Medication charts

• National Inpatient Medication Chart (NIMC) - Acute
  • For patients in acute care
  • Used across health service organisations in medical and surgical wards, emergency departments and intensive care units
  • Allows for 10.5 days of administration, but this may be varied locally.
• National Inpatient Medication Chart (NIMC) - Long stay
  • For long-term, stable adult patients in acute care (e.g. patients in spinal units and rehabilitation units)
  • Allows for 28.5 days of administration, but this may be varied locally.
• National Inpatient Medication Chart (NIMC) - General Practitioner e-version
  • NIMC-compliant format for general practitioners who prescribe for inpatients (usually in rural and remote health service organisations)
  • Four A4 pages
  • Generated from general practice electronic prescribing software
  • Only use the GP e-version where specific guidance for hospitals and software vendors has been implemented (see Notes on the NIMC GP e-version).

Acute 

• National Inpatient Medication Chart (NIMC) – Paediatric
• National Inpatient Medication Chart (NIMC) - Paediatric Private Hospital
  • For all children aged 12 years and under
  • Has additional features to improve prescribing safety for paediatric inpatients, including neonates
  • dose calculation space for medicine orders
  • double signing for medicines administration
  • additional spaces for noting date weighed and gestational age at birth.
     

Long stay

• National Inpatient Medication Chart (NIMC) - Paediatric Long-Stay
• National Inpatient Medication Chart (NIMC) - Paediatric Long Stay Private Hospital
  • For long-term, stable paediatric patients in acute care (e.g. patients in spinal units and rehabilitation units)
  • Allows for 28.5 days of administration, but this may be varied locally.

• National Inpatient Medication Chart (NIMC) - Day surgery
• National Inpatient Medication Chart (NIMC) - Day Surgery Private Hospital
• National Inpatient Medication Chart (NIMC) - Day Surgery Private Hospital - single sheet
  • It incorporates standard NIMC features, plus the following features suitable for day procedure services:
    • Intravenous fluid administration
    • VTE risk assessment section without prophylaxis ordering.
  • There are two private hospital versions:
    • one with PRN medicine order tear-offs
    • one without PRN medicine order tear-offs.

• National Inpatient Medication Chart (NIMC) - General Practitioner e-version
  • The NIMC GP e-version is:
    • For general practitioners who prescribe for inpatients (usually in rural and remote health service organisations)
    • A paper NIMC generated from general practice electronic prescribing software
    • Four A4 pages in length
    • Only for use where specific guidance for hospitals and software vendors has been implemented.

We recommend health services:

• Undertake a risk assessment on using the NIMC GP e-version and supporting processes, and address any identified risks before implementing the chart
• Maintain the integrity of the chart at all times – ensure that all four pages are fixed together as a complete NIMC
• Print the chart in colour to ensure the benefits of safety elements such as the adverse drug reaction/allergy box
• Do not fax the chart – colour and resolution may be lost, and faxed pages may not be routinely stapled into one chart
• Ensure that the prescriber handwrites any new medicines added to an existing NIMC GP e-version during the patient’s admission
• Cease the order and document a new handwritten order on the existing chart when a computer-generated medicine order needs amending during admission
• Apply the Recommendations for Terminology, Abbreviations and Symbols used in Medicines Documentation when handwritten medicine orders are needed.

We recommend software vendors:

• Incorporate the National Guidelines for On-Screen Display of Clinical Medicines Information into prescribing functionality to facilitate clear, standardised communication (especially for multi-ingredient medicine names)
• Require prescribers to actively select medicine orders for their patients and whether they are ‘regular’ or ‘when required’ (PRN) medicines
• Ensure that warfarin orders are always printed in the designated warfarin section of the chart
• Ensure that ‘stat’ orders are always printed in the ‘stat’ order section of the chart
• Eliminate random hospital identifiers being printed on the chart
• Ensure that medicine administration times printed on the chart align with the frequency specified in the order
• Remove field headings (except where no medicine order is printed) and avoid text wrapping in medicine orders where they are printed onto the chart, to allow increased font size and improve legibility.

GP software that does not support principles described in the National Guidelines for On-Screen Display of Clinical Medicines Information should otherwise support the use of acceptable terms referred to in the Recommendations for Terminology, Abbreviations and Symbols used in Medicines Documentation.

Health services that are unable to ensure that there are systems in place to support these recommendations should carefully consider whether the chart will meet their needs and the requirements for patient safety.

We have produced national subcutaneous insulin medication charts for acute and non-acute hospitals and mental health facilities. These support the delivery of appropriate care and improve the management of blood glucose levels (BGLs) in these different groups of patients.

The charts are designed to:

• Link the prescribing of subcutaneous insulin with administration and recorded blood glucose levels (BGLs)
• Provide forcing functions to reduce the use of non-standard abbreviations and non-standard dosing regimens
• Provide guidelines for action to be taken in the event of BGLs reaching levels which indicate a medical officer should be alerted and action taken
• Prompt daily review and adjustment of insulin doses in response to BGLs.

• National Subcutaneous Insulin Chart

• National subcutaneous insulin chart (non-acute)

• Insulin chart quick start guide - Poster
• Insulin chart quick start guide - Handout
• User Guide to the National Subcutaneous Insulin Chart: Acute Facilities
• User Guide to the National Subcutaneous Insulin Chart: Sub-acute Hospitals and Mental Health Facilities

Our Clozapine titration chart supports the prescribing, monitoring and administration of clozapine titration.

When clozapine is used for maintenance treatment use the NIMC (acute) or NIMC (long-stay). Health service organisations implementing the clozapine titration chart are asked to provide feedback on it by contacting their jurisdictional representative or by emailing us.

• National Inpatient Medication Chart (NIMC) - Clozapine Titration guide
• National Inpatient Medication Chart (NIMC) - Clozapine Titration User Guide

Venous thromboembolism (VTE) prophylaxis

The NIMC and Pharmaceutical Benefits Scheme hospital medication chart (PBS HMC) include a section on VTE prophylaxis. The National Inpatient Medication Chart (NIMC) (day surgery) incorporates a modified VTE prophylaxis section.The NIMC and Pharmaceutical Benefits Scheme hospital medication chart (PBS HMC) include a section on VTE prophylaxis. The National Inpatient Medication Chart (NIMC) (day surgery) incorporates a modified VTE prophylaxis section.

Use of charts

The VTE prophylaxis section in the NIMC is intended to prompt prescribers to assess all adult patients for risk of VTE on admission and prescribe appropriate VTE prophylaxis.

This section should be used in conjunction with the hospital’s approved VTE risk assessment and prophylaxis policies, protocols or guides. In line with national and international guidelines, we recommend that health services develop a formal strategy that addresses the prevention of VTE.

This section of the charts is based on piloting and significant local and national development work.

• National Inpatient Medication Chart (NIMC) - VTE Phase 2 Pilot Final Report

Clinicians are required to complete this for all patients. If a previous ADR exists, they should:

• Document the (a) Name of the drug/substance, and (b) Reaction details (e.g. rash, diarrhoea) and type of reaction (e.g. allergy, anaphylaxis)
• Affix an ADR alert sticker to pages 3 and 4 of the NIMC in the spaces provided.

• Adverse drug reaction (ADR) alert sticker - printing instructions
• Adverse drug reaction (ADR) alert sticker - design files

Since its establishment in 2018, individual sites have been using the NSMC Audit System to conduct local audits.

NSMC National Audits have also been conducted, and reports are available for health services looking to understand how their organisation performs against national results. 

From 2024 onwards, we will no longer be coordinating NSMC National Audits.

The NSMC audit system will be maintained by us and will be available for Australian hospitals and day procedure centres to access the system and conduct local audits. The following resources have been developed to support hospitals participating in the NSMC audit.

• National Standard Medication Chart (NSMC) Audit System: Summary Report Indicators Formula Sheet
• National Standard Medication Chart (NSMC) National Audit FAQs
• National Standard Medication Chart (NSMC) Audit Guide
• National Standard Medication Chart (NSMC) Audit System: Reporting user guide for coordinators
• National Standard Medication Chart (NSMC) Audit System User Guide: Hospital version
• National Standard Medication Chart (NSMC) Audit Form

Instructional videos are available for the NSMC audit system:

• Part 1 - User registration
• Part 2 - Logging in and resetting passwords
• Part 3 - Creating audits and entering audit data
• Part 4 - Generating reports (for coordinators only)

Checklist for assessors:

• NSQHS Standards Checklist for assessors - Reviewing paper-based National Standard Medication Charts
• NSQHS Standards Checklist for assessors - Reviewing information accessed and actioned by the governing body

Audit reports:

• NSMC National Audit Report 2022
• NSMC National Audit Report 2020

At this time, only Australian hospitals and day procedure services (public and private) will be able to access the NSMC Audit System. 

You can email us for enquiries.

The National Residential Medication Chart (NRMC) is for use in residential aged care facilities. It works to improve medicines safety for residents, and minimise the administrative burden of prescribers, aged care staff, and pharmacists when ordering, administering, and supplying medicines. 

We have additional information on topics related to our National Residential Medication Chart, and our frequently asked questions can help understand more about our Chart.

You can refer to our frequently asked questions about how 60-Day Prescriptions in Residential Aged Care work in aged care settings. 

• National Residential Medication Chart User Guide for Nursing Staff
• National Residential Medication Chart User Guide for Pharmacists
• National Residential Medication Chart User Guide for Prescribers

• National Residential Medication Chart skills assessment
• National Residential Medication Chart (version 4)

When a patient’s care is transferred to another clinicians, an accurate and up-to-date list of medicines for the patient, including reasons for any changes, should be given to that clinician. Some points in the patient journey are particularly risky and need extra attention, such as:

• When they are admitted to hospital
• When they are transferred from the emergency department to other care areas (wards, intensive care, home)
• When they are transferred from the intensive care unit to the ward
• When they are discharged from the hospital to home, aged care home or another hospital.

Unintentional changes to patients’ medicine regimens often happen during hospital admissions and can cause patient harm during a hospital stay or after discharge.

• Between 10% and 67% of medication histories have at least one error, and up to 33% of these errors have the potential to cause patient harm
• More than 50% of medication errors occur at transitions of care
• Patients with one or more medicines missing from their discharge information are 2.3 times more likely to be readmitted to hospital than those with correct information on discharge
• 85% of discrepancies in medication treatment originate from poor medication history taking.

Accurately matching up medicines can help ensure continuity of care and prevent harm by reducing the opportunity for medication errors.

The National Medication Management Plan (NMMP) is a standardised medication reconciliation form used at hospital admission.

The NMMP is used to:

• allow standardised recording of the medicines taken before presentation at the hospital
• reconcile patients’ medicines on admission, during intrahospital transfer and at discharge
• improve the accuracy of information recorded by clinicians and make it available to the clinician responsible for prescribing medicines.

The NMMP can be used for adult and paediatric patients.

Some states and territories and health services have modified the NMMP to align with local needs and practices.

The NMMP resources have been developed with the support of the Health Services Medication Expert Advisory Group and incorporate a number of elements originally devised by WA Health.

• National Medication Management Plan
• National Medication Management Plan - User Guide