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MaPP(s)ing the Medication Journey: Supporting Patients with Changes at Discharge

  • At: PPR 2022 (2022)
  • Type: Poster
  • Poster code: PM-09
  • By: DAR, Arzoo (Mid Yorkshire Hospital NHS Trust)
  • Co-author(s): Arzoo Dar, Trainee Pharmacist, The Mid Yorkshire Hospitals NHS Trust, United Kingdom
    Sarah Mitchell-Gears, Advanced Clinical Pharmacist in Acute Care of the Elderly, The Mid Yorkshire Hospitals NHS Trust, United Kingdom

  • Abstract:

    Poor discharge communication and lack of patient engagement are major contributors to medication-related errors during transitions-in-care. World Health Organisation Medication Safety in Transitions-of-Care 2019 report₁ acknowledged this and recommended prioritising the following:

    •collaborating with patients/families/carers
    •communicating medication changes
    •interdisciplinary working.

    Care Quality Commission 2020 national patient inpatient survey found that only 28% of participants received information regarding side-effects, 55% given explanations on medicines-use, 48% provided written information and 12% no information₂. The overall consensus was that discharge medicines counselling (DMC) was inadequate. Health information systems including Medicines a Patient Profile Summary (MaPPs) provide patient-friendly leaflets which may improve patient understanding and experience with their medicines₃. This audit aims to study patient experience of DMC.

    • Evaluate the quality of DMC at Mid Yorkshire Hospitals Trust.
    • Measure patient understanding and satisfaction with information given.
    Aim for 100% compliance with the following standards:
    • All patients with medication changes (new/stopped/changed) should receive verbal DMC.
    • Offer all patients MaPPs easy-read leaflets/charts documenting changes.

    This study did not require ethics approval. Baseline data was collected from the Trust Medicines Information department to gauge which ward projected the most discharge enquiries in October 2021.
    Patients meeting inclusion-exclusion criteria formed part of the sample.
    Inclusion: (1) ward 41(elderly) inpatient with previous admission within last 2 months AND (2) living at home AND (3) patients/relatives managing medications.
    Exclusion: (1) care-homes residents OR (2) patients with carers visiting to administer medicines OR (3) compliance aid patients OR (4) no medication changes.
    A questionnaire was used to collect data on verbal/written information given alongside patient/relative understanding and satisfaction.

    20 elderly patients/relatives were surveyed: 55% female and 45% male.
    • 40% of patients did not receive written information while 35% did receive this from nurses; none received a MaPPs leaflet/chart.
    • 40% of patients/relatives expressed dissatisfaction with DMC. 0% were informed about side-effects.
    • 55% and 70% of patients reported partially/not fully understanding why medications were indicated and changes made, respectively.
    • 85% of patients/relatives felt easy-read leaflets/charts explaining changes would be beneficial.

    Overall, DMC was consistently below national and trust standards for patient safety. Poor explanation of changes and no information on side-effects was common practice. Preference for MaPPs leaflets/charts over discharge medications lists was seen. Lack of nurses’ DMC exposure may be contributory and will be tackled through pharmacy-led MaPPs training. Audit findings are subjected to overestimation given small sample size. Other limitations were time constraints and limited generalisability to ethnic minorities. Future study to involve underrepresented patient groups and larger sample.

    • Offer all patients MaPPs leaflets/reminder charts and verbal DMC.
    • Offer all nurses pharmacy-led training on MaPPs-use.
    • Monthly reminders during morning handovers to use MaPPs.
    • Documentation on electronic prescribing system when MaPPs leaflets are provided.

    1.Medication Without Harm [online]. World Health Organisation. 2019 [cited:07/04/22].Available from:
    2.Adult inpatient survey 2020 | Care Quality Commission [online]. 2022 [cited:07/04/22].Available from:
    3.Introducing MaPPs Patient-Friendly, Personalised Medicines Information [online]. Medicines: a Patient Profile Summary. [cited:07/04/22].Available from:

Last update 4 October 2019

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