Requirements for residential aged care facilities under the NSW Poisons and Therapeutic Goods legislation | Prescribing and dispensing on a residential medication chart prescription | Stocking medications for emergency use
Requirements for residential aged care facilities under the NSW Poisons and Therapeutic Goods legislation
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.
Up to 30 June 2014 residential aged care facilities that included at least one high level of residential care allocated place under the Aged Care Act 1997 required compliance with the NSW Poisons and Therapeutic Goods Regulation 2008 as a ‘hospital’.
Pending amendments to the NSW Poisons and Therapeutic Goods Regulation 2008 to reflect the changes to the Aged Care Act 1997, residential aged care facilities that included one or more high level of residential care allocated places under the Aged Care Act 1997 on 30 June 2014 should continue to procure, store, record and administer all medications in accordance with the Poisons and Therapeutic Goods Regulation 2008 requirements for a ‘hospital’.
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.
For further information, contact the Duty Pharmaceutical Officer at Pharmaceutical Services Unit on (02) 9391 9944.
Prescribing and dispensing on a residential medication chart prescription
An authorised practitioner may issue a prescription on a compliant residential medication chart (RMC) under the Poisons and Therapeutic Goods Regulation 2008.
The residential medication chart prescription must be in a form:
- approved under regulation 41(5) of the National Health (Pharmaceutical Benefits) Regulations 2017 of the Commonwealth, or
- that complies with the requirements of regulation 41(5) of the National Health (Pharmaceutical Benefits) Regulations 2017 of the Commonwealth and that is, in all material respects, equivalent to a form approved under that regulation.
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):
- Schedule 8 medications
- anabolic-androgenic steroids
- amylobarbitone or pentobarbitone injections
- clomiphene, cyclofenil, dinoprost, dinoprostone, acitretin, etretinate, or isotretinoin.
To be valid for dispensing by a pharmacist the medication chart prescription must include the following details:
- the name and address of the patient
- the name and form (if not readily apparent) of the substance to be supplied
- the strength (if not readily apparent) of the substance to be supplied
- the route of administration (if not readily apparent) of the substance to be supplied
- adequate directions for use
- the frequency or times at which the substance is to be administered or used
- the name and designation of the person by whom it is issued
- the name, address and telephone number of the relevant residential care facility
- the period during which the substance is to be used or administered (being a period that ends on a date that is no more than 4 months from the date of first use of the relevant chart for the resident)
- the date on which it is issued.
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:
- handwritten by the authorised practitioner, or
- generated by an appropriate software system then printed on the prescription.
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.
Recording, Endorsement, Cancellation and Retention of Residential Medication Chart Prescriptions
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 date on which the medication is dispensed
- The pharmacy’s unique prescription reference number pertaining to the dispensing of the medication on that date
- The name and address of the pharmacy
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 NSW Ministry of Health by telephone on (02) 9391 9944 or email firstname.lastname@example.org.
Stocking medications for emergency use
Can a residential care facility obtain and hold stocks of medications that we may need to use in an emergency (that is, not dispensed for the individual patient)?
Yes. The NSW Poisons and Therapeutic Goods Regulation 2008 provides for the Director of Nursing at a nursing home, that is, a residential care facility with high level of residential care allocated places under the Aged Care Act 1997, to hold certain stock medications for use either for emergency treatment or when the community pharmacy which provides medication dispensed for residents of the residential care facility is closed. The medications are:
- adrenaline injection
- atropine sulfate injection
- diazepam injection
- frusemide injection
- metoclopramide injection
- morphine sulfate ampoules (up to 5 ampoules of 10mg/1ml, 15mg/1ml or 30mg/1ml ampoules)
- oral antibiotics (all forms)
- pethidine hydrochloride ampoules (up to 5 ampoules of 50mg/1ml or 100mg/2ml ampoules)
- prochlorperazine injection
The medications are to be obtained from a community pharmacist on a signed and dated written order from the Director of Nursing (defined as the registered nurse appointed as the person responsible for the overall care of the residents of the residential care facility).
The cost of the medications is to be borne by the facility.
The medications may only be administered on the authority of a medical practitioner, nurse practitioner or dentist, either in writing or by telephone, email or facsimile to a registered nurse at the residential care facility.
Where more than a few doses of the medication are prescribed, supply of the medication should be obtained as soon as possible from a community pharmacist on prescription as a dispensed supply.
Protocols approved by the facility’s Medication Advisory Committee should determine which of the above medications are needed for either emergency treatment or outside the opening hours of the community pharmacy which provides medication dispensed for residents of the residential care facility, as well as the information provided to staff on the handling, administration and recording of the medications.
Morphine and pethidine ampoules must be stored in the residential care facility’s Schedule 8 drug storage unit, and the transactions (procurement and administration) recorded in a drug register.
Approval of the NSW Ministry of Health is required to stock medications other than those listed above. An application from the Director of Nursing detailing the additional medications requested and the reason for the request should be made to the Chief Pharmacist, Pharmaceutical Services Unit, NSW Ministry of Health, Locked Mail Bag 961, North Sydney NSW 2059.
Full details of these provisions can be found in the NSW Health Information Bulletin IB2003/10.