Contents 1. Introduction 2 1.1 How to use the Requirements 3 2. Requirements for the Australian context 4 2.1 State and territory legislation 4 2.2 Australian Government legislation 5 2.3 National infrastructure and standards 6 2.4 National Safety and Quality Health Service Standards 8 3. General EMM requirements 10 3.1 EMM principles 10 3.2 Audit, access and synchronisation 11 3.3 Patient identification 11 3.4 Allergies and adverse drug reactions 12 3.5 Continuous medication management 13 3.6 Medication-related clinical information 14 3.7 Medication reconciliation 15 3.7.1 General requirements 15 3.7.2 On entry to the organisation 16 3.7.3 On discharge from the organisation 16 3.7.4 Transfer 17 3.7.5 Safety features of the printed national standard medication chart 17 4. Prescribing medicines 18 4.1 Prescriber workflow 18 4.2 General prescribing 20 4.3 Changes to medicine orders 24 4.4 PRN medicines 24 4.5 Medicines with complex instructions 25 4.6 High-risk medicines 25 4.7 Variable-dose medicines 26 4.8 Conditional dosing 27 4.9 Infusions 28 4.10 Antimicrobial medicines 29 4.11 Controlled medicines 29 5. Clinical decision support 30 6. Pharmacist review 34 6.1 Supply and interface with dispensing systems 35 7. Medication administration 36 7.1 Before administering medicines 36 7.2 Medication administration workflow 37 7.3 Medication administration 40 8. Discharge medicines 42 9. Electronic medication information exchange 44 9.1 Medication safety if there are multiple EMM systems 44 9.2 Support for medication reconciliation 45 10. Specialty-specific EMM requirements 46 10.1 Chemotherapy 46 10.2 Paediatrics 48 10.3 Anaesthetics and intensive care units 50 10.4 Emergency department, including resuscitation 50 10.5 Renal dialysis 51 11. Support for business as usual 52 Appendix Information sources 53 References 54
The electronic medication management (EMM) system should support clinical decision support, which should be: Appropriate and applicable to Australian medication practice Available and active during the prescribing process Available during medication administration Automatically re-run whenever new medicines or changed medicines are ordered for a patient Intelligently hyperlinked, so that reference material is available without the need for the prescriber to leave the prescribing function. Reference information could include: A local formulary Locally configured pharmacy-supplied information – for example, treatment options Therapeutic Guidelines Australian Medicines Handbook MIMS Australia§ Hospital policies Information on pharmacokinetics or pharmacodynamics External websites or online resources. Box 5.1 lists items and actions that benefit from using a clinical decision support system. Box and actions for decision support An electronic medication management system should include decision support tools for the following items: Medicine–allergy checks Medicine adverse reactions Intolerance Contraindications Dose range checking Therapeutic duplication Medicine–medicine interactions Medicine–allergy interactions Medicine – diagnostic test result checking Medicine–disease checking Cumulative dose checking Medicine–age interaction Medicine–gender interaction, such as excluding pregnancy and breastfeeding warnings on medicines prescribed to male patients