My Medication Passport (MMP) is a patient-held record of medicines, funded by the NIHR CLAHRC NWL, designed by patients, for patients. It is available as a pocket-sized booklet and as a smartphone app originally designed to help patients to make a record of their own medicines list and any medication changes in order to improve communication about medicines between patients, carers and healthcare professionals. Patients or carers take a blank copy of the passport and complete it themselves, so they truly own it and are responsible for making any amendments if their medicines change.
Since MMP’s launch in April 2013, over 127,000 booklets have been distributed with nearly 85,000 pocket booklets being ordered by pharmacies, hospitals, charities, GP practices, nursing homes and patients across England and Scotland. Over 5,000 downloads of the app have been made in 37 countries.
Key user groups
MMP has demonstrated usefulness in a range of groups. Older people taking an enormous amount of medicine have found MMP to be helpful. People who do not have a fixed address claims MMP allows them to keep a personal record of their medicines with them at all times. Mencap, the charity, has reported that MMP has given its service users more independence and confidence in managing their own medicines – enabling more of them to go to hospital and GP appointments without a carer. The mental health charity MIND reported that patients find it rewarding and reassuring to have a record of their medicines that belongs to them.
“Alexander is on a number of medicines and we have found at appointments that it is rare for medical professionals to have an up-to-date list of his medication. This has significant implications if it is decided that another medicine needs to be added or changed. For example, at one appointment, Alexander was prescribed an antibiotic for an ear infection. Unbeknown to the ear doctor, the antibiotic interacts with another medicine that Alexander was taking. Fortunately, because I am a pharmacist, I was eventually able to solve the problem, but at the time of the consultation I was so tired and in ‘parent mode’ that I didn’t spot the interaction.
Medication problems are not just about interactions. There is also the challenge of how we get Alexander’s medicines into him. He has a swallowing difficulty (he can’t swallow tablets) and all his fluids need to be thickened. Of all the doctors and pharmacists we have seen, no one has ever asked us how we manage to get Alexander’s medicines into him (and they do not know that I am a pharmacist).
I started a work secondment to CLAHRC NW London in 2014 and was soon introduced to MMP. I immediately thought of Alexander and other children with Down’s syndrome who may be prescribed a number of medicines. I took a copy home to show my wife. We had just had the appointment with the ear doctor where the medication interaction had occurred and we decided to complete an MMP for Alexander. It was easy to complete and we immediately found it easier and less draining to show the passport at medical appointments rather than list out his medicines verbally. There is a page for changes to medicines and it was great to be in control of Alexander’s MMP. CLAHRC NW London became interested in our experience of using MMP with Alexander. They wondered if MMP could be used for any child with a long-term condition or disability. This led to a case report written by us on Alexander’s use of the MMP for the British Medical Journal. We made a number of recommendations in the article for amending the passport for use in children, including dedicated space to record how medicines are administered in order to prompt a dialogue with doctors, pharmacists and nurses about the challenges that parents and carers may face. We were fortunate with Alexander that I am a pharmacist and my wife is a nurse, but even then, we needed the help of a specialist paediatric pharmacist to work out a way of getting some of Alexander’s medicines into him. What worries us is how other parents, carers and patients themselves manage medicines without support or input. We would like health professionals to ask families directly about how we get medicines into our children with Down’s syndrome. We are hoping that CLAHRC NW London will consider making the changes to MMP that we have suggested.” – Barry Jubraj, Alexander’s Father.
A Testimony on Ownership
“I take more ownership of my medicines, in the sense of being much more aware of what exactly I need to take every day in relation to specific indications; of when I need to renew prescription medicines; of the need for prescribers to also see vitamins and supplements I have decided, accurately or not, to purchase and self-administer. The booklet is the lynchpin for consistency, constant updating and reviewing. MMP supports me to be active, in the sense that I take responsibility for what goes in to the booklet, and in the sense that I can use it to support conversations that I have with clinicians, and to show other service users.” – Fran Husson, Patient Representative.
A Mother’s Perspective
“As the patient’s mother I have found MMP to be very helpful, particularly in not having to explain every detail about medicines at his many clinic appointments. I have made some suggestions to adapt MMP for use in other children with chronic conditions, particularly around recording exactly how we give medicines and being able to document if a child has special needs. I feel sure that MMP has real potential for use in children on multiple medications like my son. I hope that the paediatric community will consider an adapted MMP as a tool that can help many children like mine, and their families/carers, to manage medicines better in partnership with their clinicians. I am certain that many parents and carers of children with complex medical needs face the same challenges but without our medical background—they really need the help that an adapted MMP could provide.” (BMJ Case Report: 2015)
Healthcare Professionals Thoughts
One senior pharmacist always made it clear that even if patients or carers made a mistake in entering a medication dose, what really mattered to the health care professional treating the patient was the name of the medication, which would provide some indication of conditions and illnesses. Another pharmacist pointed out that medicines reconciliation should involve the use of two sources of information and that MMP can count as one of those when needed (for example on admission to hospital).
A health care professional stated “Not only is it a great tool for me to understand and reconcile all the medications a patient may be using, but I do not feel like I am subjecting elderly patients to an interrogation at each consultation. It does not matter to me if the patient has written down the wrong dosage, what really matters is for me to know all the medications, over-the-counter medicines and supplements they are taking, and to understand how these have been prescribed in the first place.”
Another doctor recalled correcting a patient’s Summary Care Record, with the help of the patient and her MMP.
New Lease of Life
“Elderly people who thought they were too old to go abroad, along came the MMP it gave them a new lease of life, now they travel once again.
What filters out is the autonomy MMP affords to elderly patients. Elderly patients ALL have deficits, whether related to lifelong learning, disabilities, chronic conditions and multi-morbidities resulting from illnesses or accidents, and of course, cognitive decline linked to growing old. In my experience, having MMP is the only affirmation tool that truly helps in this situation. It very much supports us to say and to show ‘This is me. I am a person. I am going to place my MMP on your desk and I expect you to use it!’” Margaret Turley, Patient Representative.
Difficulties the My Medication Passport Helps Resolve
- A lack of a single, complete medication list for patients in the UK including dosage
- The associated risks of interacting medicines being prescribed by clinicians oblivious to other medicines being taken by the patient
- The draining and stressful experience of recalling and explaining the history and medication list
- No integrated healthcare IT system in UK making it difficult to find complete complied and updated list of individuals patient’s prescribed medication
- The lack of routine dialogue between professionals and parents/carers about the administration of medicines to disabled children, young people and the elderly.
My Medication Passport will be featured at the NIHR at 10 conference on 18 May 2016.
For more information on the MMP please visit: My Medication Passport
Have you ever had a horror story due to misprescribed medications?
Do you know anybody that would benefit from having a copy of the MMP?
Or maybe you have a great example of excellent care.
Comment below, we’re interested to hear your stories.