RACFs prescribing changes ‘an important step forward’

Morgan Liotta

29/07/2022 2:51:51 PM

Adoption of electronic medication charts in residential aged care facilities could be ‘a game changer’ for GPs who provide aged care.

GP with aged care patient
The use of electronic medication charts in aged care facilities can help to simplify prescribing processes and reduce medicine-related harm.

In the Royal Commission into Aged Care Quality and Safety’s final report, recommendation 68 calls for ‘universal adoption by the aged care sector of digital technology and My Health Record’.
In response, the Department of Health and Aged Care engaged the Australian Commission on Safety and Quality in Health Care to develop online resources to support the rollout of electronic National Residential Medication Chart (eNRMC) services.
From July, all residential aged care services (RACFs) now have the option to adopt transitional eNRMC products to better support medication management.
Under a Transitional Arrangement, prescribers in RACFs can use transitional eNRMC products for PBS medication chart prescribing, dispensing and administration, eliminating the need for paper medication charts or prescriptions.
In addition to RACFs, eNRMC products can be used by providers of residential aged care in the National Aboriginal and Torres Strait Islander Flexible Aged Care and Multi-Purpose Services programs.
Members of the RACGP Expert Committee – Practice Technology and Management (REC–PTM) say the implementation is an important change for GPs who attend patients in RACFs.
‘The eNRMC is a great idea and will streamline the process between the RACF and the dispensing pharmacy,’ REC–PTM Chair Dr Steven Kaye, told newsGP.
Frustrated at ‘repeatedly vocalising’ the importance of this change, Dr Kaye said the ability and efficiency of prescribers to access the eNRMC has, to date, been ‘somewhat ignored’.
‘The eNRMC should be able to synchronise the medication list at the RACF, the pharmacy and the general practice,’ he said.
‘The GP should be able to see the medication list efficiently – ideally through a synchronised patient record – and have the ability to prescribe and deprescribe remotely as appropriate. Medication information should also be visible in the My Health Record in real time after dispensing.
‘It’s a complex process and this is an important step forward.’
The Transitional Arrangement is an interim measure to enable the use of eNRMC products until broader electronic prescription infrastructure is established with the help of software vendors for a national rollout.
The Department states that software vendors are helping to develop eNRMC products that meet legislative and technical requirements for electronic prescribing and PBS information requirements for medication charts.
Approval of these products is expected by the end of 2022, when they are due to be listed on the Australian Digital Health Agency’s electronic prescribing conformance register. In the meantime, all RACFs and the other eligible service providers have the option to adopt transitional eNRMC products.
Applications are currently open for the first round of the eNRMC Adoption grant opportunity, which is designed to increase the use of the new products.
REC–PTM member Dr Rob Hosking told newsGP the implementation of eNRMC will support GPs by reducing administrative burdens and risks relating to medication errors.
‘As a GP who visits aged care facilities, if this is implemented well, it will be a game changer for us,’ he said.
‘Currently, if we wish to make changes to a resident’s medication, we either need to physically attend the facility and hand-write on the chart, or the staff fax a copy of the chart, we make the changes and fax it back.
‘This is either extremely inconvenient, in the first scenario, or dangerous in the second scenario – with multiple copies and deteriorating legibility of scanned copies.
‘Provided a GP can remotely log onto the medication chart and make changes from their clinic or home, this will dramatically improve things. If, however, the facility requires us to physically attend to make changes, this may be worse.’ 
Another area that is expected to be improved by putting eNRMC products in place is the removal of the requirement to write physical prescriptions, according to Dr Hosking.
‘This will remove the list of scripts “owing” which we currently get from the pharmacies servicing the RACFs,’ he said. 
Exceptions that will still require a paper prescription include:

  • controlled substances (Schedule 8 medicines)
  • medicines only available under special arrangement (Section 100)
  • medicines requiring telephone or written authority.
Dr David Adam, also a REC–PTM member, told newsGP that although the change will only impact a small number of GPs in the short term, he agrees it will help remove administrative burden once the eNRMC products are fully integrated with existing clinical software.
‘Prescription and medication management in RACFs is a hugely frustrating process for many GPs, and one of the reasons that some doctors elect to stop working in aged care entirely,’ Dr Adam said.
‘The paper-based National Residential Medication Chart can make a big difference, although it is only available in some facilities.
‘The move to electronic prescribing will ideally streamline this process further, although it is mostly likely to only benefit those GPs working in dedicated aged care practices as the common clinical information systems in use in most practices do not [currently] integrate with the eNMRC.’
Dr Hosking agrees that, while currently limited, the development is still an important one.
‘It may not be imminently needed, but it would be good for GPs to be aware things are changing,’ he said.
‘Also, GPs can potentially put pressure on the facilities they attend to adopt the new electronic medication charts.’ 
The Department of Health and Aged Care has developed a prescriber information pack with further information.
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electronic prescribing eNRMC My Health Record National Residential Medication Chart RACFs

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Dr Graham James Lovell   2/08/2022 10:53:59 PM

Yes, multiple variations of electronic charts are already now out there in the random world of RACFs, where each facility unilaterally chooses what brand they like , without discussion or education with the attending
Medico legally I have been advised not to attend any facility where I know there is unaddressed risk. So as the RACGP and the Federal Health Department failed to follow through with and implement the National
RACF medication chart I am sensibly now only attending the 1 facility.
Yes it has an electronic chart with multiple deficiencies like a 2x3 mm square to write a dose in, but it’s not as dangerous as trying to use more than 1 different recording mechanism- ask any Risk Analyst !!!