Blanks on MARS

suzanne4, RN · Mar 31, 2006

If it is not signed out, then it is considered not given. And if nothing is noted as to why is was not given, they are responsbile for it.

If for some reason that a chart goes to court for a problem, they can be held liable for not administering the med, the lawyer for the other side woill see to that.

It can also be grounds for firing, if they are skipping meds. Sorry, but if it is not documented, it is not given.

Have you asked them why they are not charting all of them? Is it that some are actually not given and they do not know what to write? All it legally needs is a circle around the time, and then it can be a code as to why it is not given. Do you have that on your MARS?

I would do some investigating on your end with your forms first.

CapeCodMermaid, RN · Mar 31, 2006

We have the same problem. We've started a new policy on each unit where one nurse has to check the other nurse's MAR for any holes...still gives you time to give the med if you've forgotten or to sign it off if you gave it and didn't sign. It was a huge problem during one state survey.

suebird3 · Mar 31, 2006

We have a 72 Hour form my boss designed for charting on Admits/Re-admits, falls, etc. If any of us "forget" to chart (as inevitably happens when it is nuts!), my DON "tags" the sheet with a flourescent sticker with our name on it. Gets our attention, alright!

A bit off subject, but the 72 Hour sheets really come in handy, too, when there are multiple admits/re-admits. Sure beats trying to reach up and grab charts, and all are located in a binder on our desk.

And I do agree...if there are missing signatures, Public Health will crucify you for sure.

Suebird

elkpark · Mar 31, 2006

I've worked as a surveyor/inspector for my state and the Feds, and there is no question about it -- a "hole" in the MAR is considered to indicate that the med was not given, and that is A MED ERROR.

If the nice, pleasant, "carrot" approaches are not working, perhaps it's time to go to the "stick" approach -- audit the charts yourself (or, at least, a random sample of them), write up each "hole" as a med error (right then -- none of this tracking the nurse down, asking her about it, and asking her to please sign), and simply follow your facility's policy for nurses who have multiple med errors. Your facility does have some sort of disciplinary process for nurses who continue to commit med errors, right? Why would you (and, by "you," I mean the entire nursing administration, not you personally) not be following the policy??

Once there are actual consequences for not doing one's job (and, as Suzanne pointed out, legally, the med isn't given until the paperwork is complete), people will start to pay attention. As long as there are no consequences for the nurses involved, you can expect the behavior to continue.

suebird3 · Mar 31, 2006

Elkpark....I self audit. I know when there are several holes, and I catch them. It is the charting I often need to back and do. Luckily, I keep many of the Vital Sheets, so I can refer to them....

And yes, the "stick method" works and often! :uhoh3:

Suebird

geriRN1993 · Apr 1, 2006

I am having difficulty getting the med nurses to be sure they are signing out every med they give. I am auditing MARS for blanks and I'm still finding them. Any suggestions on dealing with this issue?

I would start by having the pharmacy do a med pass administration inservice. This will give them the refresher that they need. Continue the audits regularly. Daily for about a week then weekly. Inform them of the holes and inform them that every hole in the MAR is technically a medication error. Have them fill out a med error form for every hole that you find in the MAR/TAR. Just once should be enough to alert them that the holes can't happen. Then once you've done this start writing them up with corrective actions if the holes continue.

I know that the nurses are busy and a few holes is not negligence but in my experience you will identify your "problem children" by using this method.

Good luck.

nrsbetrn · Apr 2, 2006

This is helpful. I like the idea of getting a pharmacist to give the inservice. Thanks