FAQs1. What is the National Residential Medication Chart (NRMC)?
2. Why have these changes been made?
3. How was the chart developed?
4. What is the enabling legislation for the NRMC?
5. Who can use the NRMC?
6. When can I use the NRMC?
7. Can I use a compliant equivalent chart instead of the NRMC published by the Commission?
8. How can I find out if a commercial aged care residential medication chart is compliant?
9. Is it mandatory to use the NRMC in residential aged care facilities?
10. Tell me more about the trial of the NRMC
11. What are the benefits for residents?
12. What are the benefits for healthcare providers?
13. What are some other key features?
14. What is changing for prescribers?
15. What is changing for pharmacists?
16. Can prescribers still prescribe brand-specific medicines?
17. What PBS medicines can be prescribed on the National Residential Medication Chart?
18. Are there any changes to the PBS / RPBS eligibility?
19. Where do I obtain more information about the NRMC?
1. What is the National Residential Medication Chart (NRMC)?The NRMC is a medication chart developed for use in residential aged care facilities. It enables the prescribing, dispensing and claiming of eligible Pharmaceutical Benefits Scheme (PBS) medicines and Repatriation Pharmaceutical Benefits Scheme (RPBS) medicines directly from a resident’s medication chart without the need for a separate prescription form. As a single source of medication information, the NRMC will improve safety for residents, and decrease the administrative burden for prescribers, aged care staff and pharmacists.
2. Why have these changes been made?The aim of the NRMC is to reduce unnecessary paperwork for prescribers, pharmacists and nursing staff; freeing up more time for health practitioners to spend on resident care.
It also aims to improve resident safety by reducing the risk of dispensing errors associated with transcribing medicine orders from a medication chart.
The NRMC promotes a Quality Use of Medicines (QUM) approach to medicines use. Further information about QUM is available under Australia’s National Medicines Policy (NMP). The NRMC also reflects the NMP’s guiding principles for medication management in residential aged care facilities.
3. How was the chart developed?The Australian Commission on Safety and Quality in Health Care (the Commission) developed the NRMC and managed the trial of the chart in a number of residential aged cared facilities. The NRMC development and subsequent trial was undertaken in consultation with a wide range of stakeholders including prescribers, pharmacists, aged care facility staff and residents, software vendors, and state and territory governments.
4. What is the enabling legislation for the NRMC?Commonwealth and complementary state legislation supports the use of the NRMC, and legislatively compliant commercial versions, nationally.
Supply and claiming of PBS items is subject to Commonwealth legislation. Amendments have been made to the National Health (Pharmaceutical Benefits) Regulations 1960 and National Health (Claims and under co-payment data) Rules 2012 to allow the supply of PBS and RPBS medicines directly from a medication chart in residential aged care facilities.
5. Who can use the NRMC?The NRMC has been designed and tested for use in residential aged care facilities only. Experience from testing the NRMC showed that those facilities that made the shift from multiple charts to the NRMC incurred a significant change management process to fully realise the benefits of the NRMC. These included:
- Securing commitment from residents’ general practitioners regarding new medication ordering systems;
- Liaising with the facility’s supplying pharmacy about new systems to order, reconcile and manage medicine usage within the facility; and
- Working with the aged care facility’s care group or peak body for support during the change process.
6. When can I use the NRMC?The NRMC is now available for use in residential aged care facilities across Australia. A copy of the chart and printing specifications is available on the Commission’s website.
7. Can I use a compliant equivalent chart instead of the NRMC published by the Commission?“Compliant charts” in this context are those that comply with the Commonwealth National Health (Residential Medication Chart) Determination 2012, as amended, and relevant state legislation. For residential aged care service operators who wish to take advantage of the NRMC, but would prefer to use a commercial version of the chart, it is important to ensure that the commercial version is compliant with both state and Commonwealth legislation. Use of a non-compliant chart may prevent pharmacists being able to make PBS/RPBS claims for medicines supplied directly from the chart.
8. How can I find out if a commercial aged care residential medication chart is compliant?That is a matter for you to determine. Providers of commercial charts should be able to provide you with a surety that legal advice has been obtained and that their offering is compliant.
9. Is it mandatory to use the NRMC in residential aged care facilities?While there are benefits in using the NRMC, its use is not compulsory. 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 and the RPBS, requires the operators of aged care facilities to use the NRMC in delivering their services.
10. Tell me more about the trial of the NRMCThe Commission conducted a trial of the NRMC in 2013-2014 in over 20 residential aged care facilities. The trial of the NRMC demonstrated numerous benefits:
- Holistic and resident focused – the NRMC booklet format contains all relevant medication information in one place;
- Quality Use of Medicines – there were considerable improvements in safety and quality, including a reduction in the number of medications prescribed (from 13.8 per resident down to 5.7 per resident over the trial period);
- Reduced incidents – the use of the trial NRMC reduced staff medication administration errors and resulted in fewer errors in packaging of dose administration aids for residents’ medicines (from 9.2 errors per 1000 prescriptions down to 3.5 errors for 1000 prescriptions);
- Standard fields for all staff, prescribers and pharmacies – the NRMC layout provides a consistent approach to medicine prescribing, administration and supply across a variety of settings through standard and intuitive design;
- Compliance – using the NRMC can help residential aged care services meet medication management standards as part of aged care accreditation processes; and
- Cost effectiveness – use of the NRMC reduces duplication and costs associated with purchasing and administering multiple forms.
11. What are the benefits for residents?
- More time for health practitioners to spend on a patient’s clinical care
- Improved medication safety
- Improved quality use of medicines leading to improved healthcare outcomes
- Improved, more efficient and convenient prescribing and dispensing services
12. What are the benefits for healthcare providers?The NRMC aims to reduce the administrative burden for healthcare providers by:
- Improving the timely supply and claiming of PBS/RPBS medicines
- Minimising PBS/RPBS duplication of documentation for prescribing, dispensing and claiming for PBS/RPBS medicines
- Allowing healthcare professionals more time to spend on patient care
- Supporting electronic medication management and clinical decision support tools
13. What are some other key features?
A central point for informationA key feature of the NRMC is that both the PBS/RPBS prescription and the record of medicine administration are documented on the NRMC. The resident’s details, including their photograph and known adverse drug reactions, are visible on 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 patient and their medication orders.
Relevant pathology (such as results to support Warfarin dosing), PBS/RPBS prescriber instructions, and special considerations applying to the administration of medicines to a patient are all included on the NRMC. The layout supports informed prescribing, accurate medicines dispensing and administration, and improved clinical monitoring of residents.
Duration/length of the NRMC and supply of medicinesThe NRMC ‘charting cycle’ is a maximum of four months. An approved pharmacist is required to meet the healthcare practitioner’s order until the stop date or chart expiry date, whichever is earlier. If the medicines are not re charted prior to the chart expiry date, all PBS / RPBS medicine orders on the NRMC cease to be valid for supply and claiming 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 PBS / RPBS medicine order, the healthcare practitioner must specify a period of time that a medicine is to be administered and supplied. This removes the requirement for PBS / RPBS repeat authorisation forms.
14. What is changing for prescribers?All PBS/RPBS prescribers can use the NRMC for their patients in the residential aged care facility setting.
There are no changes as to who can prescribe PBS/RPBS medicines. PBS/RPBS prescribers retain the option to use PBS/RPBS stationery forms.
PBS/RPBS prescribers are required to comply with Commonwealth, state and territory law, enforced, for the use of the NRMC.
Medical practitioners are not required to write a separate PBS/RPBS prescription for PBS/RPBS claiming purposes. However, under the current arrangements, a separate PBS/RPBS prescription must be written by other approved prescribers, such as aged care nurse practitioners and dentists, for PBS/RPBS claiming purposes.
15. What is changing for pharmacists?Pharmacists are able to dispense and claim (using PBS Online) eligible PBS/RPBS medicines directly from a patient’s medication chart where these are prescribed by a medical practitioner without the need for separate (additional) PBS stationery forms. For prescriptions written on the NRMC by other approved prescribers, such as aged care nurse practitioners and dentists, a separate PBS/RPBS prescription will be required for PBS/RPBS claiming purposes.
16. Can prescribers still prescribe brand-specific medicines?Yes. Prescribers can prescribe brand-specific medicines when prescribing on the NRMC.
17. What PBS medicines can be prescribed on the National Residential Medication Chart?The NRMC will enable the prescribing and supply of most medicines, and the 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 to be written in addition to an order on the NRMC. These medicines include:
- All PBS Authority Required items needing 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.
- Life Saving Drugs (LSD Program)
- Aids and Appliances (Stoma, Appliance Scheme and Paraquad)
18. Are there any changes to the PBS / RPBS eligibility?No. Patients continue to pay the PBS/RPBS patient co-payment contribution. Where a patient pays a PBS/RPBS patient co payment for their PBS/RPBS medicines, the PBS/RPBS co-payment amount continues to contribute to the patient’s PBS/RPBS Safety Net Record.
19. Where do I obtain more information about the NRMC?Further information and guidance material for the NRMC can be obtained from the Commission’s website or by contacting the Department of Health.
If you have a question about:
- introducing the NRMC in your residential aged care facility, please liaise with your group’s clinical governance team, and/or aged care peak bodies;
- the role of the NRMC in meeting accreditation standards, please contact the Australian Aged Care Quality Agency on 1800 288 025;
- updating your pharmacy software to be able to dispense and claim PBS and RPBS medicines from the NRMC, please contact your pharmacy dispensing software vendor;
- putting in PBS/PRBS claims after supplying medicines from the NRMC, please first read the NRMC FAQs (this document) and, if necessary, call the PBS Information Line 132 290; and/or
- how to prescribe medicines using the NRMC, please read the Prescribers’ Guide to the NRMC.