Initialing MARs with no prescription and no access to doctor

[SusanKayBergman]

Nurses at a residential mental health treatment facility are being encouraged to initial MARs for meds that are brought in by patients admitted without prescriptions or a doctor or ARNP directly following them. Patients come in with bottles of pills that we take the info from and put on the MAR record and initial and sign below with our initials. The nurses have no way of knowing what is in the bottles and only pharmacists are licensed to identified meds. Some patients have CD problems and frequently mix up medications in different containers. We have no way of knowing if they have placed street drugs or controlled substances in the containers. No way of confirming the prescriptions during the noc or on evening shift. The doctor whose license is supposed to cover us is not easily or open to interaction with nurses at all hours. Help! If a patient is harmed or we mishandle a controlled substance wouldn't we be open to a law suit or disciplinary action. Our employer invariably puts the responsibiltiy on the nurses for all mistakes in the facilities. And I mean all. When the DMHPs did not route their legal paperwork properly nurses were charged in making sure the documents were placed in the legal liaison's box.

[caliotter3]

Disaster waiting to happen. They are not likely to change their policy, so if it were me, I would look for a new job.

[MunoRN, RN]

In my state confirming the identity of meds is not outside the scope of RN's and we do so regularly during the medication reconciliation process. What we can't do is to relabel medications that don't match the label in the bottle or container they are in.

We use this: Pill Identification Wizard from Drugs.com

[NRSKarenRN, BSN, RN]

In my state confirming the identity of meds is not outside the scope of RN's and we do so regularly during the medication reconciliation process. What we can't do is to relabel medications that don't match the label in the bottle or container they are in.

We use this: Pill Identification Wizard from Drugs.com

Same in PA. Home care RN's often check what inside the pill bottle when doing med reconciliation + evaluating med compliance. Can't believe # woman that mix several meds in one bottle. Along with my drug book, I've used drugs.com website.

What is a National Drug Code (NDC)?

The NDC, or National Drug Code, is a unique 10-digit, 3-segment number. It is a universal product identifier for human drugs in the United States. The code is present on all nonprescription (OTC) and prescription medication packages and inserts in the US. The 3 segments of the NDC identify the labeler, the product, and the commercial package size. The first set of numbers in the NDC identifies the labeler (manufacturer, repackager, or distributer). The second set of numbers is the product code, which identifies the specific strength, dosage form (i.e, capsule, tablet, liquid) and formulation of a drug for a specific manufacturer. Finally, the third set is the package code, which identifies package sizes and types. The labeler code is assigned by the FDA, while the product and package code are assigned by the labeler.

The FDA maintains a searchable database of all NDC codes on their website:

http://www.accessdata.fda.gov/scripts/cder/ndc/default.cfm

U.S. National Library of Medicine FAQ re Pill Identification:

These Internet services may help you identify pills sold in the United States.

• NLM Pillbox enables identification of unknown solid dose medications (tablets and capsules) based on physical characteristics and images.
  
• Drugs.com Pill Identifier can help you match the imprint, size, shape, or color and lead you to the detailed description in a drug database derived from Micromedex^™, Cerner Multum^™, Wolters Kluwer^™, and others.
  
• FDA Center for Drug Evaluation & Research (CDER) Division of Drug Information (DDI) staff can identify drugs for you based on physical appearance (color, shape, size, etc.) and markings. E-mail DDI your drug description.
  
• Poison Control Center staff provide confidential, free pill identification 24 hours a day, seven days a week, 365 days a year.
  In the case of an emergency, please contact the Poison Control Center 1-800-222-1222.
  

Meds don't match = physician notification and do not administer until clarified.

[TriciaJ, RN]

When I worked in the jail, we used to set up meds brought in by inmates. Everything on the prescription label had to be in order. We visually inspected the pills; there had to be a correct number in the bottle based on when it was filled. Way more or way fewer pills than there should be meant it wasn't being taken as prescribed and therefore not set up. Most pill bottle labels now carry a description of the pills inside, so that helps.

If it was deemed legit, then a doctor's order slip was made out and all the slips were given to the doctor to sign on his weekly day in the clinic. Of course, this was our protocol so we were (hopefully) covered to an extent if we let something slip by. Always helps to carry your own Liability Insurance. If your employer is too fond of throwing nurses under the bus, might be time to look for the exits. Good luck.

[Susie2310]

I just want to suggest to the original poster that you consider changing your user ID name to something more anonymous.

[KelRN215, BSN, RN]

Most pill bottles do say something like "this is a round, orange tablet with M325 imprinted on one side and X454 imprinted on the other" or something to that effect. So if the bottle says that and that's what's in it, you can probably reasonably conclude that the med is what the patient says it is. You can also use the website previous posters have given to verify.

I once had a patient who came in with all of her HIV meds in a pill box. Mom didn't know what they all were, she just knew that she gave 1 blue one, 1 white one and 2 orange ones (making that up, I don't remember what the pills were or what colors they were). One of the meds we didn't carry and the pharmacy wouldn't label any home meds for our use if they were not in their original container. The pharmacist and I did verify together using an online drug identifier that the med we didn't carry was in the box and I gave it because the child needed it.