medical practitioner details

3. Essential prescription fields

4. Specific requirements in NSW

Essential fields: Medical practitioner details

These fields MUST be completed by a medical practitioner to be a valid prescription for supply.

Each chart MUST be signed by the prescriber.

Prescriber detail boxes are on the front page of the NRMC. Each prescriber (i.e locum, specialists) MUST complete the necessary information.

Essential fields: Prescriber details (The NRMC front page)

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The residents regular GP details are entered in this box Prescribers who are not the

residents regular GP, such as the GP who visits when the residents regular GP is away, or a medical specialist, who sees this resident, enter their details in these boxes

Essential fields: Resident details

These fields MUST be completed for the NRMC to be a valid prescription.

Provide information in this box if another resident has a similar name

Record all known drug allergies and reactions in this box

Attach recent resident photograph

MUST BE COMPLETED

Prescriber box Essential fields that MUST be completed

The medical practitioner MUST indicate if PBS/RPBS eligible.

The medical practitioner should complete the CTG box if their resident is registered for CTG.

The medical practitioner MUST

fill in either ongoing or a start

and stop start date to indicate the

duration of therapy. This allows the

medical practitioner to select a different

start date for administration where

this differs from the date of prescribing.

The medical practitioner MUST sign name and enter the date of prescribing.

The medical practitioner MUST write legibly the dose, route, frequency and strength as well as the medicine name as indicated in the prescription box.

The medical practitioner MUST complete the four digit streamlined authority code for medicines to be supplied as Authority Required STREAMLINED.

Communicating the medication order

Each time there is a change the RACF MUST:

Communicate this to the pharmacy as soon as possible by:

✔Copy and fax the NRMC; or

✔Scan and email the NRMC (cc GP and care manager); or

✔Copy and hand deliver the NRMC.

Communicating the medication order cont

The most current copy of page one

and

The most current copy of the page (where the medicine is prescribed)

Note: The pharmacy cannot supply medicine to residents unless they receive

Different sections of the NRMC

✔ Front page (resident, prescriber, pharmacy and RACF information)

✔ Nutritional supplements

✔ Insulin

✔ Variable dose medicine

✔ PRN medicine

✔ Short term medicine

✔ Nurse initiated medicine

✔ Phone orders

✔ Regular medicine

✔ Non prescription medicine

✔ Comment/other information page

✔ Instructions for prescribers/abbreviations/six rights of medication administration

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The NRMC: Front page, Resident considerations

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Information that helps staff enable residents to take their medicines can be written in this box. Things like ‘needs a special spoon’, ‘likes one

pill at a time’, ‘has difficulties swallowing’, ‘crush medicines in jam’, or ‘holds pills in

mouth’.

Indicates the number of charts for this resident

Information that lets staff know if this resident is on a complex medication regime.

Regular medicines

Important abbreviations

Abbreviations to be used when medicine has not been taken as ordered.

The NRMC: Nutritional supplements

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The person responsible for weight monitoring write Instructions of how much and which type of nutritional supplement is to be given to this

resident

Directions for entering amount of nutritional supplements

The person responsible for weight monitoring writes in this section about the progress of the resident in terms of weight gain/loss and how

the resident is managing the supplement

This section is for residents identified at risk for weight loss

and under 80 kgs

This section is provided to record information about significant weight gain or loss for the resident (eg: returned from hospital,/nil by mouth PEG inserted/palliative care/ new

diagnosis

Under 80 kgs

The BMI score (if known) is written here

The NRMC: Nutritional supplements cont.

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Circle the current month

Check the current date

the date

Write resident weight in this box and also place a mark

onto the graph

Write how much (serves) you gave the resident on the morning shift and sign your initials

Write how much (serve) you gave the resident on the afternoon shift and sign your initials

The NRMC: Nutritional supplements cont.

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Place a ‘dot ‘onto this graph to indicate resident weight each fortnight, or as directed by the GP or

registered nurse

The NRMC : Insulin and BGL recording

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Blood glucose level (BGL) are documented in this area in 24 hour

time (ie;0700 = 7am) and also the BGL result as a number (ie: 3.2)

This section is for information related tot his resident that may be relevant to BGL readings. (e.g. had lunch out; ate some lollies on and/or unwell and not eating today.

It is important to date and sign this information.

The prescriber (GP) or Registered Nurse writes

instructions for how often the BGLs are to be taken and when to notify prescriber if BGL is outside of specified

range for this resident

Plot BGL on graph by using a dot to indicate BGL progress. You may plot up to 3 BGLs if required in different colours (i.e Blue for morning, red for lunch and green for evening)

Circle the current month Check the current

day

The NRMC : Insulin prescribing and administration

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The NRMC: Variable dose medicine (not insulin)

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The NRMC: PRN (as required) medicines

This box identifies the

drug, the reason that the

prescriber wants it given (ie: back pain)

and the maximum dose

in any 24hr period

Circle yes or nor (Y/N) in this box to indicate whether you think the medicine has been effective for the resident (ie: did the pain

lessen?, did the agitation improve?)Note: you will also need to write in the progress notes whether the PRN medicine has been effective and how (ie: did the pain

lessen?, did the agitation improve?)

! check order for maximum dose per 24hr prior to

administrationWrite the dose given in this

box

! Check the time any previous dose given and confirm correct period between doses as per order prior to administration

Write the time given in this box in 24 hour time (1800 = 6pm)

The NRMC: Short term medicine

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This is the last valid date for the medicine order. The medicine cannot be administered after this date.

Note; once course of drugs is completed, check with GP whether repeat pathology is required (ie; urinalysis/bloods)

Date where medicine is to

commence

Circle the month

Write your initials in here once medicine is given

Write the current the day before signing

Medicine order

The NRMC: Phone orders

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Ensure that 2 nurses listen to this order over the phone separately and verify with

each other what the order is.

Clearly write the prescribers directions for administering the medicine in this column, as well

as the stop and start date

Write the time and date doses given in this

column. in this box. 24 hour time (ie:1800 = 6pm)

and date format as day/month/year _ /_ /_ -

Record the second signature in this box

Record the first signature in this

box!Prescriber to sign to confirm order

when next at facility

Write the prescriber’s reason for the order and

any additional instructions (e.g. take

with food)

Print legibly the name of

the medicine

Print legibly

the prescrib

er’s name

Summary: Key Messages

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Further resources

RACF pack supplied to each home (contains all the NRMC support materials)

User guide for nursing and care staff

Medication skills assessment for nursing and care staff in residential aged care

Follow the medication safety links @ www.safetyandquality.gov.au

or email @ nrmc@safetyandquality.gov.au

Contact the NRMC team at (02) 9126 351

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NRMC Quiz

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Quiz : Characteristics of the NRMC cont

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The NRMC was developed to:a) set national standard for medication charts in residential aged careb) reduce medication errors through effective chart designc) remove the need for GPs to write traditional medication prescriptions

for most medicinesd) contain specific sections for variable dose medicines, insulin,

nutritional supplementse) all of the above

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Quiz : Characteristics of the NRMC cont

The duration or maximum length of the NRMC is:a) 1 monthb) 12 months c) 4 monthsd) 3 months

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Quiz : Characteristics of the NRMC cont

List 5 different sections of the NRMC below

1. _______________________________________________________________

2. _______________________________________________________________

3. _______________________________________________________________

4. _______________________________________________________________

5. _______________________________________________________________

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Quiz : Characteristics of the NRMC cont

Indicate your answers( true or false) to the following questionsT/F The NRMC is based on evidenceT/F Blood Glucose Levels (BGLs) are not recorded on the NRMCT/F Nutritional supplements are recorded and monitored in the

NRMCT/F The NRMC is based on legislationT/F Only registered nurses can use the NRMC for the delivery of

medicines to residentsT/F Pharmacists can supply most medicines from the NRMC

without a traditional prescription T/F Residents on more than 11 regular medicines will require

more than 1 NRMC T/F Allergies and adverse reactions are not documented on the

NRMC

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Quiz : Characteristics of the NRMC cont

List 2 abbreviations and their meaning when residents have not received their medicines?1. __________________________ 2. _____________________________

Where are commonly used abbreviations located in the NRMC?_____________________________________________________________

Where are the prescriber details located on the NRMC?____________________________________________________________

Where are the special considerations for each resident written?___________________________________________________________

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Quiz: Medicine administration on the NRMC

What are the 6 rights of medication administration on the NRMC?

1 _____________________________________

2 _____________________________________

3 _____________________________________

4 _____________________________________

5 _____________________________________

6 _____________________________________

Quiz: Medicine administration on the NRMC

How do you confirm if there is a special consideration relevant to the resident and medicines?

a) The resident tells youb) The front page of the NRMC states information in the

special considerations boxc) You just know that they dod) None of the abovee) All of the above

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Quiz: NRMC Communicating the medication order

When the medical practitioner makes a change or ceases an order on the NRMC, how is this communicated to the pharmacy?

a) You phone the pharmacy

b) Someone else phones the pharmacy

c) You send a copy of the changed or ceased order to the pharmacy

d) You send a copy of the changed or ceased order and the front page of the NRMC to the pharmacy

e) None of the above

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Congratulations!!

✔ You will soon know if you have successfully passed this quiz and are ready to use the NRMC to administer medicines safely to your residents. WELL DONE!

✔ Your trainer will be notified shortly and you will be able to see your results in your education portfolio.