Home' Australian Ageing Agenda : AAA Jan-Feb 2015 Contents The Australian Commission of
Safety and Quality in Health
Care (ACSQHC) has recently
endorsed and released
the National Residential
Medication Chart (NRMC) that recognises
the need to track resident care in a
holistic and resident-centred approach,
including nutrition care interventions.
The NRMC is designed to replace
existing medication charts nationally
across the residential aged care sector
and streamline associated documentation
such as blood glucose records and
nutrition supplement administration.
These charts are for voluntary uptake by
aged care facilities.
ACSQHC trials have shown the charts
promote holistic resident focused care,
reduce medication related incidents,
increase compliance with accreditation
medication management and are cost
effective. The new charts increase
efficiency through documentation of
nutrition supplements within the resident's
medication chart and settle the age old
debate of who can prescribe supplements
(doctors, dietitians, nurses).
There will no longer be a need
for separate nutrition supplement
administration sign-off charts floating
about medication trolleys that get tattered,
torn or are often incomplete.
The chart also prompts evaluation of
nutrition supplements use by documenting
weight change within the supplement
administration record. This will assist
nursing staff to identify when a resident
may require dietitian review and
adjustment of supplement doses.
Accredited practising dietitians (APDs) are
trained in medical nutrition therapy, the
in-depth understanding of the interaction
between diet and disease, including the
impact of nutrition on malnutrition risk.
This training is recognised in the new
medication charts whereby dietitians are
authorised to prescribe and document the
prescription of nutrition supplements in
the 'Nutritional Supplement intake and
Weight Monitoring' section of the charts.
Allowing dietitians to document nutrition
supplement prescription facilitates
multidisciplinary co-ordinated resident
care and will assist residents to receive the
right supplement in the right dose for their
There are many oral nutrition
supplement products currently in the
marketplace, all have clinical indication
in specific circumstances but not all
supplements are equivalent. Doses of oral
nutrition supplements need to be calculated
based on an individual resident's nutrition
requirements and their current intake
deficits. For example, if a resident who is
losing weight is only able to achieve 80 per
cent of estimated nutrition requirements
through foods and food fortification, then
we need to supply an additional 20 per
cent of nutrition through oral nutrition
supplements. If only 10 per cent additional
nutrition is provided through incorrect dose
or type of nutrition supplements then the
resident will likely continue to lose weight.
Unfortunately due to lack of
dietetic support, many residential aged
care facilities are currently stocking
supplements that are not the most effective
or are providing supplements in incorrect
doses. This has the potential to increase
the healthcare burden of malnutrition and
associated negative health outcomes.
On the flip side, some residents are
being over prescribed supplements,
resulting in unnecessary waste and costs.
For example, a supplement may have
been prescribed on admission to an aged
care facility, or whilst a resident was in
hospital unwell and this prescription has
not been reviewed or ceased if no longer
It is expected that with the wider
adoption of the new medication charts,
some of these issues will be addressed and
there will be widespread improvements to
the nutrition care of senior Australians in
aged care facilities.
Further information on the
NRMCs can be found ACSHC website
Denise Burbidge is an APD working as
the chief dietitian with Leading Nutrition, a
national aged care dietetic services provider.
She is chapter co-ordinator for the Victorian
Branch of the DAA Rehabilitation and Aged
Care dietitians Interest Group. To find an
APD, go to daa.asn.au
of nutrition care
New charts increase efficiency through documentation
of nutrition supplements within the resident's
medication chart, writes Denise Burbidge.
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