Writing a MAR w/doc's notes.

[dirtyhippiegirl, BSN, RN]

Just curious -- the last note (7/25) said that the feed should be 65 ml/hr for a total of 780/ml. Plus another feed in the evening which was not mentioned. previously.

Currently -- how do I write this on the MAR? The parents have her at 62 ml/hr with 480/ml total. They haven't even started the night feedings. I wrote "advance to" in the MAR but was wondering if this is what I should write?

[caliotter3]

We put feedings on the TAR. You could close out the line with a "changed"----- then, just rewrite the line with the new parameters. I think it would probably be easier.

[dirtyhippiegirl, BSN, RN]

The MAR/TAR is the same thing (well, same sheet of paper) at my agency. I guess I'm just confused because the doctor's order ONLY states that she should be at XYZ feeding rate/volume, but obviously she's slowly being advanced to XYZ feeding rate/volume. So do I transcribe what is in the doc's note directly to the MAR and...put a sticky note stating what she's currently at?

[systoly]

My personal preference is to D/C old orders and treat the new order as such, a completely different order. In this case, I believe it would be best to clarify the order and get specific orders for titrating up to desired volume. This is a huge change and not something I'd expect to see as a routine increase d/t growth. So without knowing the hx, all i can say is to clarify with doc. Without actually running the numbers, I'd say the desired feed volume (gastric) is good for a 80 to 90 lbs pt., whereas the 480 ml wouldn't even come close to sustain a pt. that size, let alone, allow for growth.

[dirtyhippiegirl, BSN, RN]

^ Was re-reading what I posted and realized that I forgot to clarify quite a few important things. Originally, the kiddo was getting 780 ml *BID*, with one feeding in the morning/day and the other at night. I wasn't thinking about the night feed since I don't work with her at night. Her dad actually commented to me that they were trying to make it so all her feedings were done during the day. (Don't know why -- I usually hear the exact opposite but whatever.)

There actually isn't an increase. The new orders just want the initial feed run faster and longer for an increased volume. And the evening feed is tacked on -- so no increase in total volume.

I will call the doc tomorrow to get specifics on titration, however. Thank you for suggesting that! :)

[systoly]

Nothing wrong with being vague when talking about a real case. One thing that comes to mind about night feedings is the increased need for personal care and possibly disturbing the pt.'s rest to the point where it might affect activity level the following day.