National residential medication chart
The national residential medication chart (NRMC) was developed for use in residential aged care facilities (RACF). It works to improve medication safety for residents, and to minimise the administrative burden of prescribers, aged care staff, and pharmacists when ordering, administering and supplying medicines.
Benefits of using the NRMC
Fewer prescriptions to write
The NRMC will enable:
- The prescribing and supply of most medicines without the need for a separate prescription to be written
- Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS) claiming by pharmacists where applicable, directly from the NRMC.
However, certain medicines will still require a traditional prescription to be written, in addition to an order on the NRMC. These include:
- All PBS Authority Required items requiring prior approval (written and telephone approval, including PBS/RPBS items with increased quantities)
- PBS items only available under Section 100, for example Highly Specialised Drugs
- Controlled drugs (‘Schedule 8’ medicines)
- Extemporaneously compounded medicines
- Some other medicines, subject to state/territory restrictions.
(a) Authority Required (STREAMLINED) items are eligible for supply and PBS claiming from the NRMC, provided the prescriber includes the PBS Streamlined Authority Code in the appropriate area of the NRMC for each relevant medicine.
(b) Some states/territories have not yet finalised the necessary regulatory change to enable use of the NRMC. For more information see the section below on ‘Who can use the NRMC?’
A central point for information
A key feature of the NRMC is that ‘prescriptions’ and the record of medicine administration are co-located on the NRMC. The resident’s details, including their photograph and known adverse drug reactions, are visible from each page of the NRMC to enable correct identification when prescribing, supplying and administering medicines. Faxed, photocopied and emailed scanned images of the NRMC will also contain this information to assist pharmacists in identifying the correct resident and their medication orders.
The NRMC includes:
- Relevant pathology (such as results to support warfarin dosing, and blood glucose levels)
- Medical practitioners' instructions
- Special considerations applying to the administration of medicines to a resident.
The layout supports informed prescribing, accurate dispensing of medicines and administration, and improved clinical monitoring of residents.
Duration/length of the NRMC and supply of medicines
The NRMC ‘charting cycle’ is a maximum of four months. As the NRMC nears its expiry date, there is a reminder in the administration area of the NRMC for RACF staff to contact the medical practitioner to review the resident and re-chart their medicines. If the medicines are not re-charted, all orders on the NRMC cease to be valid for supply and administration after the chart expiry date. Unlike the existing process for supplying medicines from prescriptions, the amount of each medicine supplied by the pharmacy will not be determined by a maximum quantity and ‘repeats’. For each medicine order, the medical practitioner must specify a period of time that a medicine is to be administered and supplied, thereby removing the requirement for PBS repeat authorisation forms as they are used today.
Who can use the NRMC?
The NRMC has been designed and tested for use in RACFs only. If you manage residential aged care services and you wish to consider changing from your present medication charts to the NRMC or a compliant equivalent chart, you will need to consider a range of processes, including:
- Change management processes for your service’s staff
- Securing commitment from residents’ general practitioners regarding new medication ordering systems
- Liaison with your supplying pharmacy about new systems to order, reconcile, and manage medicine usage in your service
- Working with your aged care group or peak body for support during the process.
Experience from testing the NRMC showed that aged care services that changed from a range of medicine chart products to the NRMC incurred a significant change management process to fully realise the benefits of the NRMC.
Is it mandatory to use the NRMC in RACFs?
Neither the Aged Care Act 1997, under which Commonwealth subsidies are paid for providing aged care services, nor the National Health Act 1953, which governs the operation of the PBS, requires operators of residential aged care services to use the NRMC in their services. However, there are benefits in doing so.
What are the benefits of using the NRMC?
Holistic and resident focused
The NRMC booklet format contains all relevant medication information in one place.
Evaluation of the NRMC testing phase demonstrated significant reductions in staff medication administration error, and incorrect packaging of resident medicines following the NRMC’s introduction
Standard fields for all staff, prescribers and pharmacies
The standardised layout, functionality, and fields in the NRMC results in a consistent approach to medicine prescribing, administration and supply across a variety of settings through standard intuitive design.
Using the NRMC can help residential aged care services meet medication management standards as part of aged care accreditation processes.
Use of the NRMC reduces the number of separate paper forms to be purchased, and reduces medication administration costs.
How can my organisation obtain copies of the NRMC?
Residential aged care services will need to organise their own printing and supply channels for NRMC charts, or use commercial suppliers of medical charts. While high resolution printer files for the NRMC (link to PDFs) are available free of charge from the Commission, neither the Commission nor the Department of Health coordinates NRMC printing and logistics. Aged care peak bodies may also be able to advise on some aspects of chart supplies.
Compliant equivalent charts
‘Compliant charts’ in this context are those that comply with relevant state legislation, and the Commonwealth National Health (Residential Medication Chart) Determination 2012, as amended. For residential aged care service operators who wish to take advantage of the NRMC, but use a commercial version of the chart, it is important to ensure that any commercial products used are compliant with both state and Commonwealth legislation.
Use of a non-compliant chart may prevent, for example, pharmacists being able to make PBS claims for medicines supplied directly from the medicine order on the chart. It is the responsibility of aged care service operators to obtain relevant advice on the compliance, or otherwise, of a medication chart before considering introducing it in their services. Chart producers should be asked to provide written confirmation of their products’ compliance with applicable legislation.
During 2013–14, the Commission tested and evaluated this standardised national medication chart in over 20 residential aged care services.
NRMC files for printing
- NRMC v3 high resolution printer file
- NRMC v3 high resolution printer file with commercial printer instructions
NRMC resources and tools
The Commission has developed separate NRMC guidance material for prescribers, aged care service staff, and pharmacists. These include:
- Chart sticker templates
- NRMC FAQs
- NRMC guidelines for nursing / RACF staff
- NRMC guidelines for nursing / RACF staff: appendices
- NRMC guidelines for pharmacists
- NRMC guidelines for pharmacists: appendices
- NRMC guidelines for prescribers
- NRMC guidelines for prescribers: appendices
- NRMC interactive PPT: Education for nursing and care staff
- NRMC Medication Skills Assessment
- NRMC phased implementation evaluation report
- NRMC phased implementation evaluation report summary
- NRMC sticker instructions
- Supply and Pharmaceutical Benefits Scheme (PBS) claiming from the medication chart
- National Health (Residential Medication Chart) Determination 2012 (PDF 255KB)
|If you have a question about …||… please:|
|… introducing the NRMC in your residential aged care service||liaise with your group’s clinical governance team, and/or aged care peak bodies.|
|... the role of the NRMC in meeting accreditation standards||contact the Australian Aged Care Quality Agency on 1800 288 025.|
|... updating your pharmacy software to be able to dispense and claim PBS medicines from the NRMC||contact your pharmacy dispensing software vendor.|
|… putting in PBS claims after supplying medicines from the NRMC||contact the PBS Information Line 132 290.|
|… how to prescribe medicines on the NRMC||read the prescribers’ guide to the NRMC, located in the ‘Useful Resources’ section of this web page|