Epworth utilises the National Inpatient Medical Chart for inpatient prescribing and Medical Practitioners are required to adhere to laws regarding the Drugs, Poisons and Controlled Substances Act 1981 and Regulations 2006.
MIMs Online and eTG (Therapeutic Guidelines) are available to you on all desktops and via the intranet and library link.
Any medications intended to be administered to the patient during their hospital stay including pre-existing medication must be prescribed on the inpatient medication chart.
National inpatient medication chart (NIMC)
The doctor is responsible for ensuring medication orders are complete and legible and include the following details:
- Computer generated patient Medical Record Label
- Date of prescription
- For intravenous therapy, the rate of the infusion
- Instruction for starting, stopping and changing treatment regimes
- Quantity or duration of treatment with medication administration times
- Name of the drug (generic), strength, dose, frequency (including admin time) and route
- Patient's name and medical record number in the doctor's own handwriting, with the exception of an approved electronic prescribing tool
- Printed name, signature and PBS prescribing number of the doctor (please note any stamps used still require a signature from the medical practitioner)
- Use of recommended medicine prescribing terminology, abbreviations and symbols
Pre-existing medication should be indicated on the medication chart by a doctor, nurse or pharmacist ticking the appropriate box.
When a medicine order needs to be changed, the prescriber must not overwrite the order. The original order must be ceased and a new order written. Self-administration of medication by patients requires a written order by the treating doctor. Patients may not self-medicate, but may administer their own medication under direct supervision from a nurse.
Telephone and verbal orders
Nurses accepting a telephone or verbal order from a doctor must do the following:
- Repeats the order back to the doctor
- Writes the order in the ‘Telephone & Short Term orders’ section of the Medication Chart and signs his/her name
- A second nurse or pharmacist verifies the order using the same procedure or using the speaker facility on the telephone
- For telephone order obtained by pharmacists, only one pharmacist is required for a telephone order and the quantity supplied can be the full PBS quantity
- Telephone orders are to be countersigned and dated by the prescriber within 24 hours
Duration of medication orders
- A maximum of 24 hours of therapy can be enacted under telephone and verbal orders
- Ceased medications must be documented and signed by the doctor on the Medication Chart
- Medication Charts used in specific clinical areas e.g. ICU and PACU must not be used as a treatment sheet outside of these clinical areas
- Medication orders are valid for the duration of the Medication Chart unless otherwise specified by the doctor
- The Emergency Department 24-hour Medication Chart is used as a treatment sheet in the clinical areas for the first 24 hours of the inpatient stay
Discharge medication orders
Doctors prescribe discharge medications on the Medication Chart and must document specific instructions as required. The nurse and/or pharmacist will contact you for clarification of discharge orders if required.
The protocol for prescribing at Epworth provides details on PBS, non-PBS, special access schemes and veteran affairs are also included.
- Medication Prescribing Protocol
Please note that you will need to be logged into the Staff Portal to access policies
For further information regarding expectations of medication orders by doctors please refer to the NIMC (ACSQH) guidelines.
Antimicrobial stewardship
Epworth offers an Antimicrobial Stewardship (AMS) service for all doctors and patients. The AMS aims to help patients by optimising antimicrobial use and reducing the redevelopment of resistant micro-organisms.
This can be achieved by optimising antimicrobial use and reducing the development of resistant micro-organisms. This can be achieved through monitoring local trends in prescribing and microbial sensitivity. The AMS team help ensure that (for patients not already referred for an infectious disease consultation) the antimicrobial prescription is reviewed and optimised as further information becomes available.
This includes offering timely feedback on prescribing to doctors, or recommending referral to an infectious diseases consultant when necessary. These unsolicited reviews intend to assist clinicians and are reliant on information available from the drug chart, the pathology system and progress notes.
Clear documentation of the indication for treatment and the plan for review help to focus AMS advice, and to satisfy the requirements around the Accreditation and Clinical Care Standards for AMS.
For direct patient consultations, staff should continue to refer to the Infectious Diseases Consultants accredited at Epworth. The AMS team consists of a pharmacist and physicians. Further details can be obtained via the intranet.
For antimicrobial stewardship queries, email: [email protected]
Further information regarding antimicrobial prescribing is available from the Antimicrobial prescribing protocol.
Please note that you will need to be logged into the Staff Portal to access policies.
Venous thromboeembolism
Venus Thromboembolism (VTE) at Epworth requires a VTE Nursing Risk Assessment tool (MR 46D). This form is part of the suite of clinical risk assessment forms completed when all patients are admitted, or when their clinical condition alters. The patient will be assigned a high or low risk status and then their contraindications (if any) to chemical or mechanical prophylactic measures will be determined and you will be contacted and informed of the patient's risk status and asked what treatments (medicine and/or mechanical) you would like commenced.
Treating consultants are also required to complete the VTE section on the medication chart, which includes acknowledgement that the patient has been risk assessed and the prescription of appropriate prophylaxis is required. Clear documentation in the medical notes with clear indications is required if, in your opinion, chemical or mechanical prophylaxis is to be withheld for clinical reasons despite the VTE risk assessment tool indicating that they are of high risk.
ARIA medical oncology information system - chemotherapy prescribing
Medical Oncologists and Haematologists at Epworth Richmond and Freemasons are required to use the ARIA Medical Oncology Information System for computerised chemotherapy prescribing. The system contains over 300 regimens from eviQ and also includes other regimens with supportive literature as requested by clinicians, with existing processes for adding new policies as they are developed. ARIA aims to reduce risk in clinical errors by enhancing both the quality and communication of information between services.
ARIA can be accessed by using a remote login to Epworth from any computer connected to the internet. You can also use any desktop or mobile device. Any necessary training and support will be provided by Epworth.
Paediatric Prescribing
All paediatric patients are to have medications prescribed on Paediatric Medication Chart MR80AB only and all paediatric medications must have the mg/kg section documented when medications are prescribed to facilitate age/weight appropriate medication administration.
The Australian Medicines Handbook (AMH), Children's Dosing Companion is available on your desktop and the intranet.