no dose to give written on MAR anymore?

[SDALPN]

The agency I'm with has now announced that they won't be putting the ML's to give on the MAR. They will put the dose on the MAR in whatever form that is (mg, mcg, gtts, etc). I think that will lead to major med errors and possibly become life threatening...leading to lawsuits from families. We were told its corporate and the whole company will be doing it. But I'm wondering if its only local or even just our office.

We all have run in to that nurse that we know couldn't do the math! What if that nurse gives a wrong dose at the end of their shift and then you are the next nurse? The patient is overdosed. Or maybe doesn't get enough of a seizure med and has a seizure. Of course, you don't know what the nurse did. You can only respond to the situation you've been put in to. What if the nurse before you gets scared because s/he can't do the math and fails to give the med at all? Of course, the nurse before you has documented that the patient was stable or VSS prior to leaving their shift. 30min later the med has had time to start taking effect. Now the office is saying the child was fine when the other nurse left and is now questioning you. What about emergency meds? I'd rather calculate them ahead of time and have the ML's to give written down so I don't have to do a calculation in an emergency. That could waste valuable time. If the nurse is slow at calculations, then what?

I feel very confident doing med calculations. But I'm human and could make a mistake. Even with the ML's to give on the MAR I do the math to make sure its right. I've caught others med errors doing that.

Opinions?? If this sounds familiar, please post. I'm curious if this is agency wide or just local. I'm not going to mention agency name at this time.

[SDALPN]

Sounds like an awful practice. I don't understand the "why" behind it. Another thing you could do is make a chart (a dollar store marker board would work well for this) with the meds and their "correct" ML doses. :)

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I think the reason is to protect the agency from making a mistake on a calculation on the mar. That puts it on the nurses. It's obvious where their priorities are.

[caliotter3]

I think the reason is to protect the agency from making a mistake on a calculation on the mar. That puts it on the nurses. It's obvious where their priorities are.

If that is the reason, it could also be like refusing to accept order changes from field nurses. After all, faxing an order sheet to the doc for signature and then making the changes to the 485, or even calling the MD office, means work. Some office support personnel avoid effort at all costs and they are not shy about this policy.

[PerfectlyPlump, ADN, RN]

Only problem is that it sometimes takes a good amount of time for a lawsuit to develop. The majority of my clients act like they have never taken a peek at our documentation in the field chart, and some of them have even stated that they don't give a hoot about the paperwork. The paperwork doesn't get important until the lawyers demand that it be produced.

Yes, lots don't get how important the paperwork is...to their hours! I know of a family that just got their hours cut, and in this case I think that more accurate assessment findings would have prevented this.

The family was in denial about their child's cognative disability...so the nurse never checked that box. Big mistake.

[smartnurse1982]

I don't like putting "ml" on the Mar.

Its better that you put "mg" and leave it at that.

Ex:

Mar says 3ml neurontin.

That's what we were giving for the past yr.

Noticed a smaller bottle from pharmacy last month.

Most of us still gave 3ml....until someone noticed we were supposed to only give 1ml,as it was concentrated(hence the smaller bottle).

The Mg stayed the same. My agency no longer writes ml on the mar.

[caliotter3]

I don't like putting "ml" on the Mar.

Its better that you put "mg" and leave it at that.

Ex:

Mar says 3ml neurontin.

That's what we were giving for the past yr.

Noticed a smaller bottle from pharmacy last month.

Most of us still gave 3ml....until someone noticed we were supposed to only give 1ml,as it was concentrated(hence the smaller bottle).

The Mg stayed the same. My agency no longer writes ml on the mar.

But that is why the unit of concentration is written as part of the order, so that every time the med is given, you are not relying upon the nurse to redo the calculation. Yes, there are nurses that don't pay attention to the units of concentration, as there are nurses that don't pay attention to any changes at all. Those are the ones that are going to make a med error, no matter how 'fool-proof' the MAR entry. Sad thing is when the supervising personnel refuse to take action to prevent med errors by requiring consistency and completeness.