1. MAP Month Ward Nursing & Allied Health Staff
Pharmacy, Medication Safety Working Group & WHO High 5s Working Group
September 2011
Take MAP procedure, some blank MAPs

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
BPMH = best possible medication history
Allows clinical handover at all points of admission

4. 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 information provision 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’
Often happens when eg resident writes in the notes, reg writes on the med chart and the consultant instructs
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
If a Dr had completed the ‘Dr’s plan’ column, we’d easily know what the plan was

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 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
A real example found by a ward pharmacist

11. On the MAP: documented, has contact number, responsible person, follow up etc, as well as being for a specific patient.

12. Some real-life examples so far
Daily supply requirements – much better than relying on memory/post-its!

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 Specialist Nurses Dietician
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. Who looks after the medications
Recent changes
BPMH documentation
2+ sources required
Who looks after the medications
Dr’s plan & INDEPENDENT Reconciliation
GP/Pharmacy/NH information
Explain the different sections:
Recent changes – may affect current treatment, may contribute to presenting complaint eg frusemide recently ceased, present with HF exacerbation
Sources – allows for subsequent clinicians reviewing the BPMH to know the sources and assess validity/gaps etc; need to validate with more than 1 source
Who looks after medications – need to know so eg don’t ask patient questions they can’t answer
Community carers – for discharge planning
BPMH checklist – to see if all Qs have been asked, patient risk factors eg blind/deaf etc
BPMH documentation – others can add to it if more info comes to light
MATCH UP – reconciliation/plan: clear decision documentation
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