RM Partners is working with partners in north west London to pilot and test new integrated community palliative medicines authorisation and administration record (MAAR) charts in Harrow.

All patients discharged from Northwick Park Hospital in the last phase of life who require (or are anticipated to shortly require) medication to be administered by nurses in the community, will leave hospital with the drugs and a MAAR chart, which can be used by staff in London North West Healthcare University Trust (LNWH), Central London Community Healthcare (CLCH), and by GPs in Harrow.

There is evidence that when a patient approaching the end of their life is discharged from hospital, the current system for writing MAAR charts (colloquially called drug charts) for EOLC medication (e.g. syringe driver +/or prn doses) creates delays, inefficiencies and poor experiences for patients, carers and community nurses and GPs.

A recent survey of LNWH and CLCH community nurses showed that between 2-6 hours a week of community nursing time was used to ensure that a valid MAAR chart is in the patient’s house in a timely way. GP time is also spent duplicating what was requested on the Electronic Discharge Notification. As a result, there are many experiences of urgent requests for something which could have been anticipated, of delay, and of occasional examples of readmissions to hospital.

A group of nurses, doctors and pharmacists from LNWH and CLCH have made changes to the recently revised RM Partners EOLC MAAR chart. The ambition is to adopt a unified set of documentation for syringe pump management of palliative patients in the community across north west London (NWL), based on the documentation currently used in south London, but to do so in an incremental and controlled rollout.

In the first instance, we will test these charts and a new way of working for patients being discharged from Northwick Park Hospital. If successful we plan to subsequently extend their use to any patient in Harrow and from there to other parts of NWL.

The palliative care team will help ward doctors complete the new MAAR charts, prescribe the TTAs and the pharmacy will dispense the medications, so that all patients go home from hospital with the drugs and MAAR charts in their possession. By so doing it is hoped that more patients will be able to receive the right care immediately and provide more efficient use of limited community and GP resource.

The new MAAR charts will also be made accessible on EMIS-Web so that community nurses and GPs can access them even more easily.

The impact of this change on the following will be evaluated:

  • Patient and carer experience based on having the right drugs and charts in place from the moment of discharge
  • Staff experience  of GPs and community nurses and hospital staff
  • Efficiency based on use of community staff time
  • Safety

The findings of the evaluation will be shared across LNWH community teams and used to spread improved practice.

For further information please contact Dr Charles Daniels, 020 8382 8001, cdaniels@stlukes-hospice.org

Harrow pilot MAAR charts updated April 2019