National Inpatient Medication Chart (NIMC) - Frequently asked questions
Page contents: General questions | Telephone orders | Medication history | Warfarin | Regular medications | Discharge section
General questions
Telephone orders
Medication History
Warfarin
Regular medications
Discharge section
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General questions
Q. Can I amend the NIMC to meet local needs?
A. Yes. Some aspects of the NIMC can be adapted to meet local needs. These are outlined in the Interim Specifications document. To download this document, see Variations and version control.
Q. Which versions of the NIMC are being used at state and national level?
A. There are two versions of the NIMC. Version D integrates ‘telephone orders’ with ‘once only’ orders. Version E has a separate section for telephone orders.
In Victoria, version E has been implemented by all health services except for two metropolitan sites.
Nationally, Queensland and South Australia are using version D and Northern Territory, Western Australia, New South Wales and Tasmania are using version E.
Q. Which variations and versions have been endorsed by the Australian Commission on Quality and Safety in Healthcare (ACSQHC)?
A. Dr Diana Horvath, Chief Executive Officer, ACSQHC, has endorsed version E for use nationally. Fold-out versions and versions that incorporate non-carbon-required (NCR) copies are endorsed variations, provided that the format and relative positions of the sections are consistent with version E.
Q. What ancillary charts are available?
A. The following ancillary charts are in various stages of development:
- insulin chart
- palliative care chart
- intravenous chart
- paediatric chart
- long stay (35 day) chart
- residential aged care.
The implementation of ancillary charts is outside the current phase of implementation. Health services therefore may use existing charts for these situations.
For more information see Ancillary charts under development.
Q. Who is developing the ancillary charts?
A. A national NIMC Oversight Committee has been established to maintain version control of the NIMC and to support the development of standardised ancillary charts. Until national standardised ancillary charts have been developed, health services may use locally developed ancillary charts.
For more information see Ancillary charts under development.
Q. Will private hospitals use the NIMC?
A. A number of private hospitals have adopted the NIMC to maintain the safety benefits of standardisation. The chart used in private hospitals needs to facilitate the submission of prescriptions for inpatient medication to the Health Insurance Commission, as applicable.
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Q. Will hospitals be required to perform pre-implementation audits?
A. The completion of audits is not mandatory, however, sites reported that pre-implementation audits were helpful for generating local data to support education sessions.
Q. Will we be able to make changes to the NIMC in the future?
A. The ACSQHC has stated that the NIMC will be updated only when there is a powerful, evidence-based case for change. In Victoria a ‘change register’ has been developed to incorporate recommendations for changes to the NIMC. These changes will be submitted to the National NIMC Oversight Committee. It has been proposed that this committee will meet annually to maintain version control and support the development of ancillary charts.
To access the Change register, see Registers.
Q. How does this initiative integrate with the development of electronic prescribing?
A. The Quality Use of Medicines (QUM) Program is collaborating with electronic prescribing agencies to ensure that the safety features of the NIMC are maintained. It has been suggested that the implementation of the NIMC will assist evaluating safe prescribing and administration features and will act as a standard platform on which to implement electronic prescribing.
Q. What resources, tools, information and guidelines are available electronically to support the implementation of the NIMC?
A. The following resources are available on our website:
- implementation register
- change register
- Health Ministers’ communiqué
- NIMC pdf files
- fact sheets
- presentations
- guidelines
- audit tools
- poster template.
To access these tools see NIMC toolkit.
Q. Is it mandatory to implement the NIMC in intensive care units, day case units and emergency departments?
A. No. It has been acknowledged that the NIMC may not best suit the needs of certain specialist areas. A decision may therefore be made whether to adopt the NIMC or continue with locally developed charts, taking into consideration the benefits of standardisation and minimising the number of different charts available.
 NIMC implementation in specific patient groups (44kb, pdf)
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Telephone orders
Q. We are a metropolitan site and wish to limit doses for telephone orders to one. How do we adapt the NIMC to achieve this?
A. A consensus was reached by the Victorian NIMC working party to ‘black out’ three of the four doses in the telephone order section of NIMC, version E, to limit the number of doses that may be prescribed by telephone order, to support local policies.
Medication history
Q. Is it mandatory to complete the ‘medicines taken prior to presentation to hospital’?
A. No. This section is included in the medication chart to facilitate quick and effective documentation of, and access to, medication history information for medication reconciliation. Some health services have opted to use this section of the NIMC for ‘low risk patients’ and adopt a ‘medication reconciliation for ‘high risk patients’. Visit the Safer Systems Saving Lives website for a medication reconciliation form.
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Warfarin
Q. The recommended dose time for warfarin on the NIMC is 1600. In rural and regional healthcare services visiting medical officers receive INR results around 1700 and prescribe the warfarin dose to be administered at 1800. What is the rationale behind the pre-determined warfarin dose time of 1600?
A. A standard dose time of 1600 hours (4pm) is recommended as this allows the medical team caring for the patient to order the next dose based on INR results, rather than the after-hours team, who may be unfamiliar with the patient details. In regional and rural areas, where prescribing is by visiting medical officers, a later dose administration time may be more appropriate to ensure that INR results are available to inform the choice of dose. Upon discharge, some patients may find an alternative dosage schedule facilitates compliance, for example taking warfarin in the morning with other ‘once daily’ medication. For all warfarin patients it is important that dosing times are consistent and that the prescriber is aware of the regular dose time in relation to the INR sample time.
Q. In regional and rural settings the warfarin dose is frequently advised by telephone order. How should this be documented on the NIMC?
A. The NIMC is not specifically designed to cater for this scenario at present. It has been suggested that the warfarin section within the ‘regular medications’ section might be adapted for this purpose as it possible for two nurses to countersign the documented warfarin dose. The prescriber may then sign below the corresponding dose in the same way as would occur for telephone orders. Using the chart in this way will ensure that the INR doses and trends can be easily reviewed, whilst legislative requirements for telephone orders are adhered to.
Regular Medications
Q. Our current medication charts include a section for a cease date for medication orders. Can this be incorporated into the chart?
A. The NIMC represents a compromise, balancing the need to include information required for safe prescribing and administration of medication, with the need to maintain clarity. Suggestions for amendments to the NIMC together with a rationale for change should be submitted onto our ‘change register’. In the meantime, education for ceasing medication should include the following:
‘When stopping a medicine, the original order must not be obliterated. The doctor must draw a clear line through the order in both the prescription and the administration record sections, taking care that the line does not impinge on other orders.’
The doctor must write the reason for changing the order (for example, cease, written in error, increased dose) at an appropriate place in the administration record section.
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Q. The National Inpatient Medication Chart (NIMC) requires prescribers to endorse administration times. What is the rationale for this?
A. When nursing staff write the administration times, evidence suggests that there is potential for the frequency to be misread or administration times to be incomplete. When a prescriber writes the administration times the need for interpretation of instructions by a second party is removed and therefore the risk of the drug being administered at the wrong frequency is reduced. During the pilot study, the incidence of administration times being different from the prescribed frequency reduced from 10.5 per cent to 2.9 per cent following implementation of the NIMC.
Q. How are variable doses of insulin prescribed on the NIMC?
A. A consensus was reached amongst members of the Victorian NIMC working party, in conjunction with representatives from Victorian Health Services, that best evidence based practice did not support widespread use of insulin sliding scales. It was suggested that insulin should be prescribed and reviewed daily, with supplementary ‘prn’ doses. Some health services reported that local forms had been developed to facilitate insulin prescribing.
Q. How can the NIMC be used to promote venous thromboembolus (VTE) prophylaxis?
A. A range of approaches has been adopted across Victoria to promote VTE prophylaxis.
Discharge section
Q. We are unlikely to use the discharge prescription section of the NIMC as our healthcare service uses separate Pharmaceutical Benefit Scheme (PBS) discharge prescriptions. Can we remove this section and replace it with additional administration boxes?
A. The discharge section was integrated with the NIMC in order to minimize the potential for transcription errors that might occur when a separate discharge prescription is written. At present there is no statewide approval for the NIMC to be used by the Health Insurance Commission (HIC) for reimbursement of PBS prescriptions. Therefore hospitals using PBS discharge prescriptions may replace the discharge section with additional administration boxes.
For further information about the NIMC implementation please visit the VMAC website.
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