For health services
The Commission recommends that 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.
For software vendors
The Commission recommends that 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.