Anyone having problems with preprinted MARS?

NurseFirst · Feb 3, 2005

Wondering if anyone is having problems with preprinted MARS. We started using them again about 2 weeks ago. Orders are entered into computer and we were told that the computer generated orders are interfaced with the pharmacy and our pyxis. Pharmacy assured us all of the "bugs" were out of the system and we should not see errors.
MARS are printed for the next day at 10PM. After checking the charts for new orders written that day and ensuring they were written on the MAR, the night nurse (me!) compares the old MAR with the new one for accuracy.
You expect that orders written/changed after 10PM won't be on the new MARS - no big deal. We are still seeing mistakes. Meds are on MARS that were never ordered. Wrong route, meds that have been dc'ed still showing up, meds ordered not on the MARS.
We (psych) are the pilot program for medicine. They want this to be hospital wide by the end of the year. I told them they were out of their minds if they expected medicine (who writes a ton of orders) to be able to check MARS every day AND get their patient workload done.
Management started cutting back to one RN on nights last week because of low census (15). I asked them today not to leave me as the only RN. If I am not disturbed, I am relatively okay but if I am interupted, I fear making a mistake and it takes me twice as long to check the MARS. If I get an admission or someone goes bad (both happened to me this week), I could be checking charts till close to the end of the shift. Also, it's mind numbing!
So, wondering how other nurses manage this and if they come acrosws frequent mistakes on the MARS. Thanks!

One of the things I used to do was software quality assurance.

If your hospital is interested in the system, I'd tell them to ask the company providing the software to provide a copy of their test plan. They may not get it, but you can try. Then your hospital can find out how much testing the software company did vs. how many bugs they are expecting their customers to find.

That many bugs in such a "mission critical" application is just horrifying to me.

What good does a system with so many bugs do you? You could do better by hiring two different checkers to check the MAR every day and comparing their results (no computer software at all.), resolving discrepancies. I thought medical software companies had higher standards than that. If you can, you might try to find out just how the hospital decided to get this particular piece of software---in the name of patient advocacy!!!

NurseFirst

medpsychRN · Feb 3, 2005

I'm sure they researched the software. Two years ago (last time we had preprinted MARS) we were led to believe the orders although entered on the computer were still being manually entered into pyxis and that was the problem. I have no idea what's wrong this time. I intend to ask again next week. Once I find one mistake, I tend to be hypervigilent which of course then takes me longer to finish. Last night was the worst with 4 out of 9 MARS with errors.

NurseFirst · Feb 3, 2005

I'm sure they researched the software. Two years ago (last time we had preprinted MARS) we were led to believe the orders although entered on the computer were still being manually entered into pyxis and that was the problem. I have no idea what's wrong this time. I intend to ask again next week. Once I find one mistake, I tend to be hypervigilent which of course then takes me longer to finish. Last night was the worst with 4 out of 9 MARS with errors.

At how many purchases like this are done because of "old buddy" connections. Most software is too mind-numbing for most people to get into the details, so they trust their buddies, the ones they went to school with who are now working at some such or other software company. I was on a software selection committee for Apple Computer, and selecting software is really not all that easy (I, and all the other people on the committee, were software folks, too--so imagine if you are someone who is NOT a software person), and salespeople know how to take advantage of people's lack of information. If the software selection committee didn't have someone to represent each department who would use the software, then those unrepresented departments are sure to be unhappy with the software, at the expense of those departments who are delighted with it. And the department representatives should be people who will be using the software, generally, not managers (unfortunately, that is usually who gets picked to sit on such committees). Believe me, I'm sure they are paying quite a hefty sum for the software.

(Maintenance contracts are another thing to look at; and backup mechanisms for both data and hardware.)

NurseFirst

medpsychRN · Feb 3, 2005

You're right about the maintenance contracts. They must have one on our pyxis. When you call the pharmacy to complain about the pyxix, they are on the unit in minutes. It's like you called a code! LOL We actaully have someone's phone number to call at home if the problem is not resolved. Wonder what they pay for that!

You're probably right about the "buddy" system. They actually have a whole department that does nothing but computers. But, I work in Chicago. That should say it all!!!

NurseFirst · Feb 3, 2005

you're right about the maintenance contracts. they must have one on our pyxis. when you call the pharmacy to complain about the pyxix, they are on the unit in minutes. it's like you called a code! lol we actaully have someone's phone number to call at home if the problem is not resolved. wonder what they pay for that!
you're probably right about the "buddy" system. they actually have a whole department that does nothing but computers. but, i work in chicago. that should say it all!!!

probably a lot. but don't take it out on the poor sap who is answering the phone. he probably gets paid $**t.

nursefirst

asher315 · Feb 3, 2005

We have preprinted MARS as well and it's running all over the house. At first, we had alot of errors esp missing meds but pharmacy blamed it all on the nurses/wc for not faxing the order down. Then for awhile I (the nursery) didn't even receive any but the pharmacy had filled the order so they must have had it. Any time we find an error, we fill out a form with the info on it and send it to pharmacy. Eventually it does get better. Still if you have alot of meds... What I hate about our MARS is that they go into use at 0700 the next day (receive and check it on nights then day shift starts it. That would be find but the times are listed 2300-0700, 0701-1500 and 1501-2259. After day shift charts their meds

(12 hr shifts) then I'm suppose to go back and chart mine. It looks like I gave mine first. Does this make sense? More than once I've charted 24 hrs ahead of myself. Now I put the date and my initials by the time. (Yes, the date is printed at the time. Of course, I used to hate writing all those meds out by hand. The more things change...the more bugs we have to battle. Good luck. :)

medpsychRN · Feb 3, 2005

We have preprinted MARS as well and it's running all over the house. At first, we had alot of errors esp missing meds but pharmacy blamed it all on the nurses/wc for not faxing the order down. Then for awhile I (the nursery) didn't even receive any but the pharmacy had filled the order so they must have had it. Any time we find an error, we fill out a form with the info on it and send it to pharmacy. Eventually it does get better. Still if you have alot of meds... What I hate about our MARS is that they go into use at 0700 the next day (receive and check it on nights then day shift starts it. That would be find but the times are listed 2300-0700, 0701-1500 and 1501-2259. After day shift charts their meds
(12 hr shifts) then I'm suppose to go back and chart mine. It looks like I gave mine first. Does this make sense? More than once I've charted 24 hrs ahead of myself. Now I put the date and my initials by the time. (Yes, the date is printed at the time. Of course, I used to hate writing all those meds out by hand. The more things change...the more bugs we have to battle. Good luck. :)

We must have the same system. I've complained about med times eg, chsrting 6 AM meds on "yesterday's MAR. Same goes with PRN's and if meds are given at 3PM, 7 AM or 11 PM. I know there here to stay...at least for now.

There is some talk of going to computer meds. Using a bar code to identify yourself, patient and med when you give it. It automatically charts the med for you. Haven't seen it so I am clueless about "where" the med is charted and what you use to determine when the med is to be given. I have a feeling it's connected to the pyxis which is scary because sometimes meds that are listed in pyxis are incorrect.