Hospitals - Medication management

​​ On this page

  1. Prescribing and dispensing using the PBS Hospit​​​al Medication Chart
  2. Medication handling in NSW public health facilities
  3. Preparation of pharm​​​aceutical and advanced therapeutic products in NSW public health facilities​
  4. Special licence for supply of medications
  5. Public hospital pharmacist supply of medications to community patients​
  6. Image-based prescribing in public health organisations
  7. Partnered Pharmacist Medication Charting

Prescribing and dispensing using the PBS Hospital Medication Chart

The PBS Hospital Medication Chart published by the Australian Commission on Safety and Quality in Health Care may be used as a form of prescription under an exemption​ to the Poisons and Therapeutic Goods Regulation 2008.

The PBS Hospital Medication Chart may be used at a private health facility licensed under the Private Health Facilities Act 2007. Prescribing and dispensing of both Pharmaceutical Benefits Scheme (PBS) medications and non-PBS medicines is allowed.

The forms of PBS Hospital Medication Chart eligible for use are available from the Australian Commission on Safety and Quality in Health Care.

Information on the use of the PBS Hospital Medication Chart are available for prescribers and pharmacists.

For further information on the PBS Hospital Medication Chart contact the Pharmaceutical Services Unit, NSW Ministry of Health by email at MOH-Pharmaceuticalservices@health.nsw.gov.au.

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Medication handling in NSW public health facilities

The policy PD2022_032 Medication Handling consolidates best practice principles on medication procurement, storage, prescribing, supplying, dispensing and administration at NSW public health facilities with the requirements of the NSW Poisons and Therapeutic Goods Act 1966 and the Poisons and Therapeutic Goods Regulation 2008, NSW Health policies and NSW Health directives relevant to medication handling.

Best practice principles are adopted from recognised standards, such as those published by health practitioner organisations, NSW government departments, the Australian Commission on Safety and Quality in Health Care and the Commonwealth Department of Health.

The policy applies to all public health organisation health facilities including hospitals, institutions, clinical services, outpatient clinics, community health centres, day centres, Hospital in the Home and outreach services within the NSW Health system’s jurisdiction (including where a public health service is contracted to a non-government organisation).

The policy does not apply to medication handling and administration by paramedics and flight nurses employed by NSW Ambulance, except for the following specific services provided by public hospital emergency departments:

  • the provision of emergency supplies of morphine to NSW Ambulance paramedics (section 4.4.3)
  • the provision of tenecteplase to NSW Ambulance paramedics under the Pre Hospital Thrombolysis Program (section 5.13.2).

Medication handling and administration within NSW Ambulance is mandated in the Medications Management Operating Procedure endorsed by the NSW Ambulance Chief Executive.

The policy does not apply to HealthShare NSW patient transport service, which is mandated in the separate Patient Transport Service Medication Management Policy endorsed by the HealthShare NSW Chief Executive.

​​Implementing the NSW Health Medication Handling Policy Directive PD2022_032 Medication Handling

All documents endorsed under local gover​nance or department processes may be used to describe facility procedures and do not have to be in the form of a written protocol.

Form of prescriptions

Pre-printed prescription stationery may include the name, address and telephone number of the public health facility and the name and designation of the prescriber. 

Where a prescription (other than for a Schedule 8 medication) is issued in duplicate for dispensing at a public hospital pharmacy service, a pre-printed addressograph may be included on b​oth the prescription and prescription duplicate. A prescription for a Schedule 8 medication must not include any other medication, other than two strengths of the same medication, for example, buprenorphine transdermal patch 30 mcg/hour and 5 mcg/hour. 

NSW Health Schedule 8 approval for prescribing for inpatients 

The prescriber at a public health facility must obtain a NSW Health Schedule 8 approval to continue prescribing the Schedule 8 medicine ​​for an inpatient after 14 days in the following circumstances:

  • when initiated at public health facility for 

    • ​a) a drug dependent person, or for 

    b) dexamfetamine, lisdexamfetamine or methylphenidate​​*

  • ​the prescribing is not in accord with the authority/approval held by the inpatient’s community prescriber.
​*The Class authority to prescribe psychostimulants within maximum dose limits can be used by psychiatrists, paediatricians, or neurologists for the treatment of ADHD in non-drug dependent patients.
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Pharmacy support staff 

Under direct supervision of a pharmacist, designated Pharmacy support staff (e.g. technician) may be involved in accountable drug management. Processes must be in accordance with local Pharmacy Department procedures for the management and handling of accountable drugs, including dedicated training and competency-based assessment, and processes for pharmacist accountability. A pharmacist must review drug register entries and check all details are correct before signing.

Medication supplies to outpatients and inpatients on discharge 

Where clinically indicated, a pharmacist may provide a quantity up to, but no greater than, the quantity prescribed on discharge or for outpatient supply. The supply of discharge medications is limited to a maximum of up to 7 days of treatment under the local protocol other than when approved to meet a specific patient need.

The pharmacist must clearly notate on the prescription the actual quantity dispensed if less than stated on the prescription.

Destruction of expired, unwanted, or unusable Schedule 8 medications 

Any technique used to destroy Schedule 8 medication should be in line with facility approved procedures and medication must be made unusable and unrecoverable. Wherever possible destroyed, unrecoverable medication must be disposed of in a pharmaceutical waste bin.

Schedule 8 medication stock transfers 

Stock transfers to other public health facilities must be under Director of Pharmacy approved procedures.​

Two registered nurses or midwives authorised by the nurse/midwife in charge of the patient care area may transfer Schedule 8 medications within a public health facility.​

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Preparation of pharmaceutical and advanced therapeutic products in NSW public health facilities

Preparation of pharmaceutical and advanced therapeutic products in NSW public hospital is governed by the Polic​y Directive PD2023_021​. For further information see Preparation of pharmaceutical and advanced therapeutic products in NSW public health facilities​​.​​

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Special licence for supply of medications 

Special licences have been issued under the Poisons and Therapeutic Goods Regulation 2008 to supply certain medicines by wholesale.

Licence LHD006 allows a public health organisation to supply selected medicines to another public health organisation or to non-government organisations in specified circumstances.

Supply from a public health organisation may be made by:

  • the Director of Pharmacy of a public hospital or
  • the Director of Nursing at a public hospital without a Pharmacy Service.

The supplying public health organisation must comply with the conditions of the licence.

Licence COVIDVA​X007 allows the supply of ​COVID-19 vaccines to selected vaccination sites.

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​​Public hospital pharmacist supply of medications to community patients

The supply of medications to community patients cared for by a Local Health District during the pandemic, by a public hospital pharmacist, has been approved. The approval is an exception to the policy in NSW Health PD2022_032 Medication Handling (see section 4.4.1 of the Procedures) which normally limits supply to outpatients, inpatients and inpatients on discharge.

The supply by the public hospital pharmacist may be:

  1. On the digital image of a prescription, sent in a secure email or by facsimile, from an authorised practitioner (such as a medical practitioner or nurse practitioner) to the hospital pharmacy. 
  2. For Schedule 8 medications, as if a patient in special hotel accommodation is an inpatient at a public hospital. The hospital prescriber may continue to prescribe the Schedule 8 medication without a NSW Health approval in accord with the NSW Health approval held by a community prescriber.

Where there is no NSW Health approval held by another prescriber, the hospital prescriber may prescribe the medication for 14 days without a NSW Health approval then must obtain any necessary approval to continue treatment. Refer to Application forms for approval to prescribe or supply.

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Image-based prescribing in public health organisations

Medical practitioners and nurse practitioners in NSW can issue an image-based prescription for Schedule 4 and Schedule 8 medicines and send it by email or fax to a dispensing pharmacist employed in or engaged by a public health organisation.

Image-based prescriptions do not need to be followed up with a hard copy of the prescription and can be issued with repeats for Schedule 4 medicines, including those in Appendix D and Schedule 8 medicines

The steps for image-based prescribing are:

  1. Prescriber issues a regular prescription, including a handwritten signature
  2. Prescriber prepares an image of the prescription (photo or scan) and sends it directly to the public health organisation pharmacy by fax or email
  3. Pharmacist dispenses the prescription and arranges supply to the patient
  4. Prescriber keeps the signed prescription either in hard copy form or as a reproducible digital image for two years.
  5. Pharmacist keeps any repeats and all prescriptions for two years.

For a prescription issued with repeats, the pharmacist is to print the repeat authorisation form as normal and attach it to the printed copy of the image-based prescription and store them together at the pharmacy for future dispensing. 

Frequently asked questions

How does a prescriber make an image-based prescription?

​The medical or nurse practitioner can issue a prescription as normal, including signing the prescription by hand. Once the prescription is complete, the prescriber takes an image (photo or scan) and sends it to the public health facility pharmacy via fax or email. The prescriber must keep the signed prescription either in hard copy form or as a reproducible digital image for two years.

The patient has a photo of th​e​ir prescription. Can a pharmacist dispense it?
No. Image-based prescriptions are only valid when sent directly to the pharmacy by the prescriber using email or fax.

What does a pharmacist do if the medicine requested on an image of a prescription is not in stock?
If a pharmacist cannot dispense a medicine on an image-based prescription, they should inform the prescriber so that the prescriber can make other arrangements. A pharmacist cannot forward an image-based prescription to another pharmacist for dispensing.
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​Partnered Pharmacist Medication Charting

The Partnered Pharmacist Medication Charting (PPMC) is a model of care supported by the NSW Ministry of Health that allows credentialled pharmacists to chart medication administration directions as authorised by a medical officer.

The PPMC is to be used in a number of approved public health facilities and is enabled under an Approval under the Poisons and Therapeutics Goods legislation.

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Current as at: Wednesday 18 December 2024
Contact page owner: Pharmaceutical Services