The Commonwealth Government Living Longer Living Better (LLLB) reform to the residential aged care sector included removal of the distinction between ‘high level of residential care’ and ‘low level of residential care’ which came into effect under the Aged Care Act 1997 from 1 July 2014.
Pending review of the NSW Poisons and Therapeutic Goods Regulation 2008 (the Regulation) RCFs that included one or more high level of residential care allocated places approved under the Aged Care Act 1997 on 30 June 2014 should continue to procure, store, record and administer medications that have been prescribed and dispensed for residents in accordance with the requirements for a ‘nursing home’ as a ‘hospital’ under the Regulation.
These requirements under the Regulation are described in the guidance to ‘nursing homes’ in Information Bulletin 2003/10 Guide to the Handling of Medication in Nursing Homes in NSW.
However, from 7 December 2018 all NSW RCFs approved under the Aged Care Act 1997 may hold a range of urgent use medications.
From 19 July 2019 the following Schedule 4 and Schedule 8 medications may be stocked at a RCF for urgent treatment when the retail pharmacy which provides residents’ dispensed medicines is closed.
Protocols approved by the RCFs Medication Advisory Committee should determine which of the available medications are needed for urgent treatment, and provide information to registered nurses on the handling, administration and recording of the medications.
The urgent use medications must be obtained from a retail pharmacist on a signed and dated written order from the Director of Nursing or Care Manager at a RCF where there is no Director of Nursing.
The medications must be obtained from the retail pharmacist in the manufacturer’s original pack and administered to the resident directly from that pack. Morphine ampoules must be stored in the RCF’s Schedule 8 drug storage unit, and the transactions (procurement and administration) recorded in a drug register.
A written procedure for general stock control is required to ensure that stock rotation and expiry date checking of the medications occurs.
The medications may only be administered:
On receipt of the resident’s dispensed medication, the urgent use medication stock must be withdrawn from use and placed back in storage.
For approval to stock Schedule 4 medications other than those listed above, an application from the Director of Nursing or Care Manager (as applicable) can be made to the Chief Pharmacist at email MOH-PharmaceuticalServices@health.nsw.gov.au
A responsible person at a residential care facility may obtain the Schedule 4 drugs molnupiravir, nirmatrelvir plus ritonavir, and oseltamivir and supply them to a nurse at that facility for administration to a resident of the RCF on the order of a medical practitioner or nurse practitioner, in accordance with the attached Licence and Authority for molnupiravir, nirmatrelvir plus ritonavir and Authority for oseltamivir. Licence and Authority for COVID-19 antivirals and Authority for Oseltamivir .
The medical practitioner or nurse practitioner must order the medication for administration, either:
In an emergency the medical practitioner or nurse practitioner may provide the order by telephone to a nurse at the RCF and repeat the order to a second person. The medical practitioner or nurse practitioner must confirm the telephone order in the RCF eNRMC or paper based medication chart, including for ongoing administration.
The nurse must record each administration in the RCF eNRMC or the paper based medication chart.
RCFs must have arrangements in place to receive medications delivered out of business hours. The medications must be kept out of public access pending storage by the Director of Nursing or Care Manager (as applies at the RCF).
RCFs may also hold stock of a range of Schedule 2 and 3 medications for administration as nurse-initiated medications.
Any Schedule 2 medication and the following Schedule 3 urgent use medications may be held in stock:
The list of Schedule 2 and 3 medications for use at the RCF must be approved by the RCF’s Medication Advisory Committee. Written protocols for the use of each medication must provide sufficient detail for the RCF staff member to make informed decisions prior to administration and be reviewed every twelve months.
Protocols should include:
The medications must be obtained from a retail pharmacist on a signed and dated written order from the Director of Nursing or Care Manager at a RCF where there no Director of Nursing.
The medications must be obtained from the retail pharmacist in the manufacturer’s original pack and administered to the resident directly from that pack.
A written procedure for general stock control is required to ensure that stock rotation and expiry date checking of the medications occurs
An authorised practitioner (medical practitioner, nurse practitioner) may issue a prescription on a compliant residential medication chart (RMC) under an exemption to the Poisons and Therapeutic Goods Regulation 2008.
The residential medication chart prescription must be in a form:
The Australian Commission on Safety and Quality in Health Care has published guidance on use of residential medication chart prescriptions.
The prescription must relate to a patient receiving treatment in, or at, a residential care service at which the patient is receiving residential care under the Aged Care Act 1997. Compliant residential medication chart prescriptions permit both the prescribing and dispensing of Pharmaceutical Benefits Scheme (PBS) medications and non-PBS medications, with some exceptions.
A duplicate copy of a compliant residential medication chart prescription may be used by pharmacists to dispense unscheduled, Schedule 2, Schedule 3 and most Schedule 4 medications. However, the following medications ordered on a residential medication must also be prescribed on a traditional hand-written or computer generated prescription (see Criteria for Issuing Non-handwritten (Computer-Generated) Prescriptions):
To be valid for dispensing by a pharmacist the medication chart prescription must include the following details:
An authorised practitioner must complete the details above at 9. and 10. in handwriting then sign the prescription.
The details above at 1. to 8. may be:
The authorised practitioner who issues the prescription must confirm any dose that could be regarded as being dangerous or unusual by underlining the part of the prescription that specifies the intended dose and by initialing the prescription in the margin.
Pharmacists must use a procedure which ensures the retained duplicate copy of a residential medication chart prescription is contemporary and accurately reflect medications dispensed to patients.
The pharmacy’s primary dispensing software must record the current medication order for each patient. Care should be taken to ensure that the current medication order is also recorded in any secondary software program used to label medication packed in a dose administration aid.
The dispensing pharmacist must endorse the medication orders on the duplicate copy of the residential medication chart prescription with the:
The dispensing pharmacist must endorse each medication order on the duplicate copy of a compliant RMC with the word ‘CANCELLED’ on the last occasion that medication is dispensed.
The duplicate copy of each residential medication chart prescription must be retained at the dispensing pharmacy for a period of two years from the date the most recent medication was dispensed.
For further information on the use of residential medication chart prescriptions contact the Duty Pharmaceutical Officer at the Pharmaceutical Regulatory Unit by telephone on (02) 9391 9944 or email MOH-PharmaceuticalServices@health.nsw.gov.au
