Aged residential care (ARC) Medication Chart implementation and training guide (version 1.1)

Aged residential care (ARC) Medication Chart implementation and training guide (version 1.1) May 2018 Prepared by and the Health Quality & Safety Commission

Version 1, March 2018; version 1.1, May 2018 Health Quality & Safety Commission New Zealand 2018 Level 9, 17 21 Whitmore Street, Wellington, New Zealand This document is available on the Health Quality & Safety Commission website: www.hqsc.govt.nz Disclaimer The information in this guide is provided to help aged residential care (ARC) facilities, their attendant general practitioner(s) and community implement the electronic ARC Medication Chart. The information was gathered from a number of sources. Its inclusion does not constitute or imply endorsement by the Health Quality & Safety Commission New Zealand. While the Commission has taken all reasonable steps to ensure the information is from reliable and reputable sources and is accurate, it accepts no liability or responsibility for any acts or omissions, done or omitted in reliance, in whole or in part, on the information. The Commission accepts no responsibility for the manner in which this information is subsequently used. Users of this information must always consider current best practice and use their clinical judgement with each patient. This information is not a substitute for the exercise of clinical judgement by individual clinicians. The statements, views and opinions expressed in this guide do not necessarily reflect those of the Commission. Acknowledgements This implementation and training guide is based on work undertaken by PharmacyPartners on behalf of the Health Quality & Safety Commission. The electronic charting functionality was developed pro bono by Toniq Limited, Christchurch, for which the Commission is particularly grateful and indebted. The Commission acknowledges the ARC facilities that participated in the various iterations of the medication chart development. Implementation of the ARC Medication Chart will enhance the safe and quality use of medicines in ARC settings, increasing residents safety and outcomes. The Commission also thanks the people who reviewed this document and offered advice for improvement. Additional training and support Additional support and training is available from PharmacyPartners (davidm@pharmacypartners.co.nz; mobile: 021 0232 8855; phone: 04 567 8570; fax: 04 567 8571). Aged residential care (ARC) Medication Chart implementation and training guide Page 2 of 61

Contents 1. Document purpose 5 2. Contents of this guide 5 3. Overview of the ARC Medication Chart 6 Using the ARC Medication Chart 6 Implementing the ARC Medication Chart using this training package 7 Best practice guidelines 10 Factors to consider when introducing the new ARC Medication Chart 11 4. A guide to the ARC Medication Chart sections 13 5. Responsibilities of the care team 26 6. Creating and using the ARC Medication Chart 31 7. Aide memoire for prescribers 35 Operating principles 35 Best practice guidelines 35 Prescribing on the ARC Medication Chart 36 Stopping medicines on the ARC Medication Chart 37 8. Prescribing on the ARC Medication Chart 37 Prescribing medicines 38 Stopping medicines 38 Changing the dose of a medicine 39 9. Reading the ARC Medication Chart 40 Medicines to be administered to the resident 40 10. An important message for residents and their families and whānau 46 Why this is important? 46 What we will be doing? 46 Will residents notice anything different? 46 What do residents need to do? 46 11. Setting up Toniq 47 Setting up and using community pharmacy software to create Medicines Lists and Signing Sheets 47 Setting up a printed chart in Toniq that meets the content requirement 48 Setting up Toniq to create the Resident Overview Sheet 51 12. Transferring information to the new chart 52 Transfer checklist (available as an editable PDF) 53 Monitoring for medication errors 53 13. ARC Medication Chart checklist 55 ARC facility checklist 55 GP checklist 55 Pharmacy checklist 56 Aged residential care (ARC) Medication Chart implementation and training guide Page 3 of 61

14. Common problems 57 Appendix 1: Glossary 59 Appendix 2: Example medication chart forms provided by the pharmacy 60 Appendix 3: Example medication chart forms provided by the ARC facility 61 Aged residential care (ARC) Medication Chart implementation and training guide Page 4 of 61

1. Document purpose This implementation and training guide has been developed to support aged residential care (ARC) facility management, general practitioners (GPs) and pharmacists to familiarise themselves with the ARC Medication Chart and its introduction to practice, then train their staff in its use. You can also draw on the advice and support of an expert appointed by the Health Quality & Safety Commission to help you throughout the period of introduction. Please note the ARC Medication Chart as described in this guide is only available through community pharmacies that use the Toniq pharmacy software system. It is not available through LOTS software. 2. Contents of this guide The contents of this guide and the audiences for each section are summarised below. Sections Facility managers and nurses Prescribers Pharmacists Pharmacy technicians Caregivers 3. Overview of the ARC Medication Chart 4. A guide to the ARC Medication Chart sections 5. Responsibilities of the care team 6. Creating and using the ARC Medication Chart 7. Aide memoire for prescribers 8. Prescribing on the ARC Medication Chart 9. Reading the ARC Medication Chart 10. An important message for residents and their families and whānau 11. Setting up Toniq 12. Transferring information to the new chart 13. ARC Medication Chart checklist 14. Common problems Aged residential care (ARC) Medication Chart implementation and training guide Page 5 of 61

3. Overview of the ARC Medication Chart A variety of people in the sector have had concerning experiences with medication charts. This indicates that present handwritten charting systems and processes could be improved. Handwritten charts can be difficult to read and some doses can be misinterpreted. It can be difficult to determine the current medicine regimen when the same chart has been changed a number of times without being rewritten. It is sometimes easier for caregivers to work from the pharmacygenerated Signing Sheet without referring to the resident s medication chart for authority to administer a particular medicine. In turn, this can result in residents continuing to receive medicines that were to be stopped, not receiving medicines that were to be started, or receiving incorrect doses. These things put residents and staff at risk. Similarly, processes around medicine charting and administration can be difficult or time-consuming to use. This diverts caregivers from looking after residents needs, making the experience of residents and caregivers alike less than desirable. A single electronically generated national chart that was easy to use and interpret was tested. It showed that resident and staff safety could be improved by lowering the risk of medication errors and streamlining medicine management processes. The ARC Medication Chart has been developed to be easy to use and interpret, using a workflow that any facility can follow. The electronically generated ARC Medication Chart is viewed as an interim step pending the adoption of fully integrated electronic medication management systems, which integrate into a single system the prescribing/charting (GP, nurse practitioner (NP)), supply (community pharmacist) and administration of medicines (ARC staff). Using the ARC Medication Chart Operating principles 1. All prescriber instructions to nurses and pharmacists will be legible, unambiguous and signed by the prescriber. 2. Records at all stages of the medication prescribing, preparation and administration process will be complete, accurate, unambiguous and legible. 3. Prescribers, nurses and pharmacists are individually responsible for keeping the residential medication chart up to date. 4. Prescribers, nurses and pharmacists will follow the medication charting standards and processes for their ARC facility. Care team members responsibilities Good teamwork is essential and it is important that all team members know their obligations and roles. 5. Responsibilities of the care team outlines the roles and responsibilities of prescribers (GPs, NPs), nurses and pharmacists in the care team. Please read and understand this section and incorporate it into the policies and procedures used to manage medication charting in your ARC facility. Aged residential care (ARC) Medication Chart implementation and training guide Page 6 of 61

Implementing the ARC Medication Chart using this training package The following suggested steps will help you implement the ARC Medication Chart in the facility and use the relevant sections of this guide. For facility management Getting ready phase 1. Obtain agreement from the facility s GPs and pharmacist to implement the new chart. 2. Read this guide and become familiar with the full training package. 3. Agree processes and responsibilities for operating the ARC Medication Chart system with the GPs and pharmacists servicing the facility. This includes: agreeing how the chart will be configured to suit local needs identifying all policies and procedures affected by the implementation of the ARC Medication Chart establishing a policy to familiarise locum staff with the ARC Medication Chart and associated procedures before beginning practice in the facility. 4. Prepare training and support material for staff using the following resources. For nurses: 4. A guide to the ARC Medication Chart sections 5. Responsibilities of the care team 6. Creating and using the ARC Medication Chart 9. Reading the ARC Medication Chart. For caregivers: 9. Reading the ARC Medication Chart. 5. Train the clinical leadership group in the use of the ARC Medication Chart and the new policies and procedures controlling its use. Getting set phase 1. Select which residents will be transferred to the new chart, the timeframe for doing so, and in which order transfer will occur. 2. Prepare to move to the new ARC Medication Chart by setting up and signing off policies and procedures to: supply the pharmacy the information they need to set up the resident s Medicines List in the new format update the pharmacy on any change about the resident s medicines, allergies and adverse events, so they can keep the Medicines List up to date and reprint it when needed quarantine new Resident Overview Sheets and Medicines Lists before sign-off by the GP manage GP sign-off for quarantined Resident Overview Sheets and Medicine Lists to ensure they enter use in the facility in a timely manner establish the process for replacing the existing Medicines List in a resident s medication chart when a new Medicines List is available. 3. Train staff in the use of the chart. 4. Let residents and their families/whānau know about the introduction of the new chart and its objectives. Aged residential care (ARC) Medication Chart implementation and training guide Page 7 of 61

GPs Getting ready phase 1. Read: 3. Overview of the ARC Medication Chart (optional) 4. A guide to the ARC Medication Chart sections (optional) 5. Responsibilities of the care team 6. Creating and using the ARC Medication Chart 7. Aide memoire for prescribers 8. Prescribing on the ARC Medication Chart. 2. Agree processes and responsibilities for operating the ARC Medication Chart system with the facility nurses and pharmacists servicing the facility. This includes: updating and signing off any processes and standard operating procedures affected by the implementation of the ARC Medication Chart establishing a policy to familiarise locum staff with the ARC Medication Chart and associated procedures before beginning practice in the facility. To help with this, ensure the Medical Centre s practice nurse is familiar with the ARC Medication Chart and its use so they can guide and support locums. Consider getting input from the ARC facility for this step. 3. Prepare training and support material for practice staff associated with medication charting using the following resources: For practice nurses: 3. Overview of the ARC Medication Chart (optional) 5. Responsibilities of the care team 6. Creating and using the ARC Medication Chart 9. Reading the ARC Medication Chart. Getting set phase 1. Establish processes with facility nurses for signing off quarantined Resident Overview Sheets and Medicines Lists to ensure they enter use in the facility in a timely manner. 2. Train any necessary staff (eg, practice nurses and locums) how to use the ARC Medication Chart. Pharmacist Getting ready phase 1. Read 3: Overview of the ARC Medication Chart and become familiar with the full training package. 2. Agree processes and responsibilities for operating the ARC Medication Chart system with facility nurses and the GPs servicing the facility. 3. Update and sign off any processes and standard operating procedures affected by the implementation of the ARC Medication Chart. This should cover: Aged residential care (ARC) Medication Chart implementation and training guide Page 8 of 61

receiving resident information from the care facility to support preparing new Medicines Lists for individual residents creating Medicines Lists and Signing Sheets, and providing them in a timely fashion to the care facility reconciliation processes to support the initial preparation of Medicines Lists for residents maintaining and updating Medicines Lists when requested or as the resident s medicine regimens change training locum staff in the medication chart system and associated procedures before beginning practice in the facility. 4. Prepare training and support material for staff involved using the following resources: For pharmacists: 3. Overview of the ARC Medication Chart (optional) 4. A guide to the ARC Medication Chart sections (optional) 5. Responsibilities of the care team 6. Creating and using the ARC Medication Chart 8. Prescribing on the ARC Medication Chart 9. Reading the ARC Medication Chart 11. Setting up Toniq. For pharmacy technicians: 6. Creating and using the ARC Medication Chart 9. Reading the ARC Medication Chart 11. Setting up Toniq. Getting set phase 1. Set up the Medicines List in the community pharmacy software. 2. Train necessary staff, including locums, in using the ARC Medication Chart and the processes that support it. Aged residential care (ARC) Medication Chart implementation and training guide Page 9 of 61

Best practice guidelines Implementation issue Guideline ARC Medication Chart content Chart components Medicine naming Dosage form image and description provision 1 Medicines Order and Verbal Medicines Order forms The ARC Medication Chart comprises: a form summarising clinical parameters that are relevant to the resident s safe use of medicines a list of the medicines the resident is currently receiving together with their dosage, frequency of administration and any other instructions needed for safe use an administration record that documents the administration of individual doses and any relevant events relating to administration. Record each medicine on a resident s medication chart by generic name unless the prescriber and ARC facility considers resident safety demands an individual medicine is recorded by trade name. Nurses and caregivers find images and descriptions of individual medicine dosage forms helpful for safely managing and administering residents medicines. However, changes in subsidised products may cause an unacceptable level of Medicines List replacement if images and descriptions are included in the Medicines List. When dosage form images are used, if there is a significant time gap before the quarantined new Medicines List is signed off by the prescriber, it is important to develop a process to highlight to care staff changes in appearance when the subsidised medicine changes. For example, a sticker could be attached to the resident s medication pack alerting care staff to the brand change. Medicine dosage form images and descriptions could be made available to care staff in the form of a glossary of all the medicines in use in the facility. File this document in the medication chart folder used during medicine rounds. The pharmacy needs to update it monthly. Archive all Medicines Lists when an updated, reprinted, signed Medicines List is placed in the resident s record. Process issues Delay between charting and availability of the current medication chart GPs, nurses and pharmacists agree processes that streamline the updating and signing off of ARC Medication Charts so there is minimum delay. They agree a maximum acceptable sign-off delay and monitor performance against that, while working together to reduce it. 1 Not all community pharmacies subscribe to the Toniq medicines images library, so they may not be able to offer this service. Aged residential care (ARC) Medication Chart implementation and training guide Page 10 of 61

Factors to consider when introducing the new ARC Medication Chart 1. View the implementation of the new ARC Medication Chart together with the processes associated with its use. Introducing the chart into a facility s and pharmacy s practices without updating the chart management processes would be unsafe and likely to reduce the benefits of moving to the new chart. The facility s written policies and procedure may need to be updated to reflect changes in the chart management process. Complete this before introducing the new ARC Medication Chart. 2. Nurses, doctors and pharmacists may underestimate the importance of process review and updating as a critical factor for success. In particular, they may underestimate the importance of testing each process step in detail and adapting it, when necessary. Further, this process should be repeated, as an initial review is unlikely to identify and eliminate all process issues. Participants need to apply quality improvement and plan, do, study, act (PDSA) 2 principles to the project. 3. The facility, pharmacy and doctor need to agree common objectives for the new chart project. They must establish a shared understanding of the processes associated with chart use in each of their disciplines so sound decisions are made and all practitioners are committed to them. If practitioners do not share common objectives and understandings, their actions will create friction points that may make the overall chart management system less efficient and increase the risk of medication errors. 4. It is important to build confidence in the chart amongst practitioners and facility staff at every stage of the process. In particular, identify known risks and design a process that either prevents them occurring or minimises risk. There may need to be flexibility in the way the chart is implemented in a facility so the practitioners are confident in using it. Investigate any issues and deal with them promptly to remove uncertainty about the new chart. This will improve resident and practitioner safety and the overall management of medicines in the facility. 5. Move all residents to the new chart as quickly as possible while recognising the extra workload and avoiding overburdening key staff members, which may jeopardise the change process. 6. Leaders of the change must be determined and resolute. They must support the change by working as a cohesive multidisciplinary team across the three professional groups managing medicines in the facility. 7. Changing charts and the associated processes are likely to reveal limitations in the way some staff adapt to the change and adhere to processes. The change may be accompanied by an increase in the number of errors as existing ways of working might be disrupted. Be prepared to mitigate for this effect. 8. The Resident Overview Sheet has coloured sections, but there is no loss of information when faxing these sheets. 9. Verbal Medicines Order sheet verbal orders must only be used as permitted by the facility s policies and procedures. If a medicine is to continue, the pharmacy will move the medicine to the appropriate section of the ARC Medication Chart (eg, regular or PRN section) and reprint the chart for sign-off. Do this as soon as possible. 10. Reprinting the chart the chart needs to be legible and uncluttered (eg, with minimal discontinued medicines). Therefore, reprint it at appropriate times to reduce the risk of medication error. The facility, pharmacy and prescriber need to establish a reprinting policy/procedure. The policy should be flexible enough for nurses and prescribers to ask for a 2 See www.ihi.org/resources/pages/howtoimprove/default.aspx. Aged residential care (ARC) Medication Chart implementation and training guide Page 11 of 61

chart reprint when they feel it is needed. (See 14: Common problems, point 3, Reprinting the chart workload). The pharmacy should consider changing its sign-off procedures so the pharmacist signing dispensed medicines out to the facility also checks if the existing chart needs to be reprinted before releasing the medicines. 11. Consider developing a policy to cover the use of the Resident Overview Sheet. Every resident needs an Overview Sheet that is kept up-to-date, particularly after each three-month medication review. The policy should include that each resident new to the facility must have a Resident Overview Sheet completed as part of the admission process. The Resident Overview Sheet uses colour enhancements as a safety feature to emphasise the high-risk allergy and adverse reaction sections. This use of colour is an important safety feature. Ideally, use a colour printer especially if using medication identification images. Aged residential care (ARC) Medication Chart implementation and training guide Page 12 of 61

4. A guide to the ARC Medication Chart sections This part of the guide will help you understand: what each section of the ARC Medication Chart looks like the purpose of each section how to use each part of the section. You may choose to enhance resident and caregiver safety by printing various sections on different coloured paper to provide visual cues to caregivers about which type of medicine they are administering. Section Role Generated by and responsibility Resident Overview Sheet Regular Medicines List Short Course Medicines Order Note: available as a printable PDF Brings together information about the resident that is relevant to their use of medicines. The resident s current list of regular packed and unpacked medicines together with dosage instructions and medicines start and stop instructions. New or changed medicines are added to the list using the blank structured prescribing spaces at the bottom of each section. The resident s current list of short course medicines. New medicines are added to the list when needed using the blank structured prescribing spaces at the bottom of the list. Complete courses are crossed off when finished but are retained on the list to provide history for the doctor to support management or recurrent conditions. The chart is faxed to the pharmacy each time a medicine is added. Created by the pharmacy using the Toniq community pharmacy management software. The sheet is generated by the pharmacy from a facility-specific template. The facility nurse and doctor need to complete the details not automatically populated. Updated by the doctor and nursing staff as the resident s circumstances change. Created by the pharmacy using the Toniq community pharmacy management software. Printed by the pharmacy from the resident s previous Medicines List and updated when the blank prescribing spaces are full or when requested by nursing staff. Used by the facility doctor to prescribe a resident s short course medicines eg, antibiotic course. Blank Short Course Medicines Order forms are held in the facility s medication chart folder so prescribers can access them when needed. Aged residential care (ARC) Medication Chart implementation and training guide Page 13 of 61

Section Role Generated by and responsibility Verbal Medicines Order Note: available as a printable PDF Admission Medicines Order Note: available as a printable PDF Signing Sheet Resident Medication Chart Transfer Checklist Note: available as a printable PDF Records verbal instructions if the facility allows verbal prescribing. If the medicine is to continue, the pharmacy will move the medicine to the appropriate section of the medication chart (eg, the Regular or PRN section). Medicines prescribed when the resident is admitted to the facility. The chart remains in use until the regular medicines list generated by the pharmacy is reviewed and signed off by the prescriber. Records administration of medicines. The checklist is used to make sure that all the resident s medicines information is safely transferred from the current (old) medication chart to the new ARC Medication Chart. Completed by the facility nurse on receiving a verbal order from a prescriber for a resident s medicine. Completed and signed for by the facility doctor for new residents. Created by the pharmacy using the Toniq community pharmacy management software and provided with the resident s medicines. Facility nurse to use when introducing the new ARC Medication Chart into their facility. Summary 1. The pharmacy provides (through Toniq; Appendix 2): a. Resident Overview Sheet b. Medicines List for regular and PRN medicines c. Signing Sheet (regular medicines) d. PRN and/or Non-Packed Medicine Signing Sheet. 2. The facility provides (through fillable PDFs; Appendix 3): a. Short Course Medicines Order b. Verbal Medicines Order c. Admission Medicines Order d. Resident Medication Chart Transfer Checklist. The sheets provided by the facility are available as PDFs with editable fields (to maintain the integrity of the form layout). These PDFs can be personalised to the facility and saved to a facility computer as a master document. Using master documents speeds up the updating of sheets at a future date. Facility personalisation can include: facility s name facility s address Aged residential care (ARC) Medication Chart implementation and training guide Page 14 of 61

facility s other contact details prescriber s name prescriber s address prescriber s registration number or other identifiers as appropriate. Aged residential care (ARC) Medication Chart implementation and training guide Page 15 of 61

Resident Overview Sheet section Facility name and address Pharmacy name and contact details GP name and contact details Resident s photo Resident s details Resident s allergies record Resident s adverse reactions record Record of important issues affecting the resident s use of medicines Record of all the resident s medical conditions (eg, COPD, diabetes, hypertension, osteoporosis) Record of previous reviews of the resident s medication Key points: 1. Initiated by the pharmacy. This sheet provides an overview of the factors affecting the resident s use of medicines. The sheet is printed by the pharmacy for each resident, and contains details on the resident, the care home, the pharmacy and the doctor. The nurse and doctor must complete the remaining details. 2. It must be signed off by the prescriber before it is used. 3. Whenever new allergies or adverse reactions are added to the Resident Overview Sheet, it must be sent to the pharmacy for adding to the Medicines List. 4. Use this form to record when a medication review has been completed. After the review, send the form to the pharmacy. The pharmacy needs this information to generate new three-month prescriptions for the doctor to sign. Aged 5. The residential pharmacy care has (ARC) the Medication option to scan Chart and implementation save completed and sheets training into guide Toniq to make the sheet Page easily 16 of 61 accessible for future printing (see the Toniq user manual).

Medicines List, section 1 of 4 regular medicines packed Resident s details Resident s allergies and adverse reactions Details of regularly administered medicines the resident is receiving Blank section to prescribe a new regularly administered medicine Key points: 1. This section is used to chart the resident s regular and PRN medicines. 2. Prepared by the pharmacy from either the resident s Admission Medicines Order or the previous Medicines List. 3. It must be signed off by the doctor before it is used. 4. The doctor or nurse asks the pharmacy to prepare an updated list when all the blank prescribing spaces for either regular or PRN medicines are filled, or on reaching a defined minimum number of blank prescribing spaces in any section of the chart. 5. If the medicines are prescribed inadvertently in the wrong chart section, the pharmacy should automatically place the medicine(s) in the correct section in the chart and reprint the chart. Aged residential care (ARC) Medication Chart implementation and training guide Page 17 of 61

Medicines List, section 2 of 4 regular medicines packed and nonpacked Blank section to prescribe a new regularly administered medicine Details of regularly administered medicines that are not contained in the medicine pack Blank section to prescribe a new non-packed regularly administered medicine Key points: 1. Prepared by the pharmacy from either the resident s Admission Medicines Order or the previous Medicines List. 2. It must be signed off by the doctor before it is used. 3. The doctor or nurse asks the pharmacy to prepare an updated list when all the blank prescribing spaces for either regular or PRN medicines are filled, or on reaching a defined minimum number of blank prescribing spaces in any section of the chart. 4. If the medicines are prescribed inadvertently in the wrong chart section, the pharmacy should automatically place the medicine(s) in the correct section in the chart and reprint the chart. Aged residential care (ARC) Medication Chart implementation and training guide Page 18 of 61

Medicines List, section 3 of 4 PRN medicines Details of PRN administered medicines that are not contained in the medicine pack Blank section to prescribe a new PRN administered medicine Key points: 1. Prepared by the pharmacy from either the resident s Admission Medicines Order or the previous Medicines List. 2. It must be signed off by the doctor before it is used. 3. The doctor or nurse asks the pharmacy to prepare an updated list when all the blank prescribing spaces for either regular or PRN medicines are filled, or on reaching a defined minimum number of blank prescribing spaces in any section of the chart. 4. If the medicines are prescribed inadvertently in the wrong chart section, the pharmacy should automatically place the medicine(s) in the correct section in the chart and reprint the chart. Aged residential care (ARC) Medication Chart implementation and training guide Page 19 of 61

Medicines List, section 4 of 4 regular medicines packed, with medicine images This example sheet is provided to support those facilities that decide to use a chart containing images of the medicines Not all pharmacies have the computer functionality to print images. This needs to be agreed with the pharmacy. Image of the medicine to help identification when administering the medicine Key points: 1. Not all pharmacies have the computer functionality to print medicine images. This needs to be agreed with the pharmacy. 2. Prepared by the pharmacy from either the resident s Admission Medicines Order or the previous Medicines List. 3. It must be signed off by the doctor before it is used. 4. The doctor or nurse asks the pharmacy to prepare an updated list when all the blank prescribing spaces for either regular or PRN medicines are filled, or on reaching a defined minimum number of blank prescribing spaces in any section of the chart. 5. If the medicines are prescribed inadvertently in the wrong chart section, the pharmacy should Aged automatically residential care place (ARC) the Medication medicine(s) Chart in the implementation correct section and in the training chart guide and reprint the chart. Page 20 of 61

Short Course Medicines Order Date this order was started Resident s details GP s details Blank space to prescribe new short course medicines Key points: 1. Used to chart the resident s short course medicines. 2. Used and signed off by the prescriber. 3. Each medicine must be signed off by the prescriber before the medicine can be administered. 4. Completed short courses will have a line drawn through them and the date and signature filled in. 5. The prescriber prescribes a new medicine by completing the medicine line. If all the prescribing spaces are full, start a new sheet. 6. Fax the sheet with new medicine orders to the pharmacy to supply the medicines. Aged residential care (ARC) Medication Chart implementation and training guide Page 21 of 61

Verbal Medicines Order Resident s details GP s details Blank space to record a verbal order to start a new medicine Key points 1. This section is used to record a resident s verbally ordered medicines. 2. Prepared by the nurse receiving the verbal order, witnessed by another facility staff member to verify the record is correct, and signed-off by the prescriber. 3. It must be signed-off by the prescriber within the time required by the facility s verbal order policy. 4. A new Verbal Medicines Order must be started every time a new verbal order is received. 5. If the medicine is to continue, the pharmacy will move the medicine to the appropriate section of the medication chart (eg, the regular or PRN section), and generate a prescription for the prescriber to sign. Aged residential care (ARC) Medication Chart implementation and training guide Page 22 of 61

Signing Sheet, section 1 of 2 Regular packed medicines Resident s details Summary of the regular medicines the resident is receiving, including instructions and prescription numbers Daily record of each medicine administration to the resident Codes to be used in the administration record when a medicine is not given or taken Key points: 1. This section is used to record the administration of individual doses of a resident s medicines. 2. Note the actual layout of the Signing Sheet may differ slightly from this example, depending on how the pharmacy configures its computer software. 3. Prepared by the pharmacy and provided with each new supply of medicine for the resident. 4. Used to record each administration of medicine to the resident. Aged residential care (ARC) Medication Chart implementation and training guide Page 23 of 61

Signing Sheet, section 2 of 2 PRN and/or non-packed medicines Resident s details Name and strength of the PRN medicine Record of each administration of the PRN medicine to the resident Key points: 1. This section is used to record the administration of individual doses of a resident s medicine. 2. The pharmacy provides blank copies for each resident receiving PRN medicines. 3. The nurse records the name of each PRN medicine prescribed for the resident. 4. Caregivers record each time the PRN medicine is administered to the resident. Aged residential care (ARC) Medication Chart implementation and training guide Page 24 of 61

Admission Medicines Order Resident s details GP s details Blank space to record details of a medicine the resident is receiving, its dose and administration Key points: 1. This section is used to record all the medicines the resident is receiving on admission to the facility. It is replaced by the Medicines List as soon as the prescriber signs off the Medicines List. 2. Completed and signed off by the prescriber when the resident is admitted to the facility. 3. Faxed to the pharmacy when completed. The pharmacy provides the medicines and prepares a Medicines List and Signing Sheet. 4. Used as the resident s chart until the Medicines List is signed off by the doctor. Aged residential care (ARC) Medication Chart implementation and training guide Page 25 of 61

5. Responsibilities of the care team This describes the responsibilities nurses, GPs/prescribers and pharmacists supporting the facility when initiating and maintaining medication charts. Read also 12: Transferring information to the new chart and 13: ARC Medication Chart checklist. Care team members Setting up Admitting new patients to the facility Maintaining and updating charts Prepare the Resident Overview Sheet and Short Course Medicines Order 1. If facility policy permits, transcribe relevant information from the resident s medication chart to the Resident Overview Sheet for each resident. 2. Ask the GP to transcribe the resident s active short course medicines to a new Short Course Medicines Order. 3. Quarantine the Resident Overview Sheet and Short Course Medicines Order to be signed off at the GP s next visit. 4. When the quarantined documents are signed off by the GP, use them as the resident s medication chart and archive the previous medication chart. When the new Medicines Lists are received from the pharmacy: 1. Check the Medicines List against the regular and PRN medicines sections of the resident s current chart. a. If correct, quarantine the document for GP sign-off at the GP s next visit. b. If problems are found, refer them back to the pharmacy for correction. When the resident is admitted, if the GP is not in attendance: 1. Provide the resident s current medication list or prescriptions from their previous GP, or hospital, or previous pharmacy to the pharmacist so a Medicines List can be set up. 2. Check the Medicines List and Signing Sheet against the regular and PRN medicines sections of the resident s medication chart. Add the Signing Sheet to the resident s medication chart. a. Where there are no problems with the Medicines List, quarantine the Medicines List for GP sign-off at the GP s next visit. b. If problems are found, refer them back to the pharmacy for correction and return. 3. Check the medicines against the Admission Medicines Order and the Short Course Medicines Order (if one has been generated by the GP). 4. Set up the resident s medication chart with the chart components prepared and signed off by the GP. Managing resident hospitalisations or referrals to specialist care 1. When a resident is hospitalised or referred for specialist care, ensure a copy of the entire medication chart accompanies the resident. 2. Ensure any medicines prescribed by external prescribers are added to the medication chart and signed off by the GP, and provide the updated chart to the pharmacist. Initiating a reprint of the Medicines List 1. Ask the pharmacy to reprint a resident s Medicines List if: a. nurses or caregivers find a resident s Medicines List difficult to understand b. there are numerous crossings out c. there are no free prescribing sections available in the regular medicines section of a resident s Medicines List Aged residential care (ARC) Medication Chart implementation and training guide Page 26 of 61

Setting up Admitting new patients to the facility Maintaining and updating charts 2. When the Medicines List is signed off by the GP, add it to the resident s medication chart and archive the previous medication chart. 5. Send the pharmacy a copy of the Resident Overview Sheet, Admission Medicines Order and Short Course Medicines Order (if required). When the resident is admitted when the GP is in attendance: 1. Set up the resident s medication chart with the chart components prepared and signed off by the GP. 2. Send the pharmacy a copy of the Resident Overview Sheet, Admission Medicines Order and Short Course Medicines Order (if required). 3. Check the medicines against the Admission Medicines Order and the Short Course Medicines Order (if one has been generated by the GP). 4. Check the Medicines List against the Admission Medicines Order. a. Where there are no problems, quarantine the Medicines List for GP sign-off at the GP s next visit. b. If problems are found, refer them back to the pharmacy for correction and return. d. there are no free prescribing sections available in the PRN medicines section of a resident s Medicines List. 2. Mark the resident s current Medicines List with a coloured 3 sticker to indicate it is being reprinted. When a new Medicines List is received from the pharmacy: 1. Check the Medicines List against the regular and PRN medicines sections of the resident s old medication chart. a. Where there are no problems, quarantine the document for GP sign-off at the GP s next visit. b. If problems are found, refer them back to the pharmacy for correction and return. 2. When the updated Medicines List is signed off by the GP, add it to the resident s medication chart and archive the previous Medicines List. 3 The colour of the sticker used will be recorded in the relevant operating procedure. Aged residential care (ARC) Medication Chart implementation and training guide Page 27 of 61

Setting up Admitting new patients to the facility Maintaining and updating charts 5. When the Medicines List is signed off by the GP, add it to the resident s medication chart and archive the Admission Medicines Order. Aged residential care (ARC) Medication Chart implementation and training guide Page 28 of 61

Pharmacist Setting up Admitting new patients to the facility Maintaining and updating charts Prepare the Resident Overview Sheet 1. Print a Resident Overview Sheet. 2. Provide the new resident Medicines List to the facility nurse in an envelope marked Medication charts quarantined for prescriber sign-off. Initiating Medicines Lists for the facility s residents 1. Prepare a Medicines List covering regular and PRN medicines for each resident in the current medicine packing run from the existing patient regimen held on the pharmacy s records. 2. Provide the new resident Medicines List to the facility nurse in an envelope marked Medication charts quarantined for prescriber sign-off. 3. Repeat steps 1 and 2 with each medication packing run until new Medicines Lists have been created for all residents. Correcting a Medicines List 1. Make any corrections for a resident identified by the nurse or GP. 2. Provide the updated resident Medicines List to the facility nurse in an envelope marked, eg, Medication chart for [Mr/Mrs X] quarantined for prescriber sign-off. When the pharmacy receives information about a newly admitted resident: 1. Establish a resident record from details provided in the Resident Overview Sheet, Admission Medicines Order and Short Course Medicines Order (if one has been generated by the GP). 2. Prepare the medicines for the resident. 3. Prepare the resident s Medicines List from the information provided by the facility. 4. Prepare the resident s Signing Sheet. 5. Provide the facility with the medicines and Signing Sheet. 6. Provide the new resident Medicines List to the facility nurse in an envelope marked, eg, Medication chart for [Mr/Mrs X] quarantined for prescriber sign-off. 7. Prepare prescriptions for GP sign-off and give them to the GP. Reprinting a Medicines List 1. The pharmacy is to reprint a resident s Medicines List if: a. the facility s nurse requests a reprinted chart b. there are numerous crossings out c. there are no free prescribing sections available in the regular medicines section of a resident s Medicines List d. there are no free prescribing sections available in the PRN medicines section of a resident s Medicines List e. the brand or appearance of a medicine on the Medicines List changes (where the care team have agreed to provide medication images on the Medicines List). 2. Provide the new resident Medicines List to the facility nurse in an envelope marked, eg, Medication chart for [Mr/Mrs X] quarantined for prescriber sign-off. Aged residential care (ARC) Medication Chart implementation and training guide Page 29 of 61

GPs Setting up Admitting new patients to the facility Maintaining and updating charts When requested by the facility s nurse: 1. If facility policy requires, transcribe relevant information from the resident s medication chart to the Resident Overview Sheet for the resident. 2. If facility policy requires, transcribe currently active short course medicines from the resident s medication chart to the Short Course Medicines Order for the resident. 3. Review each Resident Overview Sheet and sign it off as a correct record of the resident s situation. 4. Review each resident s Medicines List and sign it off as a correct record of the resident s regular and PRN medicines regimen. 5. Review each resident s Short Course Medicines Order and sign it off as a correct record of the resident s short course medicines regimen. When the resident is admitted: 1. Complete the Resident Overview section of the resident s chart, recording known allergies, adverse reactions and other factors affecting medicines use. 2. Fill in an Admission Medicines Order for regular and PRN medicines and sign it off OR check the Medicines List prepared from a reconciled current medications list and sign it off. 3. Fill in a Short Course Medicines Order for any short course medicines required and sign it off. When the resident s new prescriptions are received from the pharmacy following a regular medication review: 1. Sign off the prescriptions for the resident and return them to the pharmacy. When the resident s updated Medicines List is presented for sign-off: 1. When asked by the facility s nurse, review the updated Medicines List and sign it off as a correct record of the resident s regular and PRN medicines regimen. When the resident s Medicines List is received from the pharmacy: 1. When asked by the facility s nurse, review the replacement Medicines List and sign it off as a correct record of the resident s regular and PRN medicines regimen. Aged residential care (ARC) Medication Chart implementation and training guide Page 30 of 61

6. Creating and using the ARC Medication Chart Read this section with 8. Prescribing on the ARC Medication Chart. It provides process flow diagrams for creating and using the ARC Medication Chart under three scenarios: 1. Creating new ARC medication charts for all residents. 2. Using the new ARC Medication Chart to manage residents medicines. 3. Creating an ARC Medication Chart for a newly admitted resident. Aged residential care (ARC) Medication Chart implementation and training guide Page 31 of 61

Scenario 1: Creating new ARC Medication Charts for all residents (to transition to the new chart) Aged residential care (ARC) Medication Chart implementation and training guide Page 32 of 61

Scenario 2: Using the new ARC Medication Chart to manage residents medicines Aged residential care (ARC) Medication Chart implementation and training guide Page 33 of 61

Scenario 3: Creating an ARC Medication Chart for a newly admitted resident Aged residential care (ARC) Medication Chart implementation and training guide Page 34 of 61

7. Aide memoire for prescribers Operating principles All prescriber instructions to nurses and pharmacists will be legible, unambiguous and signed by the prescriber. Records at all stages of the medication prescribing, preparation and administration process will be complete, accurate, unambiguous and legible. Prescribers, nurses and pharmacists are individually responsible for keeping the ARC Medication Chart up to date. Prescribers, nurses and pharmacists will follow the medication charting standards and processes for their ARC facility. Best practice guidelines ARC Medication Chart content Chart components 1. A Resident Overview Sheet recording medicines-related factors and review dates. 2. A current list of the resident s medicines and instructions for their safe use (Medicines List). 3. A record of the administration of individual doses (Signing Sheet). Medicine naming Medicines are prescribed generically unless the prescriber and ARC facility decide trade (brand) name prescribing for specific medicines is required for resident safety. Medicine image and description provision 4 1. Medicine images and descriptions are helpful to nurses and caregivers. 2. Some pharmacies have the functionality to print images of the medicines in the regular, non-packed and PRN sections of the Medicines List. The care team needs to agree if medicine images are going to be provided on the Medicines List. 3. However, frequent changes in funded medicines can cause an unacceptable level of Medicines List replacement if images and descriptions are included in the Medicines List. 4. If medicine images are not provided on the Medicines List, then medicine images and descriptors could be made available to ARC facility caregivers in the form of a glossary of all the medicines in use in the facility. This document should be filed in the medication chart folder used during medicine rounds and updated monthly by the pharmacy. 4 Not all community pharmacies subscribe to the Toniq medicines images library, so they may not be able to offer this service. Aged residential care (ARC) Medication Chart implementation and training guide Page 35 of 61

Use of medication chart components Admission Medicines Order and Verbal Medicines Order forms All Medicines Lists must be archived when an updated, reprinted, signed Medicines List is placed in the resident s record. Process issues Delay between charting and availability of the current Medicines List GPs, nurses and pharmacists agree processes that streamline the updating and signing off of the Medicines List so there is minimum delay. They agree a maximum acceptable sign-off time period and monitor performance against that, while working together to reduce it. Prescribing on the ARC Medication Chart Use the correct section of the chart to prescribe a new medicine. Prescribe for newly admitted residents using the Admission Medicines Order form: tick Regular or PRN as appropriate. Fill in all sections. Name and dose form in capitals Route Indication Maximum daily dose Number of doses and time when they are administered Strength Strength unit For strength: do not use leading or trailing zeros. For strength units: write g for gram and mg for milligram, but write microgram and nanogram in full; for liquids, strength per standard volume in ml. Aged residential care (ARC) Medication Chart implementation and training guide Page 36 of 61

Stopping medicines on the ARC Medication Chart All types of medicines are stopped in the same way. Printed entries 14/6/15 A Doctor Handwritten entries Cross through the discontinued entry Record the stop date and sign Cross through the discontinued entry Record the stop date and sign Aged residential care (ARC) Medication Chart implementation and training guide Page 37 of 61

8. Prescribing on the ARC Medication Chart Prescribing medicines The ARC Medication Chart contains the following sections. Regular medicines in the regular medicines section. PRN medicines in the PRN medicines section. Short course medicines in the Short Course Medicines Order section. For a new resident, use the Admission Medicines Order. Indicate whether an admission medicine is regular or PRN by ticking the appropriate box. Use the correct section of the chart to prescribe a new medicine. Record the name and dose form of the medicine in CAPITAL LETTERS Indicate the route Indicate the reason the medicine is prescribed Indicate when doses are to be administered and the number of dose forms to be administered at that time. To avoid confusion, circle both the time and the amount of medicine to be administered to draw attention to these instructions. For oral liquids the dose should be recorded in terms of the number of ml to be administered. Record the strength of the dosage form. When prescribing: avoid leading zeros (eg, 0.5 mg should be written as 500 microgram) unless a leading zero is unavoidable do not use trailing zeros (eg, write 30 mg as 30 mg not 30.0 mg) for oral liquids, record the strength in terms of the amount of medicine present in a standard volume of liquid (eg, for amoxicillin 125 mg/5 ml). Record the maximum daily dose Record the strength unit in the strength unit box: Write microgram and nanogram in full to avoid confusion with mg. For oral liquids, lay out strength information like this following the strength description on the medicine label. Strength Strength Units 125 mg/5 ml Aged residential care (ARC) Medication Chart implementation and training guide Page 38 of 61

Stopping medicines Printed entries 14/6/15 A Doctor Cross through the discontinued entry Record the stop date and sign Handwritten entries For convenience, only the entry for a PRN medicine is shown here. Regular medicines and short course medicines are stopped in the same way. Cross through the discontinued entry Record the stop date and sign Changing the dose of a medicine To alter or change a medicine, stop the original order completely (as above) and prescribe on a new line. Aged residential care (ARC) Medication Chart implementation and training guide Page 39 of 61

9. Reading the ARC Medication Chart This guide will help ARC facility caregivers understand how to read the various sections of the ARC Medication Chart and know when a medicine has been stopped. The sections of the chart share many common features to make it easy to read. It is important to understand the additional information in the PRN medicines, Short Course Medicines Order and Admission Medicines Order sections. Medicines to be administered to the resident Medicines List regular medicines Information about the resident s regular medicine can be presented in two forms: printed and handwritten. Handwritten entries have been added after the list was printed. Printed entries Known allergies The reason the resident is taking the medicine Instructions for giving the medicine to the resident The amount of the medicine and the time it is to be given to the resident The name and strength of the medicine, and the route it is given by The date when the medicine starts Prescriber s signature confirming the start instruction The date when the medicine is to stop Prescriber s signature to confirm stop instructions Aged residential care (ARC) Medication Chart implementation and training guide Page 40 of 61

Handwritten entries SOLID DOSAGE FORMS Start date The route the medicine is given by The reason the resident is taking the medicine The name of the medicine and dose form (eg, liquid, tablet) The amount of the medicine and the time it is to be given to the resident Special instructions for giving the medicine The strength of the medicine The units the strength of the medicine is measured in (eg, mg, g, microgram) Liquid dosage forms Start date The route the medicine is given by The reason the resident is taking the medicine The name of the medicine and dose form (eg, liquid, tablet) The amount of the medicine and the time it is to be given to the resident. The size of the dose is recorded as the number of ml of liquid to be administered The strength of the medicine Note: strength per 5 ml Special instructions for giving the medicine Aged residential care (ARC) Medication Chart implementation and training guide Page 41 of 61

Medicines List PRN medicines Information about the resident s PRN medicine can be presented in two forms: printed and handwritten. Handwritten entries are added after the chart was printed. Printed entries The name, strength and dose form of the medicine (eg, tablet, liquid) The route the medicine is given by The reason the resident is taking the medicine 31/5/15 A Doctor Instructions for giving the medicine Start date The amount of the medicine to be given to the resident if not included in the instructions (the amount is included in the instructions in this example) Handwritten entries Start date The route the medicine is given by The reason the resident is taking the medicine The name of the medicine and dose form (eg, liquid, tablet) Instructions for giving the medicine The strength of the medicine The maximum amount of medicine to be given in a day The amount of the medicine to be given to the resident if not included in the instructions Aged residential care (ARC) Medication Chart implementation and training guide Page 42 of 61

Short Course Medicines Order Active entries Short course medicines the resident is taking will always be handwritten. Start date The route the medicine is given by The reason the resident is taking the medicine The name of the medicine and dose form (eg, liquid, tablet) Special instructions about how the medicine is given to the resident The amount of the medicine and the time it is to be given to the resident The strength of the medicine The date when the medicine is to stop The units the strength of the medicine is measured in (eg, mg, g, microgram) Stopped entries When a short course medicine has been completed, the entry will have a cross through it to indicate it is no longer being administered. Cross through the chart entry Aged residential care (ARC) Medication Chart implementation and training guide Page 43 of 61

Admission Medicines Order The Admission Medicines Order is used for a short time after the resident is admitted to the facility. Information on it is always handwritten. Start date Whether the medicine is regular or PRN The route The reason the resident is taking the medicine The name of the medicine and the dose form (eg, tablets, liquid) Special instructions about how the medicine is given to the resident The units the strength of the medicine is measured in (eg, mg, g, microgram) The maximum amount of medicine to be given in a day if the medicine is PRN The strength of the medicine The date the medicine is to stop The amount of the medicine and the time it is to be given to the resident Aged residential care (ARC) Medication Chart implementation and training guide Page 44 of 61

Medicines that have been stopped Medicines that have been stopped are clearly marked with a cross through them and a stop date. This applies to both printed entries and handwritten entries. Printed entries 14/6/15 A Doctor Cross through the discontinued entry Stop date and GP/NP signature Handwritten entries For convenience, only the entry for a PRN medicine is shown here. Regular medicines and short course medicines are stopped in the same way. Cross through the discontinued entry Stop date and GP/NP signature Aged residential care (ARC) Medication Chart implementation and training guide Page 45 of 61

10. An important message for residents and their families and whānau (This form is available as an fillable PDF that can be printed, see Appendix 2) Very soon << name of facility >> will be introducing a new ARC Medication Chart that will be better for residents and staff than the chart currently in use. Why this is important? Most residents in our rest home need medicines to keep them well. Managing those medicines in the rest home is complex. The medication chart that records the medicines a resident is currently taking and the doctor s instructions for using them is a very important part of the process. It ensures residents medicines are effective and residents are safe. Because it is so important, we are always looking for ways to improve how we manage residents medicines. What we will be doing? We will be introducing a new medication chart. This new chart has been developed by the Health Quality & Safety Commission for use in many rest homes across New Zealand. The new medication chart is designed to be easier to fill in, and work from, than present charts in our day-to-day operations. It has the support of the nurses, caregivers, doctors and pharmacists who care for residents in our rest home. Will residents notice anything different? It is likely residents will notice very little difference when the new medication chart is introduced. The most likely thing they will see is that the chart their medicines are recorded on will look slightly different from the chart they are used to. The new chart won t require doctors to change the medicines residents are taking. That said, as is usual, individual residents may find their medicines change from time to time as their health changes. What do residents need to do? Residents don t need to do anything different as the new chart is brought in. Caregivers will continue to ask residents to take their medicines as before. If you have any concerns about the new medication chart, please let one of the nurses know. Aged residential care (ARC) Medication Chart implementation and training guide Page 46 of 61

11. Setting up Toniq (To create a Medicines List, Signing Sheet and Resident Overview Sheet) Additional functionality has been added to Toniq to allow pharmacists to set up and generate Medicines Lists as part of the process of supplying medicines to an ARC facility. The information below describes how to set up the software to generate lists meeting the requirements for the ARC Medication Chart. Setting up and using community pharmacy software to create Medicines Lists and Signing Sheets The sections of the printed ARC Medication Chart are: Resident name Resident National Health Index (NHI) number Resident address Resident date of birth (DOB) Prescriber name and address Prescriber registration number (Medical Council of New Zealand (MCNZ) or other Registration Authority equivalent) Allergies and adverse reactions (described at present as intolerances) Date the chart was printed Regular medicines section Short course medicines section PRN (as required) medicines section Medicine name and dosage form Medicine strength, and strength units Medicine dose and the time(s) it is to be administered Route of administration Name and address of the community pharmacy preparing the printed chart Medicine start date Prescriber signature for each medicine Medicine stop date space Prescriber signature space to authorise the stop date Medicine description Medicine photograph Resident gender Resident room number Facility phone and fax numbers. Note: A record of medicine review outcomes is not required on the printed chart. Please do not provide it. Aged residential care (ARC) Medication Chart implementation and training guide Page 47 of 61

Setting up a printed chart in Toniq that meets the content requirement Note: Further assistance in setting up Toniq is available from Toniq Support (03 341 0195 during business hours; fax 03 341 0196). 1. Printed chart options required to meet mandatory requirements The following three screenshots record the Toniq dosepack chart settings needed to create a printed chart meeting the mandatory requirements outlined above. To access these option screens, follow these commands from the main Toniq screen: 5. Dosepacks/Charts 7. Administration 6. Edit dosepack chart types Note: Pharmacy can edit an existing chart type OR add a new one. The latter is recommended if the pharmacy services more than one ARC facility and the new standards are not being implemented at the same time across all facilities. Press spacebar to see the current chart types setup and possibly select one to edit. If only the default chart type is listed, editing this will affect all charts produced in Toniq regardless of facility. Only select this if you know what you are doing! If there are other chart types listed it may be appropriate to select one of these and edit it, but again if you don t know for sure that this is used by the relevant ARRC facility that is changing to the new standards do NOT select it. OR Add a new chart type (recommended) Press F3 ADD to add a new chart type Press F10 Other and select Row layout default settings First dosepack chart option screen Aged residential care (ARC) Medication Chart implementation and training guide Page 48 of 61

Second dosepack chart option screen Third dosepack chart option screen Aged residential care (ARC) Medication Chart implementation and training guide Page 49 of 61

In the Message lines, insert: 1. Use blank prescribing spaces to add new medicine or change existing medicines ; and 2. Fax the chart to the pharmacy each time a new medicine is added, changed or reviewed, to prompt the ARC facility staff to provide the printed chart to the pharmacy even if the medicines on it are to be continued unchanged. This ensures the pharmacy has full information about the outcome of a medicines review. 2. Printed chart sections required to meet mandatory requirements The following two screenshots record the Toniq dosepack chart settings needed to create the medicine sections in the printed chart meeting the mandatory requirements outlined above. To access these option screens, follow these commands from the main Toniq screen: 5. Dosepack/Charts 7. Administration 7. Edit dosepack chart sections Spacebar (to select the section to set up) Edit the name of each section and order to follow the names and sequence appearing below using the appropriate edit screen. Note: The chart sections already set up may be used for other facility charts. If you are not changing all institutions to the new standards now, add new chart sections rather than editing existing ones. If you do need to add new ones it will be important to check that Rx s in packs for the relevant facilities are moved to the appropriate setups. Required chart sections and sequence Chart section edit screen setup for each of the five sections is shown: Aged residential care (ARC) Medication Chart implementation and training guide Page 50 of 61

3. Recording information to appear on the printed chart The prescriber needs to record the following additional information on the Admission Medicines Order and the Verbal Medicines Order: indication route. Record this information on the medicine label to ensure the information appears on the printed chart. Setting up Toniq to create the Resident Overview Sheet In Toniq, some pharmacies use a short-form facility name to suit the pharmacy processes, rather than using the facility s actual full name. The facility and the pharmacy should agree the preferred facility name to appear on the facility s Resident Overview Sheets. The preferred facility name should be set up in a separate Resident Overview Sheet template for each facility. If a separate template is set up, you do not have to enter the facility name each time a Resident Overview Sheet is printed. 1. Setting up a separate template for each facility The TQ Toniq templates cannot be edited, but a pharmacy template can be created as a copy of the TQ template. Start at the Other/Templates menu, Add, F10 Copy from existing template. If you service, for example, two facilities, create two templates and title them appropriately. Add the agreed facility name to each template. 2. Setting up the Doctor field The Resident Overview Sheet picks up the Usual Doctor field in Toniq. If the Usual Doctor is not to be printed on the sheet (for example, if it is known that another doctor will be signing the sheet off), the Usual Doctor field in Toniq must be updated before printing the template for a patient. Aged residential care (ARC) Medication Chart implementation and training guide Page 51 of 61

12. Transferring information to the new chart When a printed chart is created for the first time, to prevent transcription errors, pay close attention to the need for close liaison and a formal medicine reconciliation process. To formalise this process, use the following process flow: Step 1 See checklist below Step 2 See checklist below Step 3 See checklist below Step 4 See checklist below Use the transfer checklist (below) to make sure each critical step is completed and no medicines are missed off the new chart. Step 1. Initiated and filled in by the pharmacy; reviewed by the facility. Step 2. The new chart is populated with the resident s medicines by the pharmacy. Step 3. The facility confirms the medicines entered into the chart are correct/as they expect. Step 4. The prescriber confirms the medicines by signing the new chart against each individual medicine. Aged residential care (ARC) Medication Chart implementation and training guide Page 52 of 61