What happens if you find a med error on MAR/TAR?

[Plagueis]

I'm asking this question because I'm learning how to do changeovers/recaps at the LTC I work at, and I'm a bit confused. I know that some newer orders can get left off the new month's MARS or TARS because they are written at the end of the month, but they might be on the current month's MARS or TARS. However, what if a new order for Prilosec 20mg daily, for example, comes in on the 25th of a month, and the nurse faxes it to the pharmacy, but forgets to put it on the MAR? If you are the one doing the recap on the 29th, and find this order in the person's med chart, but not on the MAR, do you just write the order on the MAR dated the 29th as the order date? Or is there another procedure? I've heard that some nurses just write the order on the MAR on the date they find the error, but what if someone else tries to verify that order, and sees that an order was written on the 25th, but not started until the 29th? Thanks in advance.

[classicdame, MSN, EdD]

there should be a written policy to cover this. I would date the order on the date I write it, same as nursing notes. I would then write an incident report because this patient received several days worth of the wrong med, or did not receive the med at all. I also believe the MD ought to be notified, but I work in acute care so that may not be appropriate in LTC.

[kristinlpn]

That's the problem with written MARS/TARS..... Everything should be on the computer, most nurses don't take the time to actually look in the chart to find out when the order was first actually written.... UGH. Just thinking about it makes me nauseated!

[CoffeeRTC, BSN, RN]

If it was written on the 25th and not put on the current MAR and not given from the 25th to the end of the month then that is an error in transcription. I would write up a med error report or incident report or what ever your facility uses. It is an error since the med wasn't given and the error was not transcribing it to the MAR.

After doing the report..put it on the old (current MAR) and date it the date you put it on then add it to the next month's MAR and recap sheet.

I do the monthly checks and see this happen a good bit of time, so that is what we do.

When the med error report is done, it gives the DON some info and something should come out of this and it should be used for teaching.

Now that is has happend a bit too often the nurse in question is counseled and now the 11-7 nurse does nightly checks of the chart or redlining.

[pennyaline]

That's the problem with written MARS/TARS..... Everything should be on the computer, most nurses don't take the time to actually look in the chart to find out when the order was first actually written.... UGH. Just thinking about it makes me nauseated!

Even when MARS and TARS are on computerized systems, it is still required to have signed recertification orders on record. If an order is received during the last days of the month and entered dutifully in the computerized record, it will still be missed on the recerts if they were printed off before that. Whatever new orders there are have to be added to the hard copies by hand, and dated as of the day they were originally written by the prescriber.

[CapeCodMermaid, RN]

If you are doing the edits and notice a med wasn't put on the new MAR, simply add it with the original order date. It's not a med error if the new month hasn't started. What's really scary is doing the edits and finding an error 3 months ago that 5 nurses haven't picked up on.