Transcript Australian Commission on Safety and Quality in Health Care

The National Residential
Medication Chart (NRMC)
For use in Australian
Residential Aged Care Facilities
✔Introduction module for
nursing and care staff
Learning outcomes {USE VOICE TO TEXT ANNOTATION ELEMENT HERE}
Through this module you will learn
about:
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
✔
Introduction
{USE VOICE TO TEXT ANNOTATION ELEMENT HERE}
To successfully complete this module you will need to:
√ 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 [email protected]
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).
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.
Slide 5 of 27
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.
Slide 6 of 27
Characteristics of the NRMC
The NRMC has been designed to enable:
✔ 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)
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;
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
Slide 8 of 27
.
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)
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
Slide 14 of 27
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
MUST BE
COMPLETED
Attach recent resident
photograph
Prescriber box Essential fields that MUST be
completed
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 indicate if
PBS/RPBS eligible.
The medical
practitioner should
complete the
CTG box if their
resident is
registered for CTG.
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 sign
name and enter the
date of prescribing.
Communicating the medication order
Each time there is a change the RACF MUST:
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.
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)
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
Slide 19 of n
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.
Slide 20 of 27
Regular medicines
Important abbreviations
Abbreviations to be
used when medicine
has not been taken
as ordered.
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 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
Slide 23 of 27
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
Slide 24 of 27
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
Slide 25 of 25
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
The NRMC : Insulin prescribing and administration
Slide 27 of 27
The NRMC: Variable dose medicine (not insulin)
Slide 28 of 27
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?)
The NRMC: Short term medicine
Date where
medicine is to
commence
Write the current the
day before signing
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)
Slide 30 of 27
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 prescriber’s
reason for the order and
any additional
instructions (e.g. take
with food)
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 _ /_ /_ -
Print
legibly the
name of
the
medicine
Print
legibly
the
prescrib
er’s
name
!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 first
signature in this
box
Record the second
signature in this box
Slide 31 of 27
Summary: Key Messages
Slide 32 of 27
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 @ [email protected]
 Contact the NRMC team at (02) 9126 351
Slide 33 of 27
NRMC Quiz
Slide 34 of n
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
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
Quiz : Characteristics of the NRMC cont
{USE SHORT ANSWER ELEMENT HERE}
List 5 different sections of the NRMC below
1. _______________________________________________________________
2. _______________________________________________________________
3. _______________________________________________________________
4. _______________________________________________________________
5. _______________________________________________________________
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
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?
___________________________________________________________
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
{USE MULTIPLE CHOICE ELEMENT HERE}
How do you confirm if there is a special consideration relevant
to the resident and medicines?
a) 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
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?
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
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.