The National Inpatient Medication Chart (NIMC) was developed to standardise the processes for prescribing, dispensing, administering and reconciling medicines across all health service organisations, and ensure patient information is communicated consistently between health professionals. All Australianpublic and private hospitals must use the NIMC.
The Australian Commission on Safety and Quality in Health Care (ACSQHC) have developed a number of training and education materials. These resources are available from the ACSQHC website.
As the NIMC is a fundamental element in patient safety, revisions are occasionally required to further improve this tool. The NIMC was updated in March 2014 to include a dedicated section for VTE Management and changes to the PRN section.
Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in Australia. The Clinical Excellence Commission is currently developing a comprehensive strategy to reduce the rate of VTE in NSW. A component of this strategy is the implementation of the revised NIMC. It has a dedicated sectionfor VTE, including area for documenting VTE risk assessment (as indicated by arrow 1, below), prescribing pharmacological prophylaxis (arrow 2), and prescribing mechanical prophylaxis (arrow 3).
This revised NIMC was developed and piloted by the ACQSHC in a number of facilities across Australia. They were able to demonstrate an improvement in the documentation of risk assessment by over 21 per cent and improved provision of prophylaxis to patients in these facilities.
As of March 2014, the revised NIMC will supersede all earlier versions of the NIMC in NSW public hospitals. All clinicians need to be aware of the change and trained on how to use the chart. Educational resources are available from the Australian Commission on Safety and Quality in Health Care website.
The prompt for PRN (pro re nata) has been revised to read "Max PRN dose/24 hrs" to indicate the maximum amount of medicine to be administered in 24 hours for PRN doses only. The original PRN prompt "Max Dose/24 hrs" has been used for some time, however this wording has caused confusion particularlywhen medicines are prescribed as both regular and PRN orders. It is unclear as to whether the maximum dose indicated is the PRN dose or the overall daily dose.
The PRN section of the NIMC is used to order 'as required' medicines. Prescribers must indicate the maximum PRN dose to be received in a 24-hour period to avoid over-dosage.
This revision affects all variations of the NIMC, including the regular, long stay chart and paediatric charts.