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The National Residential Medication Chart (NRMC)

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1 The National Residential Medication Chart (NRMC)
Narration Welcome to the learning module for the National residential Medication Chart, or the NRMC as it is better known. We hope you enjoy working through this module as you learn about the chart and how to administer medicines safely and correctly. For use in Australian Residential Aged Care Facilities ✔Introduction module for nursing and care staff

2 Learning outcomes Through this module you will learn about:
{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 Narration Introduction: This module for the National Residential Medication Chart (NRMC) has been developed for nursing and care staff currently working with the NRMC. Safe and correct use of medicines is important to residents and their families. It is also an important part of practice for a nurse or carer. Medication management in residential aged care is a complex area. Understanding which medicines are prescribed for each resident and ensuring that the right resident receives the right medicine, at the right dose, by the right route and at the right time can be a challenge. Communicating this relies heavily on clear and accurate information that is easy to read and easily located in the medication chart. A medication chart is an essential part of any medication system and is used by medical practitioners (usually the resident’s GP) to order medicines for residents. The medication chart is also a record of administration and provides important information about each resident. Completion of this module will enable nurses and carers to complete medication rounds with ease and confidence. Narration below to be in sync with each following dot point 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 ✔ Available resources and support materials

3 Introduction To successfully complete this module you will need to:
{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 Narration Read the above and then wish the learner good luck The NRMC team can be contacted on or

4 Lets get started Narration
Ok…Lets get started. Make sure that you are comfortable and have some time to accurately read through and participate effectively in this module. Remember that you may contact your trainer is you have any questions.

5 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. Narration Synch x 3 as follows Block 1 text : The NRMC was developed by the Australian Commission on Safety and Quality in Health Care. The National Residential Medication Chart (NRMC) is intended to be used as a record of orders and administration of prescription medicines, non-prescription medicines and nutritional supplements for residents living in approved residential aged care facilities (RACFs) Block 1and 2 text: 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 reflects evidence based practice and is consistent with the requirements of the aged care Accreditation Standards and the Aged Care Act 1997 (Commonwealth) and other legislation related to the safe use of medicines. It is intended to assist health professionals and care staff working in the residential aged care sector by providing a consistent basis for safer prescribing, dispensing and administering of medicines. It is also intended to improve resident safety by reducing the risk of adverse medication events. Block 4 text : 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. The NRMC enables the direct supply of many PBS/RPBS and non-PBS/private prescription medicines from the medication chart without the need for a traditional paper prescription. Some medicines however (such as S8 medicines and those medicines requiring an Authority) will still require a traditional prescription from the medical practitioner to the pharmacy to enable supply to the resident. The NRMC has specific fields adopted from traditional prescriptions which are embedded into the chart for the medical practitioner to complete. This is covered in more detail later in this module.

6 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 : Narration 1. Text on slide to be synched with narration of each point as they appear. prescribing, dispensing; and administering of medicines.

7 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 3.1 The medication chart as a prescription The NRMC enables the prescribing and supply of most medicines, and PBS/RPBS claiming where applicable, directly from the NRMC without the need for a separate written prescription. However, certain medicines will still require a traditional prescription in addition to an order on the NRMC. These include: All Authority Required items requiring prior approval (including PBS/RPBS items with increased quantities) All items only available under Section 100 e.g. Highly Specialised Drugs Controlled drugs (‘Schedule 8’ medicines) Some other medicines depending on state and territory law – see the relevant appendix for state and territory details Other prescriptions for Schedule 4 medicines or dose forms of a medicine which are not Australian Register of Therapeutic Goods (ARTG) registered medicines, other than those extemporaneously compounded by a pharmacist on the order of a medical practitioner. Note: Authority Required (STREAMLINED) items are eligible for supply from the NRMC, provided the Streamlined Authority Code is included on the NRMC. A central point for information Relevant pathology (such as INR results and BGL levels), medical practitioner’s instructions and special considerations applying to the administration of medicines to a resident are all included in the NRMC. This results in central point information that is readily accessible at the time of prescribing, supply and administration. Medical practitioner, pharmacy and RACF details are documented clearly on the front page of the NRMC and detailed resident identification, along with their allergies and adverse drug reactions, appears on each page of the NRMC. The intention of the central point information layout is to support informed prescribing, accurate dispensing and administering, and the clinical monitoring of residents. The duration of the NRMC is a maximum of four months, no repeats Different sections for different types of medicines The NRMC has different sections designed for different types of medicines. Nutritional supplements and over-the-counter (non prescription) medicines are also recorded on the NRMC as they are used in most residential aged care facilities and often given to residents during medication rounds. Including this information will assist nurses and carers to know exactly what has been ordered for residents and what they have chosen to take without a prescription or medical order. For example, a resident may choose to take vitamins, or choose to use a particular moisturising cream as part of their day to day healthcare. While resident choice is an important part of residential aged care, it is also important that nursing and care staff, and the medical practitioner, are aware of these choices in case the resident becomes unwell or is prescribed a medicine that may affect other medicines. This information helps the resident’s GP and other medical practitioners or medical specialists to safely prescribe and the resident’s pharmacists to safely dispense their medicines. In addition, weight monitoring for residents under 95 kilograms can be recorded. This is important as a person’s weight will often affect the dose of medicines ordered by the GP. Evidence based The NRMC has been designed and tested using safety and human factors evidence. It is designed to reduce medication errors and to ensure that residents receive their medicines as intended by their medical practitioner. The NRMC is intended to be easy for nursing and care staff to use so that they can be confident when administering medicines that the right resident receives the right medicine, at the right dose, by the right route and at the right time. The layout and specified fields of the NRMC have been derived from research undertaken by the Commission on medication charts in residential aged care. The national Analysis of Residential Aged Care Facilities Medication Charts 2012 and the Analysis of Residential Aged Care Facility Staff and Approved Provider Surveys (2012) are available on the Commission website at Design considerations include pre-population of fields with units to avoid misinterpretation of dose, the use of icons to distinguish between different sections of the NRMC, and the use of colour tints, specific fonts, horizontal and vertical cues and consistent labelling to assist users in accurately completing the required fields. Legibility testing has also been undertaken to ensure that faxed and scanned copies of the NRMC are legible to facilitate use by medical practitioners and pharmacists. Evidence based National standard medication chart for use in Residential Aged Care Facilities (RACFs)

8 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 . Narration Synch x 3 as follows Block 1 text : All prescribers must order medicines for residents in accord with legislative requirements as required by State/Territory Health (Drugs and Poisons) Regulations; Block 2 text : The NRMC is to be completed for all residents and to be available for prescribing, dispensing, administering and reviewing; and Block 3 text All medications should be reviewed regularly to identify potential drug interactions and to discontinue medicines that are no longer required All medications should be reviewed regularly to identify potential drug interactions and to discontinue medicines that are no longer required

9 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 Narration Text on slide to be synched with narration

10 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 Narration Text on slide to be synched with narration of each point as they appear.

11 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

12 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 Narration Narration prior to the first line of text appearing. Essential fields on the NRMC MUST be completed accurately to enable the pharmacists to supply medicines to residents without the need for a traditional prescription. Text block 2: Text on list to be synched with narration of each point as they appear. These essential fields are located within the NRMC and include Resident identification Medical practitioner details Prescription fields for each medicine ordered in the chart

13 Essential fields: Medical practitioner details
Prescriber detail boxes are on the front page of the NRMC. Each prescriber (i.e locum, specialists) MUST complete the necessary information. These fields MUST be completed by a medical practitioner to be a valid prescription for supply. Narration Synched with picture 4 (prescription box) prior to other animations Each medical practitioner is required to document their details clearly on the front of the NRMC. This also includes medical practitioners that may not be the resident usual doctor. For example a locum, an after hours GP or a specialist. It is necessary that the required information is provided and a signature to ensure that the pharmacy has the correct information to identify the prescriber in the dispensing of medicines. This information can be pre printed and applied to the NRMC, however each prescriber MUST sign each NRMC to ensure signatures in the chart are matched with the correct prescriber. To be synched with autoshape 9 and 9 Details must include: name and address of the medical practitioner medical practitioner prescriber number phone number/s including out of hours contact (see diagram below) To be synched with autoshape 1 …. and the medical practitioner signature Each chart MUST be signed by the prescriber.

14 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 Narration Text to be read and synched with pictures in the order they appear

15 Essential fields: Resident details
Record all known drug allergies and reactions in this box These fields MUST be completed for the NRMC to be a valid prescription. Resident details The details of each resident must be clearly seen on each page of the NRMC. Details must include the resident’s full name as it appears on their Medicare card, their preferred name, gender, date of birth, a URN/MRN, a recent photograph that can be accurately used to identify the resident and an Individual Health Identifier (IHI), if the resident has one. This information is often completed on admission by the registered nurse of person responsible for admission. The medical practitioner may also complete this information. E-templates are available to generate stickers for placement onto the chart. These fields MUST be completed for the NRMC to be a valid prescription.The Residential Aged Care Services Identification Number (RAC ID) should be clearly marked on the NRMC as this is the resident’s address (see below). The RAC ID is a number assigned to each facility by the Department of Health and Ageing for identification. Each facility has a unique number. Resident identification Provide all of the requested resident information in this box The preferred name of the resident and their room number is provided on the front cover. Inside the NRMC more detailed resident information is visible from each page of the chart when it is open to ensure accurate identification of the resident. See below. Resident alerts Resident alerts are documented with the resident identification so that these can be seen on each page when prescribing and administering medicines. The alert boxes are in red to signify their importance. There are two resident alerts as discussed below. Allergies and Adverse Drug Reactions Medical practitioners and nursing staff are required to complete the Allergies and Adverse Drug Reactions (ADR) box for all residents and to sign and date their entries (see circled section below). Write the name of the drug/substance, the reactions (i.e. rash, diarrhoea) and their type (i.e. allergy, anaphylaxis), and the date they occurred. If the resident is not aware of any allergies or ADRs, then circle Nil known. Resident with similar name The second alert is to let nurses and care staff know if there is a resident with a similar name living at the RACF .See above. This is important so that the resident receives the medicines prescribed for them and not the medicines prescribed for another resident with a similar name. Provide information in this box if another resident has a similar name Attach recent resident photograph MUST BE COMPLETED

16 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 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 indicate if PBS/RPBS eligible. Narration Text to be read and synched with pictures in the order they appear The medical practitioner should complete the CTG box if their resident is registered for CTG. The medical practitioner MUST sign name and enter the date of prescribing.

17 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 the NRMC (cc GP and care manager); or ✔Copy and fax the NRMC; or ✔Copy and hand deliver the NRMC. Narration Prior to text It is important for the pharmacists to be aware of any changes to the residents medication order so that they can adjust supply accordingly. The timing of changing medicines can have side effects and even do harm to the resident if not completed promptly. Text to be read and synched with pictures in the order they appear After text has been displayed When a resident’s NRMC is faxed, or scanned and ed, or photocopied for delivery to the pharmacy in order to request a medication, the front page of the NRMC, containing the medical practitioner’s details, must always be included. A copy of the NRMC must be sent to the pharmacy by the RACF as a complete unit when first charted, with all pages kept together to avoid confusion.

18 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) Narration Text to be read and synched with text in the order they appear Remember that… When a resident’s NRMC is communicated to the pharmacy, the front page of the NRMC, containing the medical practitioner’s details, must always be included. Note: The pharmacy cannot supply medicine to residents unless they are in possession of the most current copy of page one and the most current copy of the page where the medicine being requested is prescribed.

19 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 Narration Text to be read and synched in the order they appear Sections and pages of the NRMC The NRMC has multiple sections designed to communicate clearly essential medication information and to minimise medication errors. The sequencing of the NRMC sections is as follows: Front page (resident, prescriber and pharmacy 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 Privacy/other information The following section provides snapshots of the different sections of the NRMC. The pages are presented in the way that they are sequenced throughout the NRMC.

20 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 Narration To be synched with the appearance of Picture 2 (front page) Considerations related to the residents physical or cognitive health that may affect the administration of medicines is highlight on the front page as this is the very first item of information that you should read. See circled section below. Things to consider such as the resident ‘needs a teaspoon for pills’, ‘needs an adaptive spoon to hold in their hand’, ‘likes one pill at a time’, ‘has difficulties swallowing’, ‘crush medicines in jam’, or ‘holds pills in mouth’. Text to be read and synched with pictures and text in the order they appear Final narration Note: If more than one NRMC is in use for a resident, then this must be indicated by entering the appropriate chart numbers on the front of the NRMC to reflect the number of NRMCs currently in use e.g. Medication Chart 1 of 2. If additional NRMCs are written, this field must be updated. Information that lets staff know if this resident is on a complex medication regime.

21 Regular medicines Narration
To be synched with the appearance of Picture 2 (medicine page) The prescribed medicines (or regular dose) section is where the medical practitioner orders the medicines that the resident takes on a regular basis, at the same dose, and usually at regular times throughout the day. The NRMC has space for up to 11 regular dose prescribed medicines. The resident may also be taking other medicines classified as short term, PRN (as required), variable dose, insulin or non prescribed medicines. Nurses and care staff need to check the other pages on the chart for these medicines to ensure that none of the resident’s medicines are missed. The prescribed medicines (regular dose) section has two different areas to indicate that the resident has received their prescribed medicines. The blue area is for multi-dose packaged prescribed medicines (regular dose) and the purple section is for single packaged prescribed medicines (regular dose). To be synched with the appearance of autoshape 4 The blue section is for care staff to sign when the resident receives their medicines from a multi-dose packaged system, often referred to as a dose administration aid (DAA). Care staff should initial this section to confirm that the resident has received the packed medicines to be given at that particular time of day (i.e. breakfast, midday or evening). Care staff delivering medications this way do not sign in the purple section, as this is intended for nursing staff who administer individual prescribed medicines (regular dose) from a single packaged system. To be synched with the appearance of autoshape 6 These can be pre-packed containers such as blister packs or sachets or they can be from the original packaging such as bottles or boxes. See below for the correct signing areas.

22 Important abbreviations
Narration To be synched with the appearance of picture 4 Abbreviations are important in the administration and accurate documentation of medicines for residents. When resident does not receive their medication as ordered, the staff MUST place an abbreviation in the space where they would have signed when administering the medicine. This is important as the next person administering the residents medicine needs to understand what the resident has taken. To be synched with the appearance of autoshape 1 Abbreviations are visible from each page in the NRMC underneath the resident ID label. Abbreviations to be used when medicine has not been taken as ordered.

23 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 Narration To be synched with the appearance of picture 2 The ordering and recording of nutritional supplements is vital to maintaining or increasing a residents weight when they are identified as a high risk of weight loss, often indicate by their BMI (Basal Metabolic Indicator) which is calculated using the residents weight and height.  Remaining narration to be text as shown on screen to be synched as they appear 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

24 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 Narration to be text as shown on screen to be synched as they appear 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

25 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 Narration to be text as shown on screen to be synched as they appear

26 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) Narration to be synched with the appearance of Picture 2 (medication page) Insulin is a commonly used drug in elderly populations with serious outcomes for residents if not monitored correctly. It is administered by sub cutaneous injection into the upper skin layers via either a syringe where the insulin is drawn up manually, or via a specially designed insulin ‘pen’ that has a small needle and can be adjusted to administer a preloaded dose. The insulin section of the NRMC includes prescribers instructions, blood glucose levels (BGLs), orders and administration for insulin that are all recorded in one place so that staff are not having to refer to different places for the prescribed dose, the BGL when administering the insulin. It is important to note the range of BGL and contact prescriber as indicated in the order if the figure is above or below the specified range. The insulin section has enough space allocated for those residents who require 3 BGL readings per day and/or 3 doses of insulin per day. Remaining narration to be text as shown on screen to be synched as they appear 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 26

27 The NRMC : Insulin prescribing and administration
Narration to be text as shown on screen to be synched as they appear

28 The NRMC: Variable dose medicine (not insulin)
Narration to be synched with the appearance of Picture 2 (medication page) The variable dose section is designed to prescribe, administer and monitor the therapeutic levels of the medicine on resident’s health. Frequent pathology is often required for this group of drugs and the dose may vary dependent on the levels indicated by pathology. This is why this group of drugs is referred to as ‘variable dose’. Although Insulin is also a variable dose drug, the NRMC has specific pages dedicated to its use. It is important to note the range of pathology and contact prescriber as indicated in the order if the figure is above or below the specified range. Remaining narration to be text as shown on screen to be synched as they appear

29 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 Narration to be synched with the appearance of Picture 2 (medication page) Often residents require some form of medicine in between their regular prescribed doses. These are referred to as PRN (as required medicines). These can be important in keeping a resident well and assist the prescriber to monitor the therapeutic levels required without increasing a dose and/or adding another medicine. It is therefore important to refer to the regular medicine section to see if the PRN medicine is ordered as a ‘breakthrough’ or ‘rescue dose’ to ensure that the time between regular doses and PRN doses are correct with the prescriber’s orders. You also need to check the maximum dose as per the PRN order and to ensure the your reason for giving the resident a PRN medicine and the prescriber’s indication for when to administer the dose are correct. For example, the PRN dose may be prescribed for back pain or increased agitation or for pain. The effectiveness of the PRN medicine is also important in understanding whether the desired effect has been achieved in order for the prescriber to either adjust the PRN dose/type of drug or cease it. For example, has the pain lessened? or has the agitation lessened? Remaining narration to be text as shown on screen to be synched as they appear 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?)

30 The NRMC: Short term medicine
Write the current the day before signing Date where medicine is to commence Circle the month Medicine order Write your initials in here once medicine is given Narration to be synched with the appearance of Picture 2 (medication page) Residents often need short term medicine in addition to their regular prescribed medicines. This may be because of a change in their health, such an infection, that requires a short term treatment. It is important to note that when the medicine is complete, the prescriber may want to repeat pathology tests (ie: blood test or a urinalysis) to be confident that the treatment has worked and that the resident does not require any further short term medicine. You may need to check the resident’s notes to ensure that the prescribers instructions are carried out in relation further pathology tests so the resident remains well. Remaining narration to be text as shown on screen to be synched as they appear 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)

31 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 time and date doses given in this column. in this box. 24 hour time (ie:1800 = 6pm) and date format as day/month/year _ /_ /_ - Write the prescriber’s reason for the order and any additional instructions (e.g. take with food) Print legibly the name of the medicine Print legibly the prescriber’s name Record the first signature in this box Narration to be synched with the appearance of Picture 2 (medication page) Phone orders a occur in residential aged care for various reasons, but mostly because the resident doctor is unable to visit the resident and the nursing staff are concerned that a medicine needs to be ordered as a priority due to the resident’s condition. Important elements need to be taken into consideration when taking a phone order for medicine and you will need to check with your homes policy and procedures. Phone orders must include the following: Resident name; Date phone order prescribed; Route, time and frequency ordered; Reason for adminstration, Name of prescriber; Signature of 2 staff to confirm order given via phone; Route, time and frequency medicine administered; and Initials of person administering medicine. See below where this is to be recorded on the NRMC Remaining narration to be text as shown on screen to be synched as they appear !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 second signature in this box

32 Summary: Key Messages Narration to be synched with the appearance of Picture 7 (diagram) All in all medication management and the safe use of medication charts relies on communication between all those concerned. The residents doctor, for example, has a responsibility to ensure that they prescribe and monitor the effect of appropriate medicines for their residents. The pharmacists needs clear instruction as to which medicines to supply and when this is required. Staff at the RACF are important in communicating any changes in resident condition to the doctor, changes that doctors make to medicines to the pharmacist and are often the linch pin in effective and safe medication practices. In all of this however, the resident and/or their representative is integral to positive outcomes for medications that are being consumed. Slide 32 of 27

33 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 or Contact the NRMC team at (02) Narration Text on slide to be synched with narration of each point as they appear. And continue narration with… The next section is a quick quiz for you to do. Slide 33 of 27

34 NRMC Quiz Narration Welcome to the NRMC quiz. You must score at least 80% to pass this quiz. Each question can be attempted at least 3 times and if you are having difficulty you will be directed back to some revision slides to support your learning. Good luck!

35 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

36 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

37 Quiz : Characteristics of the NRMC cont
{USE SHORT ANSWER ELEMENT HERE} List 5 different sections of the NRMC below 1. _______________________________________________________________ 2. _______________________________________________________________ 3. _______________________________________________________________ 4. _______________________________________________________________ 5. _______________________________________________________________

38 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

39 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? ___________________________________________________________

40 Quiz: Medicine administration on the NRMC
What are the 6 rights of medication administration on the NRMC? _____________________________________

41 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? 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

42 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? You phone the pharmacy Someone else phones the pharmacy 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

43 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.


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