The NRMC is a medication chart developed for use throughout the residential aged care sector. It has been designed 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.
During 2013-14, this standardised national medication chart was tested and evaluated in over twenty residential aged care services by the Australian Commission on Safety and Quality in Health Care.
The NRMC will enable the prescribing and supply of most medicines, and PBS/RPBS claiming by pharmacists where applicable, directly from the NRMC without the need for a separate prescription to be written. However, certain medicines will still require a traditional prescription written, in addition to an order on the NRMC. These include:
Note: (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.
Note: (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 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.
Relevant pathology (such as results to support warfarin dosing, and blood glucose levels), medical practitioners’ instructions, and special considerations applying to the administration of medicines to a resident, are all included in the NRMC. The layout supports informed prescribing, accurate medicines dispensing and administration, and improved clinical monitoring of residents.
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.
The NRMC has been designed and tested for use in residential aged care services 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:
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.
Useful tools including user guides and training materials can be found below in the ‘Useful resources’ section.
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. Some of these are outlined below.
The evaluation of the NRMC in practice revealed numerous demonstrated benefits.
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 Australian Commission on Safety and Quality in Health Care, 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 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.
The Australian Commission on Safety and Quality in Health Care has developed separate NRMC guidance material for prescribers, aged care service staff, and pharmacists. These can be accessed and downloaded by clicking on the links below.
|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|