The Register of Emergency and Life-saving Medicines (REALM), formerly known as the Life Saving Drugs Register (LSDR), is a NSW Health resource that provides indicative information regarding where emergency and life-saving medicines are held across NSW Health facilities. The register was previously managed by the NSW Therapeutic Advisory Group (NSW TAG) as web based excel spreadsheets and is now supported and managed by the Clinical Excellence Commission (CEC) as an online searchable database.

The REALM does not recommend or endorse the use of any medicine, but supports timely access to antidotes, antivenoms, and other critical medicines used to treat infrequent, acute and life-threatening illnesses or poisonings when they are clinically indicated.

REALM is supported and managed by the Clinical Excellence Commission (CEC). The Emergency and Life-saving Medicines Expert Advisory Group (ELM EAG) is a multidisciplinary advisory group that provides the CEC with expert advice on emergency and life-saving medicines. This includes advice relating to which medicines are listed on the REALM, the design and functionality of the REALM, and the need for statewide direction regarding emergency and life-saving medicines.

Medicines in the REALM include antidotes, antivenoms, and other emergency and life-saving medicines used to treat infrequent, acute and potentially life-threatening conditions or poisonings. These medicines may not be routinely stocked by all facilities, or depending on patient requirements, facilities may require access to additional quantities to support timely patient care. Uncommon or specialised testing kits may also be included.

The REALM includes indicative stockholdings held at NSW Health facilities within pharmacy departments and clinical areas. It also displays indicative stockholding information for selected affiliated services, including Sydney Adventist Hospital, Albury Wodonga Health, The Canberra Hospital, and North Canberra Hospital. Facility contact details are also provided to support NSW Health clinicians and services in contacting the relevant facility to source medicines when clinically required.

The REALM is an information resource and does not provide medicines directly to members of the public. If you are a member of the public and require access to a medicine, please contact your healthcare provider for advice and assistance. In an emergency, call Triple Zero (000). For poisoning-related advice, contact the NSW Poisons Information Centre on 13 11 26.

For NSW Health clinicians and services seeking to source a medicine, the facility contact details listed within the REALM should be used to contact the relevant facility directly.

Stockholding information is obtained from i.Pharmacy, the clinical application used by NSW public hospitals for medicines inventory management. The REALM captures stockholding information for selected products and locations that have been mapped to each medicine/indication.

For NSW Health pharmacy departments, REALM stockholding information reflects the quantity on hand as at close of business the previous business day. Data is extracted from i.Pharmacy overnight, and the REALM is updated at approximately 11 am the next business day. Stock movements occurring after the extract will not be reflected in the REALM until the following update.

For other NSW Health clinical areas, such as ward imprests, REALM stockholding information reflects the quantity designated to be routinely stocked within that location.

Stockholding information for affiliate sites is provided directly by the affiliate site and reflects the quantity designated to be routinely stocked at that location.

As a result, the information displayed in the REALM should be considered indicative of medicine availability.

Indicative stockholding information for NSW Health facilities is updated at approximately 11 am each business day, using data from close of business the previous business day. For affiliate sites, stockholding information is updated twice yearly. Other changes, such as updates to medicine information, facility contact details, or medicines included in the REALM, are made on an as-needed basis.

Requests for changes to the REALM are reviewed by the CEC and the Emergency and Life-saving Medicines Expert Advisory Group using an endorsed decision-making tool that considers whether the medicine is used as a first-line treatment, time-criticality, alternative treatment options, and whether the medicine is expected to be routinely stocked in the required quantities.

NSW Health clinicians, services, and partnering organisations may request the addition, update, or removal of a medicine from the REALM. Change requests can be submitted using the REALM change request form.

Previous changes to the REALM can be seen in the REALM Decision and change summary. This summary includes medicines endorsed for inclusion in the REALM, medicines removed from the REALM, change requests not endorsed, and change requests currently under consideration.

No. Inclusion on the REALM does not mean every facility is expected to stock the medicine, nor is it an endorsement for the use of the medicine. The REALM provides visibility of where medicines are available and may also include medicines that are centrally held or accessed through specialised services. Health services should determine local stockholdings based on clinical need, service capability, NSW Health policy directives, and relevant recommendations.

Newly stocked medicines will generally appear in the REALM within 24 hours (typically around 11 am the next business day) of being added to a facility’s inventory. If the medicine does not appear after 24 hours, the issue may be related to local system configuration or product and location mapping. In these circumstances, please contact the CEC via email for assistance.

For any questions, queries, or assistance relating to the REALM, please contact the CEC via email.