MAP MonthWard Nursing & Allied Health Staff

Pharmacy, Medication Safety Working Group & WHO High 5s Working Group

September 2011

Agenda

• What is the MAP?• Why have the MAP?• How can you use the MAP?

What is the MAP form?

• MAP = Medication Action Plan

• Clinical handover of medication management– Admission: BPMH & reconciliation with medication chart – Daily: medication review & issues log for handover to

prescribers and other clinicians

– Discharge: reconciliation & discharge medication record provision

• Kept in bedside folder: ALL clinicians have easy access

• A daily tool to improve patient care & planning for discharge

Why have the MAP form?• 1 in 2 patients have one regular medication omitted

unintentionally on admission(1-3)– MAP allows ‘MATCHING UP’ of medications at home vs charted

• Up to 5 medication histories documented per patient per admission(4)– Do not correspond to each other, often incomplete/inadequate, on 9 possible QH forms– BUT used as a baseline for future management decisions

• Decisions not clearly documented– MAP: a defined place to record medication issues/plan

vs interspersed throughout progress notes

• Post-it note culture– No formal tool for handover/documentation/interventions– Loss of information & inefficiencies eg work duplication

• Facilitates timely discharge & accurate informationprovision to patient & community health-care providers

– Part of Clinical Handover– Issues resolved before discharge: improve bed-flow issues

(1) Stowasser DA. [PhD] The University of Queensland; 2000; (2) Lum E, [MClinPharm] The University of Queensland; 2002; (3) Cornish P, Knowles S, Marchesano R, et al. Arch Intern Med 2005;165:424-9;(4) QH Sites Baseline Audit 2005 (SMPU)

Mismatch?

- Plan was to ‘Continue all meds’

- BUT some meds not charted; different doses charted

Which is right??

‘Dr’s Plan’ column completed on admission enables medication reconciliation with medication chart

Medication-Related Issues

Issues identified by ALL clinicians are noted on the front page

What to document when issue identified

• Time & date• Clear, concise detail of issue• Proposed action• Person responsible to solve issue & if notified• Progress if appropriate• Name & contact number of person identifying issue• Date & result of action

Who can document on the MAP form

• ALL clinical team members:– Doctors

– Pharmacists

– Nursing Staff

– Allied Health (Dieticians, Speech Pathologist, Physiotherapists, Occupational Health Therapists, Social Workers and more)

A Nursing Example

• A great intervention, but…• No name of contact

person, in case feedback is needed

• Not ‘formally documented’: no record of intervention

• Post-it can easily be lost

• Could have been written on the MAP

Some real-life examples so far

Allied Health Examples

• Physiotherapist – Mobility problems worsened by

medications– Medications potentiating falls

• Speech Pathologist– Safety of crushed medications– Medications affecting

swallow/salivation

• Occupational Therapist– Pt requiring dose administration

aids (e.g. Webster pack)– Falls risk and medication

• Social Worker– Place of Discharge (Home Vs

Nursing Home)– Capability / frequency of carer

• Specialist Nurses– Availability of alternative

formulations/ drugs– Medication review to identify

medication worsening disease

• Dietician – Medications affecting weight– Interactions with medications

and enteral feeding– Nutritional supplement

availability

NB: MAP doesn’t replace a phone call if issue is clinically urgent!

Record of all patient’s medication history as it was just PRIOR to admission

Best Possible Medication History (BPMH)

2+ sources required

GP/Pharmacy/NH information

BPMH & Risk Factor Checklist

BPMH documentatio

n

Recent changes

Who looks after the

medications

Dr’s plan & INDEPENDENT Reconciliation

How can you use this section?

• Doctor’s admission plan will be documented– Use to answer patient/carer queries

• Add to BPMH if further information comes to hand– Eg ‘I haven’t received my Fosamax tablet that I

usually have on Fridays’

• Add further patient details as they come to hand– Eg risk factors, nebuliser at home, is blind/deaf

Cross-referencing

• Alerts clinicians to availability of MAP and issues raised

• Prevents work duplication

Thank you!

Questions