Pharmacy is now doing our MARS...

[Finallydidit]

Pharmacy has now taken over our MARS. Effective 6/1... After one week it is unbelievable the ERRORs that have been made. Medications not listed. They have completly changed the times. My huge 5p pass is now an even more huge 9p pass because it now includes the HS meds. BIDs are now given at 9&9 So yea, BID lasix is given to these poor old residence at 9pm, and we are now waking residence up to give them the ativan that they needed at 5pm. Also the way the order is written on the MAR is not at all clear at all unless you read a whole "chapter" (Each discription is no less then 12-15 lines) For example it will say Tegretol 100mg, then 3 or 4 lines lines down it will say take 3 tablets to equal 300mg. Its a nightmare to say the least. Say if a Resident got Tegretol TID but diff. dosages like 300mg @ 9a and 5p and 400mg @ 9p they have the 5p dosage to be given at 9p also, so there is 2 diff orders one stating Tegretol 200mg then later say give 2 tablets to equal 400mg the other stating Tegretol 100mg give 3 tablets both sched at 9p. Thats 700mg. to be given at 9pm on 2 diff. orders. These are just a few examples

Thankfully I know my cart and my Res. and know what they get for the most part and have been able to prevent errors on my shift, but OMG the time that it has consumed is unbelievable!

Anyways, just venting, if anyone wants to share their nightmares or perhaps tell me that it will get better I will be glad to listen

[Nascar nurse, ASN, RN]

Ugg..my facility is scheduled to begin having the pharmacy do MAR's next month. I have been dreading it prior to reading this thread but now I'm really worried.

[CapeCodMermaid, RN]

BID Lasix does NOT have to be 6am and 2 pm. Please don't wake me up at 6 am to give me anything. YOU are the customer....have the DNS or ED call your pharmacy account rep. and complain. My pharmacy is horrible and we are currently looking for a new one. YOU are the customer. YOU pay them for the service.

[morte, LPN, LVN]

BID Lasix does NOT have to be 6am and 2 pm. Please don't wake me up at 6 am to give me anything. YOU are the customer....have the DNS or ED call your pharmacy account rep. and complain. My pharmacy is horrible and we are currently looking for a new one. YOU are the customer. YOU pay them for the service.

lol, but it is a heck of a lot better than 9+9.....and many are already awakened for thyroid meds/antigerd meds

8+2 would work.....

[JenniferSews]

Our pharmacy does our MARs too and it's a train wreck. It still takes 3 good days for someone to double check them and correct times, etc. They had that one pt should be wearing someone elses c-collar! So we double check them, then I go through and triple check mine before I give meds. It takes forever and a day and I dread the end and beginning of the month.

[GooeyRN, ADN, BSN, CNA, LPN, RN]

When we have issues with that, we have the doc SPECIFY the times when he writes the order. No one likes Lasix at 9pm.

[txredheadnurse, BSN, RN]

We have a closed door pharmacy that is under our corporate umbrella. They do our MARS. I hate their MARS. No matter how many times I clarify meds, dosages, times etc. every month it is the same errors plus some new ones for grins and giggles. It is time consuming to correct and have to manually write out the corrections. We used to do our own MARS and could go in and make the changes as they occurred on the template MAR stored on the computer. However since this is an affliated company we are forced to use their inferior product. The real heartbreaker in all of this is the pharmacy knows we can't fire them so they don't worry about losing us or fixing their mistakes. It totally sucks.

[Finallydidit]

Its all corporate.... Hands are tied at this point, DON is going thru all the carts, charts, and MARs.. Spent 12 hours on 2 of them today, and thats after all the corrections that were made during last week. She actually is listening to us, and knows we are right in advocating for our Residents. She is between a rock and a hard place because she knows that if she allows us to get the Drs to change the orders that she is going to end up in a ******* contest with the pharmacy at corporate. So she is trying to get her ducks in a row to do battle. She promised that she would have something in Corporate hands by the end of the week. So now we wait!

NASCAR NURSE.. You will be thinking of me when you get your new MARS.. :)

[diane227, LPN, RN]

Our pharmacy has always done our MARs and they have established set times for medication administration which makes med passes easier for everyone. Once your system is established, you will find that it is much easier and you have the added check of the pharmacist to assure the medication and dose is correct.

At our hospital, all medication orders are scanned to the pharmacy. The pharmacy enters all those medications onto the MAR and then either they print the MAR or you go into the pharmacy system and print it for yourself. The pharmacy tech puts the meds into the system and the orders are then checked by the pharmacist. Once the MAR is printed, the charge nurse checks and verifys all orders and signs them off. The pharmacy does not add the stat or one time orders. The charge nurse adds them in writing to a special place on the MAR and notifies the nurse of those orders. The pharmacist, nurse and charge nurse all share the responsibility for catching errors written by the doctor and we rarely have a medication error because of this. We catch most transcription errors before meds are given. As the day goes by the charge nurse willl DC orders on the MAR, add new meds etc and make the appropriate changes on the current MAR in use for that day. Pharmacy is responsible for auto sub for some medication and for making corrections in the dose if the dose is incorrect according to established hospital protocol. They also dose certain antibiotics according to protocol such as Vancomycin. They check cultures and make recommendations regarding the proper antibiotics to use. The pharmacist also does medication consults for patients in pain to establish a pain medication protocol for them. They write order clarifications for the chart and we transcribe those orders onto the MAR.

New MAR's are printed for the next day every night at 23:30 and the night charge nurse and nurse check all the MAR's with the old one from the previous day to make sure all new orders are there and all meds that have been DC'd are gone. The MAR from the previous day goes into the charrt behind he doctors orders.

This system works really well for us and we have very few medication errors because of this cross check system.

[morte, LPN, LVN]

diane....what you have and what the OP has are two different systems....she/he is in long term care. The timing issue is being addressed in a cookie cutter manner, no differences allowed. What "reasonably prudent nurse" would give a nonemergent, ie scheduled, dose of lasix at 9p? We need to remember that this is the patient/client's home. Do you think they would do that to themselves at home? Another thing, how dare corp. interfer with the docs practice of medicine?!!!!

PS diane, only the first comment was aimed at your post....

[CapeCodMermaid, RN]

I'm pretty sure a pharmacist doesn't actually check the MARs before we get them. I worked in one place where the data entry person did ALL the MARs and TARs. It was wonderful...SHE was wonderful and editing at month's end was a piece of cake.

[Nascar nurse, ASN, RN]

NASCAR NURSE.. You will be thinking of me when you get your new MARS.. :)

Actually I was already talking about you today at work when someone else was saying that they are just dreading this change. Was telling the DON that I suspect this poster on allnurses probably works for same corporation as us and probably talking about the same pharmacy corporation?? Good luck to you

[debRN0417]

So when did the Nursing facilities start working for the pharmacies- I mean who is the one being paid for the service? Looks to me like the one getting paid should be the one doing what the customer wants, not the other way around.....