An evaluation of the utilisation of the Medication Action Plan form in a tertiary hospital: what is the impact of the pharmacist?

Abstract

Background: The Medication Action Plan (MAP) form was introduced in Queensland Health to communicate accurate medication histories and interventions between pharmacists and other clinicians. Concerns have been raised about the utilisation of this form at the Princess Alexandra Hospital (PAH). Aim: To identify how frequently the MAP form was utilised at PAH for documenting medication histories and pharmacists' interventions, and to evaluate category, clinical appropriateness, wording, outcome and significance of the documented interventions. Method: One hundred patients were retrospectively audited to identify whether a MAP form was completed. Interventions were categorised according to their significance, wording and clinical appropriateness. Notification and acceptance by the Medical Officer (MO) and their documentation in iPharmacy TM were also evaluated. Results: Sixty-five patients (65%) had a MAP form and 100 interventions were documented on these forms. 'Proposing change of dose' was the most frequent type of intervention. The majority of interventions (59%) were low risk. Eighty-five per cent of interventions were deemed to be clinically appropriate; however, 65% of interventions were considered to be poorly worded. Fifty-eight per cent had documentation of notification of the MO and 67% were acted on by clinicians mostly (58%) within 24 hours. Only 17% of interventions were documented in iPharmacy TM . Conclusion: Although the MAP form is used by pharmacists for documenting medication histories and interventions, they are often documented using poor wording, and many are not acted on by clinicians. Standards for documenting recommendations on the MAP form and notifying MOs have subsequently been developed.

Documentation and classification of hospital pharmacist interventions: A scoping review

“…All studies were descriptive, with three prospective 21,22,27 and six retrospective, 6,17,18,28,34,39,45 while one also included a survey 17 . Most of the studies were from the Middle East (Saudi Arabia, 6,17,22 Iran, 21 Lebanon 28 and Oman 18 ), two were from the United States, 27,34 one from Germany 39 and the other one from Australia 45 . For their own use, the hospitals or private health systems developed the internal documentation and/or classification systems mentioned in these studies.…”

“…The other studies focused instead on providing a detailed analysis of PIs performed within the institution, with reference being made to the documentation/classification approaches employed 17,18,21,22,27,28,39,45 . Documentation methods included (a) direct entry through the EHR, 17,18,22 (b) electronic forms adapted from other practices, 18,39 (c) paper‐based forms alongside the electronic system 27,45 and (d) exclusively paper‐based documentation/classification 21,28 . Regarding the classification methods, most of them (60%) were in‐house developed, without any reference to the literature 6,17,21,27,34,45 .…”

“…57 The information collected confirmed that the majority of the systems for recording and classifying PIs are designed in-house, generating tailor-made solutions to specific local needs. Some of them are entirely designed internally to meet that hospital's requirements, 6,17,21,27,34,45 while others are the result of individualized adaptation from previous systems. 18,22,28,39 Pharmacist documentation integrated into patient electronic medical records (EMRs) elevates and empowers the importance and utility of pragmatic pharmacist intervention documentation compared to web-based and silo electronic tool-based systems.…”

“…21,28 Regarding the classification methods, most of them (60%) were in-house developed, without any reference to the literature. 6,17,21,27,34,45 Others (40%) were a result of in-house modifications and adaptations of previous published studies. 18,22,28,39 The amount of information documented and the number of categories used for classifying PIs was highly variable and is detailed in Table 2.…”

“…17 Most of the studies were from the Middle East (Saudi Arabia, 6,17,22 Iran, 21 Lebanon 28 and Oman 18 ), two were from the United States, 27,34 one from Germany 39 and the other one from Australia. 45 For their own use, the hospitals or private health systems developed the internal documentation and/or classification systems mentioned in these studies.…”