Trouble reading/decipering orders & meds

augigi, CNS · Nov 19, 2006

Sounds like med errors waiting to happen - hope the computerized orders makes things easier for you!

badtz143 · Nov 19, 2006

My hospital still uses paper cards for MAR medications and it is driving me crazy. I find the handwriting very hard to read and when meds are cancelled, they highlight them in yellow. Sometimes you have a card that is half yellowed out meds and half active meds and there are several cards stapled together.
There are cards for scheduled meds....cards for one time meds.....cards for PRN meds.....and cards for fluids and when a PCA is running..........theres another card for the PCA.
These cards have little "boxes" for times meds are due and signature of the nurse and columns running across the page for dates. If it's for Insulin, the columns run down the page and you fill in all info going down the page. If for some reason you don't give the med....you are supposed to initial the square containing the med and "circle it" which is to alert that the med was not given.
I am CONSTANTLY struggeling trying to read the writing and make sure I'm "seeing" all the meds and getting them out on time. I have also missed meds on a number of occasions because these cards are so confusing to deal with. And, it seems like I am constantly going back to look at the card again because I'm afraid I've missed something......and because new meds are constantly appearing on the card to be given !!!!
Have any of you worked with this type system?
Any ideas on how to decipher the cards more effeciently an not miss meds so often?
Anyone worked the the computerized medication card system?????
We are supposed to be going to a computer system soon and I cannot wait. It just seems like it will be so much easier to see and understand meds then.
Any comments and/or suggestiong greatly appreciated

As much as I think I often have "crazy" days at the VA, I love our computerized med card system. ALL orders and progress notes are to be typed up my MDs, RNs, PTs, everyone so we are not going crazy trying to understand handwritings. Where I went to nursing school in the Southeast, all hospitals we did rotations in used paper systems....from writing orders, progress notes, signing out meds when you gave it to the pt, etc. We don't even take verbal orders, only in emergency situations we would. I am a new grad (2 months in orientation) and still think nursing is difficult but I'm afraid if I leave the VA and go to a different hospital, they won't have computerized system. This is one of the biggest reasons I stay where I work. Nursing is hard enough; they need to make our other nursing tasks easier for us. I hope your hospital gets converted to computerized system soon. I think you'll like it better =)

Daytonite, BSN, RN · Nov 19, 2006

This sounds very much like the medication and treatment card system that was used when I was a nurse in training back in the 70's. Most places abandoned the system because of the many errors nurses made. It's very easy for a card to get misplaced or forgotten about in someone's pocket. Back then, there was one med per card. Sounds like you have multiple meds on one card which can, I understand, make for a jumbled up mess. If you have a quality improvement committee or a nursing practice committee you might want to work toward bringing about a change in the way this is handled, or at least suggest a study of the reasons for med errors be examined. It won't be good enough to say the system stinks. You also need to suggest changes and be willing to help implement them.

DolphinRN84, MSN, RN, APRN, NP · Nov 19, 2006

In one of my rotations at school, almost everything was computerized. At the place I'm working now, it's like half and half. Whenever a med is to be added or changed or cancelled, the doctor puts the order on the computer and then we have to acknowledge them on the computer. After we acknowledge the orders, the printer prints labels and then we post them on the sheet. At least the labels are easy to read! All the best to you, hopefully things get better. That system sounds so confusing.

JoAnna McNurse · Nov 19, 2006

Thank you so much for replying. I was wondering if I am just incompetant or if this crazy system is causing me to have problems. Sounds like most of you agree that this is a problem system and there are much better systems in use which cut down on potential errors and are clearer to use

P_RN, ADN, RN · Nov 19, 2006

when you say "cards" do you mean little 2x2 cards, one for each med? if so that system is so out of date it isn't funny.

or do you mean card stock half notebook paper size? that's also out of date.

we had computer printed but paper managed mars. they were kept in a 3 ring binder with the current one on top and the prior day's lbehind it.

it was not the best, but goodness it was a lot better than what you are describing.

if you can't have computerized mar at least you should have a paper that is part of the permanent record with the caveat that all entries are to be hand printed, legible, and verified by the nurse.

discontinued meds are marked through with one red line. with the notation stop 11/19/06

there was a preprinted yellow bar between each of the meds. the mar also had a place for the allergies and the patient name and diagnosis at the bottom right. your facility needs to rememdy this stat.

JoAnna McNurse · Nov 19, 2006

No not small cards...... I'm talking about full page card stock.

On the left side of the page you put the drug name/dose information.

As you move across the page there is a column to put the time the drug is supposed to be given. If it is BID, TID, etc....a line is made for each of the time.

Next.....there a series of small "box" columns where at the top of the page you put the date. Down this column, we put our initials when we have given the drug "on that line / in that column/box"

If for some reason you DO NOT give the drug....you put your initials and "circle" them which inticates you didn't give the drug. Chart the reason later

On each page, there are multiple horozonal lines and room for multiple drugs ---Usually each card has 4 - 8 drugs and their times listed. If a drug is d/c......a yellow marker is used to color the line(s) used for this particular drug so you know it is d/c'ed

P_RN, ADN, RN · Nov 19, 2006

I believe the yellow marker may present a problem. Some photocopiers will not show it. I would much prefer the one line red mar, So you are saying that the person writing the med has a bad handwriting? That would be fairly easy to report as a discrepancy and let management know.

nursekatie22, RN · Jan 2, 2007

:angryfireI HATE reading peoples' handwriting!!! :angryfire

P_RN, ADN, RN · Jan 2, 2007

Mine's gotten so bad I hate trying to read my own. In college I printed everything. What does an 18 year old know? Anyway that fad went bye bye and I have/had a pretty good handwriting. I guess I need to go back to printing? Back then I did it in regular caps and small letters. NOW I find I need to use all caps. I know, I know TMI. Just wanted to assure you that I think you have a valid complaint.

crb613, BSN, RN · Jan 2, 2007

Your hospitals system sounds a lot like mine. Ours is printed out on a full sheet of paper w/three holes at the top & fits into a binder. Any added med orders are handwritten. We too use a highlighter to mark through DECed meds & circle ones not given. I agree it can be very confusing...I work nights & it is our job to check MAR's. I spend a lot of time looking at original orders/med reconciliation sheets/new orders trying to get the thing correct. I too have missed a med because of times being so jumbled up and the hand written times can be so hard to see. When we get new orders we fax to pharm & they are to print out new Mars.....I have seen these things go for days w/hand written add ons. There is nothing like having a hand written MAR for a hospice pt....horrible!