New MAPPP App Helps Physicians Prevent Adverse Events

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Patients’ increased access to a variety of oral anticoagulant drugs has complicated pre-surgical drug management and resulted in both medical and financial ramifications. Anticoagulants taken too close to surgery can increase the risk of excessive bleeding, so, often times, procedures need to be postponed, posing a financial burden to hospitals.

In 2014, Atlantic Quality Innovation Network (AQIN), the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) serving New York, South Carolina and the District of Columbia, recognized that physicians needed a standardized, easy-to-use guide for determining when to take patients off anticoagulants prior to elective surgery. With the assistance of a coalition of physicians, pharmacists and patient advocates, the QIN-QIO created a clinical guide called MAPPP (Management of Anticoagulation in the Peri-Procedural Period) that physicians adopted as a resource to help determine if and when patients should stop taking anticoagulants prior to surgery.

"MAPPP is easy to use and accessible, whenever — and wherever — physicians or other clinicians need it.”

In 2015, AQIN decided to expand the scale and scope of the original guide, turning to the smartphone, a device often used in hospitals and doctors’ offices today.

Launched in March 2016 in the Apple App Store and the Android Market, the MAPPP mobile app enables clinicians nationwide to determine, straight from their phone, if and when it is necessary for patients to stop the use of warfarin and direct oral anticoagulants when undergoing elective surgery or other procedures. Since its launch, the app has been downloaded nearly 400 times from locations in North America and Europe.

From our past experience, we knew the MAPPP guide would help prevent medication errors and adverse drug and procedure-related events in patients during the vulnerable period of time before, during and after invasive medical procedures,” said Anne Myrka, director of the New York State Drug Safety Initiative at AQIN. The big question was how to expand our reach. The MAPPP mobile app allows us to do that. It’s easy to use and accessible, whenever — and wherever — physicians or other clinicians need it.”

MAPPP is the first mobile app developed by a QIN-QIO. According to Myrka, app development is a perfect fit for the QIO Program because it is focused on innovation and quality improvement, two pillars of the Program.

Myrka hopes that the MAPPP process and app eventually will be fully integrated into electronic health records. For now, she is pleased with the positive feedback from those using the app. Physicians we’ve talked to are thrilled with the app. They have reported that more of their patients are showing up prepared for surgery. That’s good news for everyone: patients, doctors and hospitals.”

To download the app or view the online version, visit

AQIN is led by New York-based IPRO. The MAPPP app was developed as part of IPRO’s Preventing Oral Anticoagulant Adverse Events” initiative.