Advisory Ruling  MAP Policy 16-2 Hospice: Exceptions to Other MAP Policies–MAP Program Sites

Date:	06/05/2018
Referenced Sources:	Medication Administration Program (MAP)

1. The following MAP policy exceptions exist for a DDS/DMH/DCF MAP registered site that is supporting an individual who is receiving services from hospice.
   1. The sealed hospice emergency starter kit or the sealed hospice comfort care box may be reconciled as one sealed item. 
      1. When the “Hospice Comfort Care Box” or “Emergency Starter Kit” is brought into the MAP site in anticipation of increased need for medication supports, it is sealed or locked. Several of the medications in the box may be Countables. Until the box is opened for use, the program simply needs to document that the box is present and remains sealed or locked.  Once the “box” or “kit’ is unsealed, each countable medication within the box must be added to the index in the “Count Book” and the medications entered onto individual count sheets in the “Count Book”.
   2. MAP Certified staff may care for an individual with a pre-filled automatic medication infusion device.  However, MAP Certified staff may not operate the device including administration of a bolus or calibration of the device.  MAP Certified staff may observe and report the condition of a pre-filled automatic medication infusion device and insertion site.  Such observations would include but not be limited to noting if the infusion site is warm, painful, or the infusion device is dislodged.  Such observations must be documented on the Medication Sheet or Progress Note and problems reported to the hospice nurse immediately.  MAP Certified staff must receive training for such observations and reporting from the Hospice nurse.  Documentation of such training must be maintained at the program and must include the name of the trainer, date of training and signatures of staff present as proof of attendance.
   3. In recognition of the fact that orders can change frequently when an individual is receiving hospice services, labels on medications for an individual receiving hospice services may be allowed to state ‘See Health Care Provider’s orders for further instructions’.