MAP Month Ward Nursing

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MAP MonthWard Nursing Allied Health Staff

• Pharmacy, Medication Safety Working Group WHO
  High 5s Working Group
• September 2011

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Agenda

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

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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

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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/planvs interspersed throughout progress
  notes
• Post-it note culture
• No formal tool for handover/documentation/interven
  tions
• 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
2005165424-9(4) QH Sites Baseline Audit 2005
(SMPU)
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Mismatch?

• Plan was to Continue all meds
• BUT some meds not charted different doses
  charted
• ? Which is right??

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Drs Plan column completed on admission enables
medication reconciliation with medication chart
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Medication-Related Issues
Issues identified by ALL clinicians are noted on
the front page
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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

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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)

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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

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Some real-life examples so far
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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

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• 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

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• NB MAP doesnt replace a phone call if issue is
  clinically urgent!

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Best Possible Medication History (BPMH)
Record of all patients medication history as it
was just PRIOR to admission
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Recent changes
BPMH documentation
2 sources required
Who looks after the medications
Drs plan INDEPENDENT Reconciliation
GP/Pharmacy/NH information
BPMH Risk Factor Checklist
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How can you use this section?

• Doctors admission plan will be documented
• Use to answer patient/carer queries
• Add to BPMH if further information comes to hand
• Eg I havent 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

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Cross-referencing

• Alerts clinicians to availability of MAP and
  issues raised
• Prevents work duplication

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Thank you!Questions