Since 1990, under the Massachusetts Department of Public Health, the Medication Administration Program has trained and tested unlicensed direct care workers to safely administer medications to residents of community group homes registered with the Departments of Mental Health, Developmental Services, and Children and Families, and with the Massachusetts Rehabilitation Commission. Since the pandemic, group homes have faced severe shortages of MAP-certified personnel, apparently increasing the risk of medication errors. MDPH contracted with ERG to provide a detailed evaluation of MAP policies, procedures, and performance; assess the issues being raised by program stakeholders; report on relevant policies in other states; and recommend short- and long-term actions to pull the program back from crisis.
ERG program evaluation teams visited 29 community residences, interviewed over 120 MAP-certified direct care staff, residence managers, MAP trainers, nurse administrators, and other personnel at the four state agencies, as well as pharmacists, prescribing physicians, representatives of a patient advocacy group and a community residence trade group, and officers of companies providing electronic medication administration recordkeeping software to group homes in other states. We sent a brief, online survey via email to approximately 20,000 currently certified MAP personnel. We also interviewed group home managers and company officials in several other states. Our final report detailed our findings and made 34 data-supported recommendations for changes to MAP policies, procedures, and medium-term strategic goals. These ranged in scale from tweaks to the MAP test content and procedures to avoid ambiguity and minimize confusion among candidates with English as a second language, to active support for widespread implementation of eMAR software at residences, compatible with common pharmacy software.