Transcript Redland-Hospital-Med-Rec-and-MAP-training-presentation

MAP Month
Ward 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 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)
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
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•
•
•
•
•
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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:
–
–
–
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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!
Best Possible Medication
History (BPMH)
Record of all patient’s medication history as it was just PRIOR to admission
Recent
changes
2+
sources
required
BPMH
documentatio
n
Who looks
after the
medications
GP/Pharmacy/N
H information
BPMH &
Risk Factor
Checklist
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