clinical focus
intentions were clearly spelled out on the
medication chart.
By 2010, this initiative had received
funding by the Australian Government
under the Fifth Community Pharmacy
Agreement. But it wasn’t until 2013 that the
‘prescription as a chart’ became a reality,
through the development of the National
Residential Medication Chart (NRMC).
Yet this eagerly awaited innovation
still required doctors’ instructions to be
handwritten. The final design was seen by
some in government as a definitive product,
handwritten in a format that would not
go through a printer and without a plan to
translate this into electronic workflows.
One of the challenges with a 54-page
handwritten booklet is that when sending a
medication change order to the pharmacy,
the entire chart has to be sent for the order
to be reviewed properly. Yet the NRMC
required only the sheet with the change to
be sent. This ignored the common practice
of doctors sometimes increasing a dose
by ceasing a prescription and signing off
on another with a higher dose – a process
that absolutely requires checking earlier
prescriptions for the patient.
For example, consider this experience
with a change order involving the
anticoagulant warfarin: only one sheet was
provided, showing ‘warfarin 2 milligrams’
had been ordered. A request for the rest of
the chart revealed the doctor had ceased
an order for ‘warfarin 1 milligram’. Had
there not been a check, that resident would
most certainly have been administered
3 milligrams, which is potentially fatal.
It’s also not enough just to have a chart,
even with improved functionality. There
must be an anthropometrical connection
with the users and the design must support
how they work. It needs to have a sense
of kaizen, a rhythm and flow that supports
efficiency and accuracy of use. This
requires effective design, which can be a
long process of trial and error.
So Webstercare developed a version
of the NRMC that’s computer-generated,
which we called the RxMedChart system.
After trials with select facilities in various
states and investments in staff resources
and legal advice – there were 135 iterations
– it was released in last year.
Today, those facilities now using
the RxMedChart system are close to
eliminating their owing prescriptions. The
work is completed within the legislative
framework of dispensing PBS medicines,
payment is made for what has been
dispensed, and there is no difference
between what is written in a chart and
what is written on a prescription.
An innovation is successful only if
the implemented change improves the
quality of the system. National legislative
changes can reform the way medications
are managed in residential aged care but
change is difficult. Part of the process was
recognising what could be changed and
what could be worked with. There must
be an understanding of the subtleties of
advocacy and working as partners when
providing a quality healthcare solution. ■
Gerard Stevens is a pharmacist and
founder and managing director of
Webstercare.
SARAH AGED CARE
MANAGEMENT SOFTWARE
Sarah Aged Care Management is a privately owned Australian company
which specializes in the development of software for the aged care industry.
Our mission is to assist our clients in their provision of quality of care
for residents by improving the productivity of staff through the use of an
effective user friendly system.
Sarah is used throughout Australia to assist in the effective management
of over 10,000 beds. Our clients range in size from the smallest facility of
9 beds to the largest of 600 plus beds.
We provide 24/7 phone support and our call response is considered superior
when compared to other vendors. Sarah automates many processes and
significantly reduces repetitive data input. Sarah has enabled one user to
get 18,000 hours back into resident care during their first year of Sarah use.
sarahagedcare.net
3928 Pacific Highway, Loganholme QLD 4129
Phone: (07) 3290 1161 • Fax: (07) 3806 5934
• A Complete suite of applications
• Chemical and supplier system
• Residential system
• Maintenance management
• Employee system
• Continuous auditing of all modules
• Mandatory reporting
• Medication management
• Continuous quality improvement
• Sarah version 2 coming soon
agedcareinsite.com.au 35