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COVID-19-Related DDS MAP Guidance

Guidance and information about the Medication Administration Program related to COVID-19

Refer below for information from Sharon Oxx, DDS director of Health Services, regarding MAP in light of the coronavirus (COVID-19).

Table of Contents

Guidelines for Virtual MAP Certification Testing

As you are aware, virtual MAP Certification testing is available through D&SDT. This Virtual Certification Testing webinar will guide you through the virtual testing process.

 

Please click here to view the webinar and PowerPoint slides.

 

Thank you,



Sharon Oxx RN, CDDN

Director of Health Services, Massachusetts DDS

MAP Re-certification

MAP Re-certification

Due to instructions by the Governor to extend professional licenses for 90 days following the termination of COVID-19 state of emergency date, we have made the change to the notice below from 90 days beyond the expiration date of the MAP Certification to 90 days beyond the lifting of the state of emergency in order to be in compliance with that instruction.

*****ORIGINAL NOTICE*****

Due to instructions that no MAP Trainings or testing should be occurring at this time due to Massachusetts COVID-19 guidelines, DDS, DMH and DCF will extend the MAP Certification expiration date on all staff due for MAP re-certification during the state of emergency by 90 days beyond the lifting of the COVID-19 state of emergency.

 MAP Certified staff whose MAP Certification expires during the COVID-19 state of emergency can continue administering medications for 90 days beyond the date that the state of emergency is lifted. 

 I will let you know if we have any further guidance in this area. Stay well everyone.

 

Thank you,

Sharon Oxx RN, CDDN

Director of Health Services, Massachusetts DDS

COVID-19 Virtual MAP Certification Testing Guidelines​

TO: MAP Providers, MAP Trainers

FROM: DDS, DMH, DCF

RE: Guidelines for Virtual MAP Testing During COVID-19 Pandemic

Date: 5/5/20

 

Guidelines for Virtual MAP Certification Testing

Objective: In light of the COVID-19 pandemic and to ensure social distancing, virtual MAP Certification Testing (computer-based Knowledge, Transcription and Medication Administration Demonstration) will be completed virtually for candidates that have already completed a full MAP Certification Training and successfully passed all pretest components. Scheduling for virtual testing can begin 5/7/20 with the first virtual tests to be conducted starting 5/11/20

Current MAP policies regarding Certification testing attempts and funding remain unchanged; see MAP Policy section 2 and the D&S Diversified Technologies MAP Candidate Handbook. The virtual MAP Testing process will be as follows:

 

Virtual MAP Certification Testing:

  • Testing will be completed remotely via Zoom.
    • The Knowledge component of the Certification test will be taken independently by the student with the D&S tester observing remotely via Zoom. For the knowledge test
      •  The student must have
        • a personal computer (PC) or laptop to log into TMU to access the knowledge test; and
        • a smartphone to access Zoom
    • The skills (Medication Administration and Transcription) components of the Certification test require that a MAP Trainer is present with the student; the D&S test observer will view the process remotely via Zoom. For the Skills Test(s)
      • The MAP Trainer must have
        • A smart phone with wifi
      • *For skills testing: all students must be screened by the MAP Trainer prior to testing for fever, cough, sore throat, unwell, etc.; if the student has symptoms the test may not continue. If the candidate is not allowed to test, they will not be charged for the test nor will it count towards their test attempts.
    • Zoom must be downloaded prior to the start of Certification testing;
      • The testing process using Zoom does take quite a bit of battery power; the smart phone should be fully charged.     

To schedule a Knowledge test:

  • Student (or responsible party) will login to TMU to schedule the test following the current practice; see MAP Candidate Handbook.
    • Confirmation of the test date and time will be sent by D&S to the student via email; and
    • The instructions and link to download zoom will be sent by D&S to the student via text or email.
      • If the student has exhausted the 3 DDS/DMH/DCF paid attempts, the testing fee must be paid first via TestMaster Universe (TMU) before the test will be scheduled.

To schedule a Medication Administration or Transcription skills test:

  • The MAP Trainer must first email Anne Shields at D&S, annes@hdmaster.com  to determine a test date based on the MAP Trainer’s and D&S test observer’s availability.
    • Once a date/time is determined, D&S will enter those test dates/times into TMU.
      • The Student (or responsible party), will login to TMU to schedule the test(s); only students attached to the MAP Trainer will be able to see the available dates/times.
        • If the student has exhausted the 3 DDS/DMH/DCF paid attempts, the testing fee must be paid first via TestMaster Universe (TMU) before the test will be scheduled.
    • Confirmation of the test date/time will be sent by D&S to the student via email.

Knowledge

  • On the day before the test the student will receive a text or email including
    • Instructions and a link to download Zoom; and
    • Meeting ID and password
  • On the scheduled Knowledge test date the student must log into Zoom via the downloaded app (once the Zoom app is downloaded only the meeting ID and password is required to connect) 20 min prior to the scheduled test time to:  
    • Ensure connectivity; 
    • show surrounding environment via zoom; andreview the testing process with the D&S test observer.
      • the student’s identification will be verified by the D&S test observer; and
      • testing instructions will be reviewed with the student by the D&S test observer;
        • The student will log into TMU and complete the test
          • 50 questions/75 minutes
            • The student must abide by all testing instructions.
    • When the test is completed or the time limit has been met the test will be over.
      • The student will log out of TMU and will end the Zoom session when the process has been completed as verified by the D&S test observer.
  • Scoring and notification of the outcome of the test (pass/fail) will be conducted by D&S per current standards and practices; see MAP Candidate Handbook.
    • If required, a second or third test attempt may be scheduled following the procedure listed above until the student reaches 3 fails in any combination or successfully completes the test.

Transcription

  • *All students must be screened by the MAP Trainer prior to testing for fever, cough, sore throat, unwell, etc.; if the student has symptoms the test may not continue. If the candidate is not allowed to test, they will not be charged for the test nor will it count towards their test attempts.
  • The day before the scheduled transcription skill test date D&S will send the
    • MAP Trainer
      • a text or email including:
        • A link and instructions to download Zoom; and
        • Meeting ID and password
      • An email including:
        • Attachments (transcription scenario/documents/medication sheet) to be used for the transcription test.
          • The MAP trainer must print the attachments in preparation for the test.
    • Student
      • A text or email reminder of the test date/time with instructions.
  • The day of the transcription test
    • The MAP Trainer must log into Zoom via the downloaded app (once the Zoom app is downloaded only the meeting ID and password is required to connect) 20 min prior to the scheduled test time to
      • Ensure connectivity;
        • Visual and audio.
      • Show surrounding environment; and
      • Review with the D&S test observer the testing materials to be used.
        • The area that the student is working in should be no more than 2 feet x 2 feet
        • A pencil is required
    • The student will enter the testing area 10 minutes prior to the test time.
      • The student’s identification will be verified by the MAP Trainer and by the D&S test observer; and
      • Testing instructions and scenario  will be reviewed with the student by the D&S test observer;
        • The MAP Trainer must ensure that all testing instructions are adhered to.
        • Once the test begins, the student has 15 min to complete the transcription skills test.
          • The student will be notified when 3 minutes are remaining.
  • When the student has finished the test or the time limit has been met the test will be over. The MAP Trainer will
    • collect all testing materials; and
    • capture images of the student’s test for D&S to score.
      • To capture an image:
        • Images will be taken of the student’s completed transcription (medication sheet) by the MAP Trainer with their smart phone.
          • The MAP Trainer will then hold each image, taken on their smartphone, up for the D&S test observer to capture with their electronic device or the trainer may also be asked to scan in clear copies and email to D&S if the test observer is unable to clearly score the documentation from the screen capturer. The D&S test observer will attach the image to the student’s file in TMU.    
            • Once it has been confirmed by D&S that images of testing materials have been received and are clear, then those test papers will be shredded by the MAP trainer.
  • Scoring and notification of the outcome of the test (pass/fail) will be conducted by D&S per their current standards and practices; see MAP Candidate Handbook.
    • If required, a second or third test attempt may be scheduled following the procedure listed above until the student reaches 3 fails in any combination or successfully completes the test.

 

Medication Administration Demonstration

  • *All students must be screened by the MAP Trainer prior to testing for fever, cough, sore throat, unwell, etc.; if the student has symptoms the test may not continue.  If the candidate is not allowed to test, they will not be charged for the test nor will it count towards their test attempts.
  • The day before the scheduled Medication Administration skill test date D&S will send the
    • MAP Trainer
      • a text or email including:
        • A link and instructions to download Zoom; and
        • Meeting ID and password
      • An email including:
        • Attachments (medication administration scenario and medication sheet) to be used for the medication administration test.
          • The MAP trainer must print the attachments in preparation for the test; the Medication Sheet must be inserted into the corresponding section of the Medication Book
            • The Medication Book, Count Book and pharmacy labels (blister packs) will be the same documents currently used in MAP Certification Training and posted on the www.mass.gov/dph/map site.
    • Student
      • A text or email reminder of the test date/time with instructions.
  • The day of the medication administration test
    • The MAP Trainer must log into Zoom via the downloaded app (once the Zoom app is downloaded only the meeting ID and password is required to connect) 20 min prior to the scheduled test time to
      • Ensure connectivity;
        • Visual and audio.
      • Show surrounding environment; and
      • Review with the D&S test observer the testing materials to be used.
        • The MAP Trainer and D&S test observer will ensure that the
          •  amounts listed on the count sheet pages and in the corresponding blister packs are correct; and
          • Correct medication sheet is in place
        • The area that the student is working in (space that contains testing materials) should be no more than 2 feet x 2 feet (the medication lock box should be just outside the 2x2 area).
        • A pencil is required
    • The student will enter the testing area 10 minutes prior to the test time.
      • The student’s identification will be verified by the MAP Trainer and by the D&S test observer; and
      • Testing instructions and scenario  will be reviewed with the student by the D&S test observer including;
        •  props (Medication Book/Count Book/medication ‘lock’ box);
        •  scenario  (individual’s name/date/time); and
        • a pencil, pill cup and ‘water cup’ will be provided to the student by the MAP Trainer.
          • The MAP Trainer must ensure that all testing instructions are adhered to.
        • Once the test begins, the student has 10 min to complete the medication administration skills test.
          • The student will be notified when 3 minutes are remaining.
  • When the student has finished the test or the time limit has been met the test will be over. The MAP Trainer will
    • Collect all testing materials; and
    • capture images of the student’s test for D&S to score.
      • To capture an image:
        • Images will be taken of the student’s completed medication administration testing documents by the MAP Trainer with their smart phone, including the:  
          • medication sheet that the student documented on;
          • count sheet page that the student documented on; and
          • blister pack of medication that the student used.
            • The MAP Trainer will then hold each image, taken on their smartphone, up for the D&S test observer to capture with their electronic device or the trainer may also be asked to scan in clear copies and email to D&S if the test observer is unable to clearly score the documentation from the screen capturer. The D&S test observer will attach the image to the student’s file in TMU.       
              • Once it has been confirmed by D&S that images of testing materials have been received and are clear, then those test papers will be shredded by the MAP trainer.
  • Scoring and notification of the outcome of the test (pass/fail) will be conducted by D&S per their current standards and practices; see MAP Candidate Handbook.
    • If required, a second or third test attempt may be scheduled following the procedure listed above until the student reaches 3 fails in any combination or successfully completes the test.

Virtual Two-Person Count and Disposal of Countable Controlled Substances

TO: Medication Administration Program Administrators and Registered Sites

FROM: David E. Johnson, Director, Drug Control Program

DATE: April 28, 2020

SUBJECT: COVID-19 MAP Virtual Two-Person Count and Disposal of Countable Controlled Substances

 

The COVID-19 public health emergency continues to produce an extraordinary demand on the Commonwealth's healthcare system.  In light of staffing shortages at Department of Public Health (DPH) registered Medication Administration Program (MAP) Community Programs (Programs), as defined in 105 CMR 700.001, and the urgent need to exercise social distancing in all locations as a result of COVID-19, it has become challenging for Programs to comply with MAP Policy 10-03 Medication Security and Record Keeping for Schedules II-V, which requires two licensed or MAP Certified staff to conduct a medication count whenever control of the medication key is passed, and MAP Policy 10-05 Medication Security and Record Keeping for Schedules II-V Disposal, which requires two licensed or MAP Certified staff to dispose of controlled substances.

For the duration of the State of Emergency, declared by Governor Baker on March 10, 2020, DPH’s Drug Control Program (DCP), in consultation with the Department of Mental Health (DMH), the Department of Developmental Services (DDS), and the Department of Children and Families (DCF), is allowing an alternative process for complying with MAP Policy 10-03 and 10-5, using the Virtual Two-Person Countable Controlled Substances Count outlined on pages 2 and 3, provided that a two-person count must be conducted in-person and on-site at least once every seven days.

This alternative process may be used for the following MAP practices, but does not change the current requirement that two licensed or MAP Certified staff are required to conduct the count:

  • Adding a newly prescribed countable medication into the count;
  • Adding in a refill;
  • Transferring the balance from a completed page to a new page, including;
    • two signatures at the bottom of the completed page; and
    • The same two signatures at the top of the new page;
  • Disposal; see MAP Policy 10-5; and
  • Two-person (in-person and on-site) count.

COVID-19 Virtual Two-Person Countable Controlled Substances Count

Virtual Counting – Conditions of Eligibility

  1. In light of COVID-19, two licensed/Certified staff persons are not scheduled to be on-site when the responsibility of the control of the medication key needs to be passed;
  2. A two-person count has been conducted in-person within the preceding seven days;
  3. One licensed/Certified staff member is on-site; and
  4. One licensed/Certified staff member is available remotely.

Virtual Counting – Required Equipment

To conduct a virtual two-person count with one on-site and one remote licensed/Certified staff person using FaceTime or other similar, secure virtual web-based platform (VWP):

  1. Each staff member must have a wifi-enabled computer, laptop or smart phone with a microphone and a camera capable of generating a live video feed; and
  2. The VWP must be downloaded on each staff member’s device prior to starting the count.

Virtual Counting – Process

Once connectivity of the VWP is established between the on-site and remote licensed/Certified staff members, the count should proceed as follows:

  1. The on-site staff member will:
  • unlock the (double) key lock box;
  • remove all of the medication from the box; and
  • open the Count Book to the Index.
  1. Both staff members (on-site and remote) will:
  • view the index page;
  • use the index as the guide; and
  • identify the first medication listed in the index to be counted.
  1. The on-site staff member will:
  • obtain the corresponding blister pack; and
  • open the corresponding count sheet page.
  1. Both staff members (onsite and remote) will:
    • view the count sheet page; and
    • view the pharmacy label.
    • the count sheet and the pharmacy label must include the following matching information:
      • the individual’s name;
      • the medication name;
      • the medication strength; and
      • instructions for use;
    • view the amount of tablets listed in the “amount” (left) column; and
    • view the number of tabs in the medication blister pack.
      • both staff members will confirm that these numbers agree.
    • examine the blister pack carefully for signs of tampering
      • remote staff will witness documentation of irregularities; and
      • on-site staff will notify the supervisor immediately of any irregularities.
  2. If all information is in agreement, the on-site staff member will:
    • place the medication container back into the (double) key locked box.
  3. Both staff members will repeat steps 2-5 until
    • all countable medications are accounted for; and
    • all countable medications are secured into the (double) key locked box.

Virtual Counting – Documentation of Process

  1. The on-site staff member will document the completion of the virtual count on the Count Signature Sheet in the Count Book, including the following:
    • date/time count is complete;
    • confirmation that the count is correct;
      • note “Yes” or “No”;
    • on-site staff member signature; and
    • printed name of remote staff member
      • note “virtual count”
  2. The remote staff member will send an email to the on-site staff member, confirming:
    • date/time count is complete;
    • confirmation that count is correct;
      • note “Yes” or “No”;
    • name of on-site staff member that was witnessed conducting the count; and
    • remote staff member’s name and contact information.
  3. The on-site staff member will print and file the email in a Virtual Count Sheet Verification notebook, created on-site for this purpose, each time virtual verification is completed.

 

The above mentioned count process may be adapted to accommodate the other associated processes as well. If you have any questions please contact your DDS, DMH or DCF MAP Coordinator, who will make available Example COVID-19 Documentation for these virtual processes.

Flexibility Measures for Medication Administration During the COVID-19 Pandemic

The recent DPH Notice for expansion of the LOA policy (COVID-19 – LOA Medication Supply Expansion 4/1/20) is restricted to non-MAP registered sites, mostly temporary sites set up to manage issues related to the COVID-19 pandemic. This alert addresses medication administration guidance for DPH MAP registered sites that are experiencing a shortage in MAP Certified staff during the COVID-19 pandemic. 

 

COVID-19 Procedural Guidelines for Medication Administration by Non-MAP Certified Staff in DDS, DMH and DCF MAP Sites​ can be found here

 

If you have questions please contact your DDS, DMH or DCF MAP Coordinator.

 

Thank you,



Sharon Oxx RN, CDDN

Director of Health Services, Massachusetts DDS

COVID-19 MAP Certification Reinstatement Notice

For the duration of the State of Emergency, declared by Governor Baker on March 10, 2020, the Department of Public Health’s Drug Control Program (DCP), in consultation with DMH, DDS, and DCF, is waiving MAP Policy 02-6 Recertification Process and MAP Policy 02-7 Recertification Process, and hereby authorizes the reinstatement of formerly MAP Certified staff to MAP Certified status under the conditions outlined in the notices below:

 

If you have any questions please contact your DDS, DMH or DCF MAP Coordinator.

 

Thank you,



Sharon Oxx RN, CDDN

Director of Health Services, Massachusetts DDS

MAP Insulin Pen Notice

On March 10, 2020, Governor Charles D. Baker declared a State of Emergency in the Commonwealth to respond to the spread of COVID-19.

 

In light of this emergency, MAP Certified staff will be allowed to administer insulin via Insulin Pen with proper training as described in this notice.

 

This policy will apply to all DDS MAP Programs until further notice.

 

Thank you,



Sharon Oxx RN, CDDN

Director of Health Services, Massachusetts DDS

MAP Inhaler-Epinephrine-Oxygen Notice

On March 10, 2020, Governor Charles D. Baker declared a State of Emergency in the Commonwealth to respond to the spread of COVID-19.

 

In light of this emergency, administration of Epipen, rescue inhalers and Oxygen will be allowed by non-MAP Certified staff with proper training as outlined in the notices below.

 

This policy will apply to all DDS MAP Programs until further notice.

 

Thank you,



Sharon Oxx RN, CDDN

Director of Health Services, Massachusetts DDS

COVID-19 Clozapine DDS Guidance

The following guidance regarding the use of Clozapine created by DMH also applies to DDS MAP Programs during the COVID-19 Pandemic. Click here for the guidance.

 

The guidance also contains links to the following reference documents:

· Pharmacy Facts

· BoP COVID-19 FAQs

 

Thank you,

 

Sharon Oxx RN, CDDN

Director of Health Services, Massachusetts DDS

MAP MCSR Registration Expiration Date Extension

Please see the attached documents for updates on MAP-related information regarding the Massachusetts Controlled Substances Registration expiration dates extension.

Additional Resources

Methadone Clinics Advisory and MAP

Please see the attached documents for updates on MAP-related information regarding methadone clinics and opioid treatments.

Additional Resources

Extension of Testing Eligibility Timeline

Due to the suspension of MAP Testing, eligibility for testing will be extended for candidates for a period of time that coincides with the MAP Testing suspension. Providers will be informed of the extension timeline once MAP Testing resumes.

  

Thank you,

 

Sharon Oxx RN, CDDN

Director of Health Services, Massachusetts DDS

MAP Training and Testing Suspension

Due to the State of Emergency in Massachusetts due to COVID 19, all MAP Testing with D&S for DDS, DMH or DCF programs is suspended until further notice effective immediately. Because of this and because of the instructions by the Governor's office to limit group gatherings and staff's inability to get tested quickly now,it is strongly recommended that MAP Trainings also be cancelled until further notice.

 

Sharon Oxx  RN, CDDN
Director of Health Services, Massachusetts DDS

90 Day Medication Supply

In light of the possibility of limited access to medications due to COVID-19, individuals in MAP programs may have a 90 day supply of medications on hand rather than the 37 day supply noted in MAP Policy.

 

Please document in the individual's​ record that the additional supply is "In preparation for COVID-19 pandemic".

 

Thank you,

 

Sharon Oxx RN, CDDN

Director of Health Services, Massachusetts DDS

Reminder About HCP Signatures

On March 10, 2020, Governor Charles D. Baker declared a State of Emergency in the Commonwealth to respond to the spread of COVID-19. In light of this emergency and associated social distancing guidance, several Medication Administration Program (MAP) sites are engaging in telehealth, rather than in-person encounters in non-emergent circumstances.

 

For your information during this emergency, please refer to this previously-issued advisory for guidance on acceptable signatures on Health Care Provider (HCP) orders, and note that this guidance applies to orders that are emailed from a HCP.

 

Thank you,

 

Sharon Oxx RN, CDDN

Director of Health Services, Massachusetts DDS

COVID-19 MAP Method B Notice

NOTICE

From: Department of Public Health, Medication Administration Program (MAP)

To: MAP Administrators and Coordinators

Date: March 18, 2020

Subject: OTC Method B – Remote verification by licensed professionals

 

On March 10, 2020, Governor Charles D. Baker declared a State of Emergency in the Commonwealth to respond to the spread of COVID-19. In light of this emergency and associated social distancing guidance, several Medication Administration Program (MAP) sites are engaging in telehealth, rather than having licensed professionals attend these sites in-person in non-emergent circumstances.

 

For sites that use Method B to facilitate administration of over-the-counter (OTC) medications and preparations, this may pose a problem, as MAP Policy 06-6 Over-the-Counter Medications and Preparations includes requirements for a licensed professional to provide in-person verification.

 

To address this particular need and provide available flexibility during this declared emergency, the Drug Control Program and MAP is authorizing sites without non-emergent, in-person licensed professional to employ telehealth for this verification step. Specifically, the following alternative verification procedures are authorized:

 

Policy 06-6 (2)(b)(iii)-(v): A licensed professional can compare the manufacturer’s label to the Health Care Provider order and verify the contents of the OTC or preparation via photos and phone communication or video communication with MAP Certified staff. Pursuant to the licensed professional’s comparison and verification, MAP Certified staff may:

·     initial the container;

·     place the name of individual(s) on the container; and

·     place the date of verification on the container.

LOA Medication Supply Exception

It has come to our attention that families of individuals living in DDS, DMH or DCF programs have decided to take the individuals home with them rather than have them remain in the residential programs during the COVID19 pandemic. It may be unclear how long the individual will remain with their family.

 

According to MAP Policy, MAP Certified staff can package up to a 72-hour supply of medications for Leaves of Absence (LOAs). If a longer LOA is planned, the pharmacy must package the medications.

 

During the State of Emergency, declared by Governor Baker on March 10, 2020, pharmacies may not be able to prepare medications for longer LOAs in a timely manner due to volume, scarce resources, and uncertainty as to how long individuals will be with family. 

 

DPH, DDS, DMH and DCF will allow the individual's remaining supply of medications to be given to families if it is expected that they will be out of the residence for longer than 72 hours. The medications may be in blister packaging or in bottles.

 

MAP Certified staff must strictly adhere to MAP Policies on documentation of the chain of custody of the medications using the transfer of medications process and LOA medication documentation procedures typically used between MAP Programs and for LOA. Failure to do so may result in questions related to possible diversion of medications.

 

If the individual returns home earlier than anticipated, programs can accept the medications back into the program only if they are stored in tamper resistant packaging. In such cases, the contents of the blister pack must be verified by a licensed health care professional or the pharmacy.

 

No bottles of pills can be accepted back into MAP programs.

 

If you have any questions please contact your DDS, DMH or DCF MAP Coordinator.

 

Thank you,

 

Sharon Oxx RN, CDDN

Director of Health Services, Massachusetts DDS

Contact

Fax

617-624-7578

Address

500 Harrison Avenue
Boston, MA 02118
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