checking MAR

tatgirl · Dec 29, 2006

Whoever takes the order regarding changes to meds writes it in the MAR. We also have change over at the end of the month where we have to compare the docs orders to the mars and update, d/c, make changes etc. There is no way the med pass could be done in a timely manner if you had to pull everyones charts and compare them to the mar on a daily basis. We have one hour before and one hour after to stay in compliance with state regs. Also, add to the interuptions, phone ringing off the hook, families etc etc.....

Wendy

LPN

gosilverstreaks · Dec 29, 2006

In Illinois, the overnight shift was responsible for verifying the newly printed MARs that are for the following day (beginiing with the day shift med pass) with the current MAR they have for the patients they are assigned to. If there are any discrepancies found, it is then your responsibility to go back to the chart and see what the last order was and make the correction. While the Unit Secretary in some places transcribe the new med orders onto the MARs straight fromt he chart, it is the nurses responsibility to verify that the transcribing was done accurately and then sign off the order. Some hospitals have gone away from the Unit Secretaries transcribing any drug orders and the full responisibility for getting the new drug orders on the MAR are up to the nurse assigned to that patient during the shift the order was written.

withasmilelpn · Dec 29, 2006

At our facility 11-7 is supposed to do chart checks. We have a sheet in front of the physician orders where they note any new orders. I've worked with some excellent nurses that then follow through by making sure those orders were followed up on (transcribed,scheduled, etc.) Others don't even do the chart checks. Granted 11-7 can be a difficult shift- 1 nurse, 2 aides for 56 residents. Right now we have alot of residents with behavioral problems that have their days and nights mixed up. Sometimes I don't know how they get anything done.

I'm lucky, I've been there a while and know my LTC residents meds by heart. I usually can flip through and identify them(changes) then I'll double check the order and why the change was made (if I have time) before I start my meds. I usually will look through a new admissions paperwork as well (again if I have time).

I also pay attention to the meds in the drawer. It has not been uncommon for me to find meds that were ordered but not transcribed.

Also any order that seems to be a larger dose than normal I always double check and will go so far to call and clarify if need be. I have found some serious med errors this way.

The problem with LTC is you have too many patients! You are always rushing so it is amazing that more errors don't happen. I don't blame the other nurses (though yes there are some who I routinely check because of the frequency that discrepancies occur), I blame the system!

jill48, ASN, RN · Dec 29, 2006

I have worked both hospital and long term and I always check the charts for any missed orders. Some times it takes all shift, doing a few at a time, whenever I have a minute. I also sign the last order at the bottom saying I checked the chart, the date, the time, and my initials. Maybe I don't have to do this, but I prefer to.

clemmm78, RN · Dec 29, 2006

well, who is liable if there is an error?

It depends on the error. If you give a med that is obviously an error (i.e. 50 mg of morphine instead of 5), you should have known to double check against the orders as the dose is not the norm. However, if you give a dose of 5 mg, but the original order was 2.5, just transcribed incorrectly, then it shouldn't be you as the order was within regular parameters. Same thing if the order was transcribed as a PO, but pt was NPO and you gave it anyway. Those are common sense nursing issues.

As a nurse, we are supposed to question anything that doesn't seem right. If you are giving a med you don't know, you're supposed to look it up so that you do know the regular/standard dose, route and frequency. Never give a med you aren't familiar with.

CapeCodMermaid, RN · Dec 30, 2006

Why YOU of course.You really wouldnt expect the management to take the fall would you? LTC -dangerous place to work.

Why should management 'take the fall' for a sloppy or bad nurse?

Katnip, RN · Dec 30, 2006

It depends on the error. If you give a med that is obviously an error (i.e. 50 mg of morphine instead of 5), you should have known to double check against the orders as the dose is not the norm. However, if you give a dose of 5 mg, but the original order was 2.5, just transcribed incorrectly, then it shouldn't be you as the order was within regular parameters. Same thing if the order was transcribed as a PO, but pt was NPO and you gave it anyway. Those are common sense nursing issues.
As a nurse, we are supposed to question anything that doesn't seem right. If you are giving a med you don't know, you're supposed to look it up so that you do know the regular/standard dose, route and frequency. Never give a med you aren't familiar with.

Nope. The one who administers it is ultimately responsible. There's a lot of legal precedence out there, even if a physician or a pharmacist made the mistake, the nurse was found responsible.

Liddle Noodnik · Dec 30, 2006

Hi LTC nurses--what is your policy about checking MAR to the Physicians orders before your med pass? Do you look thru each and every med order and compare it to the MAR?

On nights in many places I've worked, we are supposed to, at some point in the shift, check the NEWest doctors' orders against the MAR, and sign the chart that it had been done. I think also eves had to do this, so there were two signatures, besides the nurse who had taken off the orders originally (needless to say, a big pain when it was a new admit).

Also, from month to month we were to check each doctor's order against the MAR to look for errors. I was called "lazy" at one facility because I insisted on doing this and was therefore slower at transcribing new MAR's. Didn't matter to her that I was finding multiple errors (that had been missed for sometimes months at a time).

Anyway - hope that helps!

caliotter3 · Dec 30, 2006

When I worked Noc shift in LTC I was taught, and routinely performed, the MAR check at the end of each month. Other than that, responsibility for checking for inconsistencies was handled by the nurse receiving/transcribing the order and any individual who discovered something not correct. I changed jobs to a small facility one time and was actually chewed out for doing this task at month change one time by the DON b/c she stated that at that facility this check was the responsibility of her Asst. DON.

Simplepleasures · Dec 30, 2006

Why should management 'take the fall' for a sloppy or bad nurse?

If there is a policy in place that prohibits the nurse from doing the job correctly, the mangaement should actually take the fall. As you have stated yourself, there are far too many meds that are to be given in a far to short of time PROPERLY and SAFELY.The mangament who is aware of this IS ultimatley responsible along with the med giver.I have seen cases in which the management are listed in the names of defendants in a law suit. A "sloppy or bad nurse" would most likely just not give some of the meds or give them all at a certain time , not when they were ordered, as we have discussed on other threads. Managent IS responsible for the goings on in their facilities and DO "go down" with the nurse .

not now, RN · Jan 3, 2007

Checking the MAR to the chart is done at the end of every month. Actually, the owner and his wife (both nurses) come in and review the old PO sheet with any new orders that were made during the month. Then he prints new PO's for that month. Then one nurse is given the job of auditing the PO's another audits the MAR's/TAR's (it's considered a day of work and you don't have to work on the floor that day, just audit) and a NOC nurse double checks.

Any new orders are the responsibility of the nurse taking the order. Usually the oncoming nurse will notice a new order and double check.

brendamyheart · Jan 4, 2007

Why YOU of course.You really wouldnt expect the management to take the fall would you? LTC -dangerous place to work.

I am a unit manager. I do check the end of month orders with the previous orders. I also check the the current MAR with the next MAR. We also check new orders daily to make sure that they are placed on the current MAR,s as well as checking did the med get ordered. It is called team work.!!!!!!!!!!!!!!!!!!!:blushkiss :blushkiss LTC is not a dangerous place to work, no more dangerous to work in any other health care facility.