Residential care facilities (RCF) are defined under the NSW Poisons and Therapeutic Goods Regulation 2008 (NSW Regulation), as places at which a person is provided with residential care, within the meaning of the Aged Care Act 2024.
RCFs approved to provide high level care before 30 June 2014 are classified as 'nursing homes'. Under the NSW Regulation, these nursing homes meet the definition of a 'hospital' and therefore must comply with hospital medication handling requirements.
There are two categories of medicines managed in RCFs:
Once a medicine has been prescribed, dispensed and labelled for an individual, it is no longer regulated under the NSW Regulation. This means resident medicines are not regulated under the NSW Regulation.
RCF urgent use medicines are regulated under the NSW Regulation, and their storage, supply, administration, destruction and record-keeping must comply with the relevant legislative requirements.
All medicines in an RCF should be managed in a way that supports medication safety, the quality use of medicines and continuity of care, consistent with the Australian Government Department of Health – Guiding Principles for Medication Management in the Community, the Guiding principles for medication management in residential aged care facilities and the Aged Care Quality Standards.
A residential care facility (RCF) should appoint a medicines governance group (also referred to as a Medicines Advisory Committee), as recommended in the Guiding principles for medication management in residential aged care facilities.
The medicines governance group is a multidisciplinary committee that provides expert advice and overarching governance of medication management in a RCF. Further information is available under Guiding Principle 3: Clinical governance of medication management.
The medicines governance group is responsible for approving and overseeing the governance of medicines held at the RCF, including:
Residents may obtain medicines that have been prescribed, dispensed on prescription and labelled for them by a pharmacist in a pharmacy. These medicines may be supplied in their original packaging or in a dose administration aid (DAA). These medicines belong to the resident.
Resident medicines must only be used by the resident for whom they were supplied and not shared or given to other residents. The RCF acts as the resident’s agent in managing these medicines.
The RCF medicines governance group must ensure policies are in place that outline requirements for the safe and secure storage and disposal of a resident’s medicines and prevent risk of loss and misuse.
There are no storage requirements in the NSW Regulation for resident medicines prescribed, dispensed and labelled for an individual resident, including those packed in a DAA. This means that resident medicines do not need to be stored in a safe or recorded in a drug register, even if they are S4D or S8 medicines. However, resident medicines should be stored securely in line with the RCF's medicines management policies and procedures, with appropriate safeguards in place to prevent unauthorised access, loss, theft or diversion. RCFs may choose to store S4Ds and S8s in a safe and record them in a drug register under their own local policy.
Storage arrangements should support medication safety, the quality use of medicines and continuity of care, consistent with the Australian Government Department of Health Guiding Principles for Medication Management in the Community, the Guiding principles for medication management in residential aged care facilities and the Aged Care Quality Standards.
There are no administration requirements in the NSW Regulation for resident medicines prescribed, dispensed and labelled for an individual resident. This means that resident medicines may be administered by any agent or carer. However, RCFs must ensure they have policies, procedures and guidelines in place that are endorsed by the RCF's medicines governance group, to guide the safe and effective self-administration of resident medicines, or administration by appropriately qualified and authorised persons.
These policies, procedures and guidelines should support medication safety, the quality use of medicines and continuity of care, consistent with the Australian Government Department of Health Guiding Principles for Medication Management in the Community, the Guiding principles for medication management in residential aged care facilities and the Aged Care Quality Standards.
There are no destruction requirements in the NSW Regulation for resident medicines prescribed, dispensed and labelled for an individual resident. RCFs must ensure there are policies, procedures and guidelines in place, endorsed by the medicines governance group, on the appropriate disposal of resident medicines. This may include partnering with pharmacies to develop procedures on medicine destruction and record keeping.
Under the NSW Regulation, a RCF may hold certain stock medicines for urgent use (RCF urgent use medicines). These medicines are held by the RCF for urgent use circumstances where the resident’s authorised practitioner seeks to initiate treatment ahead of issuing a prescription for dispensing at the pharmacy, or where the pharmacy is closed or unable to dispense the medicine on prescription. RCF urgent use medicines are the RCF’s stock medicines and not labelled for any resident. They must be stored securely, accessed only by registered nurses and administered under the direction of an authorised practitioner.
Only Schedule 4 (S4) and Schedule 8 (S8) listed in the NSW Health approved urgent use medicines list (see list below) may be held as urgent use medicines. If the RCF would like to hold other S4 or S8 medicines as urgent use medicines, the Director of Nursing or Care Manager must obtain medicines governance group approval and apply to the NSW Health Chief Pharmacist for approval via email at MOH-PharmaceuticalServices@health.nsw.gov.au.
RCF urgent use medicines must be:
Facilities must have arrangements for after-hours supply where required.
RCFs may hold the following urgent use medicines:
RCFs may hold Schedule 2 (S2) and Schedule 3 (S3) medicines for administration as nurse-initiated medicines in accordance with protocols approved by the medicines governance group.
Approved nurse-initiated medicines include:
Approved lists and protocols must be endorsed by the medicines governance group.
Protocols must include indications for use, form, dose, route, frequency, precautions, drug interactions and procedures for medication incidents and adverse reactions.
Protocols must be reviewed every 12 months.
RCFs may hold oseltamivir in accordance with the Authority for oseltamivir.
Key requirements include that oseltamivir:
All RCF urgent use medicines and nurse-initiated medicines that have been obtained from a retail pharmacy must be stored in accordance with the NSW Regulation.
RCFs must ensure that:
Schedule 2, 3 and 4 medicines kept as stock or urgent use medicines must be stored in a room or enclosure to which the public does not have access, such as a locked:
Note: Refrigerators used to store medicines do not need to be locked if they are located out of public access.
RCFs that are not considered a hospital within the meaning of the Regulation may store S4D medicines as for Schedule 2, 3 and 4 medicines and in accordance with the RCF's medicines management policies and procedures.
RCFs that are considered a hospital within the meaning of the Regulation must store RCF urgent use S4D medicines:
S4D medicines are not required to be recorded in a ward drug register unless the facility chooses to do so.
Any loss must be notified to Pharmaceutical Services.
For refrigerated S8 medicines, see Storage of S8 medicines requiring refrigeration.
RCF urgent use S8 medicines must be stored separately from all other medicines in a dedicated locked cupboard or safe (preferably a metal safe) that is securely fixed to the premises and kept locked when not in immediate use. The lock must be a five-lever key lock or provide equivalent security.
For RCFs that are considered a hospital* within the meaning of the Regulation, S4D medicines may be stored with S8 medicines.
The cupboard or safe must not store other items, including keys, cash or documents.
Medicine storage areas must remain locked when not in immediate use.
Keys must be kept:
Keys for S8 and S4D safes or cupboards must:
Any loss of S4D or S8 RCF urgent use medicine must be notified to Pharmaceutical Services.
The Director of Nursing, or if there is no Director of Nursing, a manager nominated by the approved provider, must ensure that:
For the format of drug registers and requirements for entries, see Drug registers.
All RCF urgent use S8 medicine receipt, administration and destruction must be recorded, witnessed and countersigned by another staff member in a compliant drug register.
Each ward of an RCF may have its own drug register. Any transfer of S8 RCF urgent use medicines between wards must be recorded in both drug registers.
Any loss must be notified to Pharmaceutical Services. This includes the loss or destruction of the drug register.
RCF urgent use medicines may only be accessed and administered by:
Additional requirements apply to S8 medicines as outlined below.
Once a resident’s own dispensed medicine is dispensed and received, urgent use stock must be withdrawn from use and returned to storage.
RCF urgent use S8 medicines may only be administered by a registered nurse or a prescriber.
Each time an S8 medicine is administered to a resident, a witness must be present. The witness must be:
The witness must be present for the entire process, including:
The national residential medication chart, when it complies with the requirements of section 41(5) of the National Health (Pharmaceutical Benefits) Regulations 2017 (Cth), is a valid prescription for prescribing, dispensing, and claiming PBS payments. This medication chart may be in a paper or electronic format.
Telephone orders are permitted in emergencies. The prescriber may provide the order by telephone to a nurse at the RCF and repeat the order to a second person. The prescriber must document the order on the resident’s medication chart as soon as practicable.
Authorised practitioners such as medical practitioners and nurse practitioners may use the paper NRMC as a prescription provided it includes:
Any dose that could be considered dangerous or unusual must be clearly identified by underlining the dose and initialling the prescription in the margin.
Additional requirements apply when the following medicines are ordered on an RMC:
These medicines must also be prescribed on:
For computer‑generated (hand‑signed) prescriptions, the prescriber must include in their own handwriting:
For Schedule 8 medicines, the prescriber must also include in their own handwriting:
Pharmacists may dispense medicines from a paper NRMC as this has been permitted under an exemption to the form of prescription requirements in the NSW Regulation.
A duplicate copy of the NRMC may be used to dispense unscheduled, Schedule 2, Schedule 3 and most Schedule 4 medicines.
Pharmacies must ensure the retained duplicate copy is current and accurately reflects medicines supplied.
The pharmacy’s dispensing system must record the resident’s current medicine orders, including alignment with any dose administration aid systems.
For each supply, the pharmacist must record on the duplicate NRMC:
When a medicine is supplied for the final time, the medicine order must be marked ‘CANCELLED’.
The duplicate copy must be retained at the pharmacy for 2 years from the date of last supply.
Prescribers may now use an electronic National Residential Medication Chart (eNRMC) instead of a paper RCF medication chart, as permitted in the National Health (Transitional Electronic National Residential Medication Chart) Special Arrangement 2025.
In NSW, an exemption under the Poisons and Therapeutic Goods Act 1966 has been issued to support the use of eNRMCs under this arrangement.
Approved eNRMC systems, as listed in the Electronic National Residential Medication Charts (eNRMC) – Conformance status tracker, can be used for:
This applies during the transition period, which ends on 31 March 2027.
After this date, only eNRMC systems that fully meet all technical and legislative requirements will be permitted for prescribing and dispensing.
More information and resources are available on Electronic National Residential Medication Chart (eNRMC) collection.
Where possible, medicines should be administered before residents leave the facility and after they return.
If a dose is required during an outing, resident medicines must be supplied in the original, fully labelled pack dispensed by a pharmacist.
Medicines must not be repacked into unlabelled containers.
Medicines no longer in use for the resident for whom they were dispensed must not be kept for administration to another resident. These should be sent back to the pharmacy for disposal in the Return of Unwanted Medicines (RUM) bin.
Arrangements should be made with the supplying pharmacist for the return of general prescription and non-prescription medicines.
Destruction of RCF urgent use S4D medicines should be destroyed in a similar manner to that for S8 medicines.
Destruction of unwanted or unusable RCF urgent use S8 medicines must be made on the premises of the RCF under the supervision of the retail pharmacist that supplies RCF urgent use medicines. For more information, see Destruction of S8 medicines.