The National Residential Medication Chart (NRMC)

1. The National ResidentialMedication Chart (NRMC) For use in Australian Residential Aged Care Facilities ✔Introduction module for nursing and care staff

2. Learning outcomes {USE VOICE TO TEXT ANNOTATION ELEMENT HERE} ✔ The characteristics of the NRMC ✔ The essential fields for supply of medicines ✔ The different sections of the NRMC ✔ Accurate documentation ✔ Communicating changes to pharmacy ✔ Available resources and support materials Through this module you will learn about:

3. Introduction {USE VOICE TO TEXT ANNOTATION ELEMENT HERE} √ Complete this Learning module √Score 80% in the assessments at the end of this module The NRMC team can be contacted on 02 912 63514 or email NRMC@safeyandquality.gov.au To successfully complete this module you will need to:

4. Lets get started

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

6. NRMC: Evidence based practice and quality aged care The NRMC is intended to reflect: • evidence based practice; • the aged care Accreditation Standards; • the Aged Care Act 1997; and • legislative requirements. It also is intended to minimise the risk of adverse medication events for residents by safer : • prescribing, • dispensing; and • administering of medicines.

7. Characteristics of the NRMC ✔The medication chart as a prescription ✔ A central point for information ✔ Different sections for different types of medicines ✔ Standard duration of a maximum of four months • Evidence based National standard medication chart • for use in Residential Aged Care Facilities (RACFs) The NRMC has been designed to enable:

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

9. 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

10. 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

11. 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

12. 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

13. Essential fields: Medical practitioner details Prescriber detail boxes are on the front page of the NRMC. Each prescriber (i.e locum, specialists) MUST complete the necessary information. These fields MUST be completed by a medical practitioner to be a valid prescription for supply. Each chart MUST be signed by the prescriber.

14. Essential fields: Prescriber details (The NRMC front page) 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

15. Essential fields: Resident details These fields MUST be completed for the NRMC to be a valid prescription. Record all known drug allergies and reactions in this box Provide information in this box if another resident has a similar name Attach recent resident photograph MUST BE COMPLETED

16. Prescriber box Essential fields that MUST be completed The medical practitioner MUSTfill 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 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. 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 sign name and enter the date of prescribing.

17. Communicating the medication order Communicate this to the pharmacy as soon as possible by: ✔Scan and email the NRMC (cc GP and care manager); or ✔Copy and fax the NRMC; or ✔Copy and hand deliver the NRMC. Each time there is a change the RACF MUST:

18. Communicating the medication order cont Note: The pharmacy cannot supply medicine to residents unless they receive • The most current copy of page one • and • The most current copy of the page • (where the medicine is prescribed)

19. 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

20. The NRMC: Front page, Resident considerations 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.

21. Regular medicines

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

23. The NRMC: Nutritional supplements Under 80 kgs This section is for residents identified at risk for weight loss and under 80 kgs 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 BMI score (if known) is written here 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 The person responsible for weight monitoringwrites in this section about the progress of the resident in terms of weight gain/loss and how the resident is managing the supplement

24. The NRMC: Nutritional supplements cont. Circle the current month Check the current date the date 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 Write resident weight in this box and also place a mark onto the graph

25. The NRMC: Nutritional supplements cont. Place a ‘dot ‘onto this graph to indicate resident weight each fortnight, or as directed by the GP or registered nurse

26. The NRMC : Insulin and BGL recording Circle the current month Check the current day 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) 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) 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. Slide 26 of 27

27. The NRMC : Insulin prescribing and administration

28. The NRMC: Variable dose medicine (not insulin)

29. The NRMC: PRN (as required) medicines ! 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) This box identifies the drug, the reason that the prescriber wants it given (ie: back pain) and the maximum dose in any 24hr period ! check order for maximum dose per 24hr prior to administration Write the dose given in this box 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?)

30. The NRMC: Short term medicine Write the current the day before signing Date where medicine is to commence Circle the month Medicine order Write your initials in here once medicine is given 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)

31. The NRMC: Phone orders Ensure that 2 nurses listen to this order over the phone separately and verify with each other what the order is. 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 _ /_ /_ - 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 prescriber’s name Record the first signature in this box !Prescriber to sign to confirm order when next at facility Clearly write the prescribers directions for administering the medicine in this column, as well as the stop and start date Record the second signature in this box

32. Summary: Key Messages Slide 32 of 27

33. 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 Slide 33 of 27

34. NRMC Quiz

35. Quiz : Characteristics of the NRMC cont {USE MULTIPLE CHOICE ELEMENT HERE} The NRMC was developed to: a) set national standard for medication charts in residential aged care b) reduce medication errors through effective chart design c) remove the need for GPs to write traditional medication prescriptions for most medicines d) contain specific sections for variable dose medicines, insulin, nutritional supplements e) all of the above Slide 35 of 27

36. Quiz : Characteristics of the NRMC cont {USE MULTIPLE CHOICE ELEMENT HERE} The duration or maximum length of the NRMC is: a) 1 month b) 12 months c) 4 months d) 3 months

37. Quiz : Characteristics of the NRMC cont {USE SHORT ANSWER ELEMENT HERE} List 5 different sections of the NRMC below 1. _______________________________________________________________ 2. _______________________________________________________________ 3. _______________________________________________________________ 4. _______________________________________________________________ 5. _______________________________________________________________

38. Quiz : Characteristics of the NRMC cont {USE TRUE/FALSE ELEMENT HERE} Indicate your answers( true or false) to the following questions T/F The NRMC is based on evidence T/F Blood Glucose Levels (BGLs) are not recorded on the NRMC T/F Nutritional supplements are recorded and monitored in the NRMC T/F The NRMC is based on legislation T/F Only registered nurses can use the NRMC for the delivery of medicines to residents T/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

39. Quiz : Characteristics of the NRMC cont {USE SHORT ANSWER ELEMENT HERE} 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? ___________________________________________________________

40. Quiz: Medicine administration on the NRMC What are the 6 rights of medication administration on the NRMC? _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________

41. Quiz: Medicine administration on the NRMC {USE MULTIPLE CHOICE ELEMENT HERE} • How do you confirm if there is a special consideration relevant • to the resident and medicines? • The resident tells you • b) The front page of the NRMC states information in the • special considerations box • c) You just know that they do • d) None of the above • e) All of the above

42. Quiz: NRMC Communicating the medication order {USE MULTIPLE CHOICE ELEMENT HERE} When the medical practitioner makes a change or ceases an order on the NRMC, how is this communicated to the pharmacy? You phone the pharmacy Someone else phones the pharmacy 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

43. 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.