For those of you that still use this method (paper) of records that need changed out at the start of the new month- what is your med error rate? Who verifies the validity of the possibly 1000's of orders that accumulate, change, expire and ec. during the prior month? When the night nurse on the last day of the month changes out MARs/TARs, can she be assured the orders are accurate? If thye are not, is that nurse responsible (as far as the SNF is concerned, we will leave the BON out of this post) for med errors that may result that first night of changeover?
Prior post 'I didn't accpet the keys'... brought this issue to my mind.
Mar 3, '14
Before we switched over to EMAR last May we had paper MARS. We were required to have 2 checks before the end of every month. The LPNs o. Day/eve did the first check and the RN on NOCS did the 2nd check.
That check usually took about 3-4 shifts to complete for each of 2 night nurses in an 82 bed SNF.
We also photo copy all new orders for each shift to review and get a triple to be signed off on NOC shift before filing the MD orders away.
Mar 6, '14
The facility that I worked at 5 yrs ago had a good end of the month checks for the MAR/TARs. The med and tx sheets were printed out about a week before the end of the month, the NOC nurses would than check the new MARs/TARs against the current ones. If a discrepancy was found it was checked via the resident's orders in their chart. It typically took us a few days to have them all checked. The system worked well and I cannot recall ever finding an error that was a result of our check.
The facility I most recently worked for changed how the MARs/TARs were checked quite frequently... When I first started the sheets were all printed by the pharmacy and checked by our DON. She would actually take the next month's sheets home along with a copy of each resident's orders!!! Holy HIPAA violation Batman!!!! The next DON changed this.. Our med sheets were printed in house, the next month's sheets along with a current copy of the MD orders were printed off about a week before the end of the month. The day shift wing nurse would sit down with two other staff members (usually the HIM, charge nurse, and/or MDS nurse). One person would than read off the med and tx orders from the Physician orders while the other two checked them off of the old and new med sheets. It was a huge pain in the rear and such a waste of time! I pointed it out that the Physician orders and the MARs were part of the same program, if the order was in the computer and on the physician orders than it will be on the most recent MARs!!! Comparing the new MAR to the most recent physicians orders made no sense! I asked them time and time again to let me check the MARs and the next DON finally allowed me to do it! The MARs were my baby and I was super anal about getting them checked! After I left I heard from my old supervisor that the MARs had become a mess since I left and weren't getting checked well... Frequent med errors since I've been gone!
Mar 6, '14
At one facility the night shift house supervisor checked the MARs at end of month. She did a good job, don't remember any problems. When she left, think they weren't being checked at all.
I am noticing some nursing homes do not take monthly changeover seriously. I thought old orders were to be filed away and on the first of each month physicians orders from pharmacy are checked and signed by the nurses during the last week of the month, before the 1st of the next month. I was told by a supervisor, your a good one, nobody has time for all that just pass the pills.
Yeah, the nightly chart checks are supposed to keep up with the new orders; once MARs come from pharmacy, all new orders have to be verified as taken off on both old and new MARs. It's an ongoing thing.
I can only dream of awesome stuff like EMARs. I work for the state, so I guess I'll be dreaming for a while yet.
But at least now I'm on a small unit. Wait until you're the only night nurse trying to organize paper MARs for 700+ prisoners. Aaargh!
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