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The changes to the business rules for Residential Medication Management
Reviews (RMMRs) in Residential Aged Care Facilities (RACFs) in March 2014
made it even more important to be efficient in providing RMMRs.
I work in a team providing RMMR and
Quality Use of Medicines (QUM) services
to five RACFs in the Hobart area under a
contract with the community pharmacy
which supplies the medication to the
RACFs. We use an Access database with
details of the resident’s name, date of
referral, dates of reviews, the general
practitioner’s name and reasons for the
referral. Every three months we generate
a report showing which residents are
eligible for a RMMR, grouped by their
GPs’ name, and send the list to the GP.
Most doctors reply within a week of
the referral letter. The doctors seem to
be checking the lists and only writing
referrals for residents with a clinical need
for the RMMR. The 5CPA has always paid
any reviews done within the two year
time frame. I keep records of the clinical
need specified by the GP in case this
information is requested by 5CPA.
The focus and the process of a RMMR is
quite different from a Home Medicine
Review (HMR). A lot of the information
needed is contained in the medical
record, which is mostly electronic
in the RACFs that I visit. Here I find
details such as blood sugar levels,
blood pressures, pain scales and
bowel charts. The resident also has
a hard‐copy drug chart and a folder
containing old records and items such
as specialists’ letters. Any instances of
refusal of a dose are documented so the
resident’s compliance is easily assessed.
Collaboration with the staff is really
important and I always ask the nurses
lots of questions. The care staff is also
a valuable source of information about
things such as the resident’s mobility.
Some residents self‐medicate, usually
with a dose administration aid. For these
residents a combination of access to the
records and an interview provides the
information for the RMMR. The nursing
staff sometimes recommend that we
interview a resident e.g. when the
» ACCREDITED PHARMACIST SPECIAL INTEREST GROUP
RMMRs – reducing tablet
BY DR MACKENZIE WILLIAMS
Dr Mackenzie Williams is a lecturer in pharmacy
practice at the University of Tasmania. She continues
to work part-time in community pharmacy and as a
consultant pharmacist providing HMRs and RMMRs.
resident is experiencing symptoms
suggesting a drug side effect.
The most critical RMMR is often the one
on admission to the RACF. It is important
to create a correct and current record for
the resident. Often the resident has had
poor compliance in the community, and
then on admission to the facility they
are dosed regularly with their medicines.
This often results in side effects and
my report to the GP may include
recommendations for dose reductions.
Three areas that always seem to be a
major focus of RMMRs are bowel function,
sleep and a reduction in tablet load. Many
residents may be taking a combination
of laxatives on an as required basis,
and benefit from a recommendation to
change to a single laxative. Some residents
complain that they are taking too many
tablets, that they don’t like large tablets
and so on. Options include ceasing some
medicines, replacing some medicines
and suggesting the use of combination
medicines to reduce tablet load.
An efficient process for generating
your RMMR reports is just as important
as your process for requesting the
referrals and conducting the reviews.
We usually attend a RACF and do three
or four RMMRs in a morning, then
send a covering letter to the GP with a
one page management plan for each
resident. With Hobart being relatively
small we have a chance to see the GPs
occasionally at the RACF and develop
Every three months we run an education
session for the staff of the RACF under
our QUM contract. Sometimes we
suggest the topic for the QUM sessions
and sometimes they are in response
to a local need. Staff have previously
asked for a session on what actually
happens in a RMMR, and this helped
with understanding and collaboration.
A recent popular topic was the use
of antibiotics for chest infections and
urinary tract infections.
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