MAP Month Ward Nursing & Allied Health Staff

1. MAP MonthWard Nursing & Allied Health Staff Pharmacy, Medication Safety Working Group & WHO High 5s Working Group September 2011

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

3. 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

4. Why have the MAP form? • 1 in 2patients have one regular medication omitted unintentionally on admission(1-3) • MAP allows ‘MATCHING UP’ of medications at home vs charted • Up to 5medication 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/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)

5. Mismatch? • Plan was to ‘Continue all meds’ • BUT some meds not charted; different doses charted  Which is right??

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

7. Medication-Related Issues Issues identified by ALL clinicians are noted on the front page

8. 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

9. 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)

10. 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 A Nursing Example

12. Some real-life examples so far

13. 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

14. 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

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

16. Best Possible Medication History (BPMH) Record of all patient’s medication history as it was just PRIOR to admission

17. Recent changes BPMH documentation 2+ sources required Who looks after the medications Dr’s plan & INDEPENDENT Reconciliation GP/Pharmacy/NH information BPMH & Risk Factor Checklist

18. 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

19. Cross-referencing • Alerts clinicians to availability of MAP and issues raised • Prevents work duplication

20. Thank you!Questions