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Discussion

Confusion over the 3 checks

Hi there -

I am an LPN currently in school for my BSN. There seems to be endless discussion over when to do the 3 checks of med admin. I hear conflicting opinions all the time, and I'm sure I will here too. Just wondering how others are doing their 3 checks.

I always do it like this: (and of course following the rights...)

After confirming the DR order, and I'm now standing in front of the med cupboard with the MAR I...

#1 - Pull the med from the cupboard and check it against the MAR.

then I pour the drug. After pouring I

#2 Check the Med package again, against the MAR and confirm I've poured the appropriate dose etc...

then I put the package away and

#3 Check the poured med against the MAR.

Then I can go to the pt bedside and administer.

The trouble seems to be with the 3rd check. People also say we should do our 3rd check at the bedside. But as I'm sure many of us do, I pour the meds in the med room or hallway and leave the cart outside the room. I don't bring my MAR with me into the room to do my final check. So if I am doing my 3rd check at the bedside, without the MAR, what exactly am I checking it against?

I hope this makes sense, and put's the issue to bed for me once and for all!

Thanks everyone:)

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    Maybe try to think about it in terms of the "5 Rights" of medication administration. Right Drug, Right Dose, Right Route, Right Time, Right Patient. I think in the scenario you are describing you are missing the opportunity to verify the MAR/drug/dose against the correct patient if it is left outside the room. This is probably where some of the other people are taking issue with this based on the way you described it. Remember that when you are in school you have to exaggerate and verbalize what you are doing so that instructors/preceptors know what you are thinking.

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    In nursing school, we were shown med administration with taking the MAR into the room with us. Have you been working in LTC? That may be where some confusion may some into play.

    Will the hospital have electronic MARs? Scanners? Computers in the rooms? These methods make it easy for doing a check in the room. When on clinicals with these we would check the MAR. Open the Pyxis, Remove the med checking it agains the MAR, take it to the room and pull up the MAR on the computer we brought with us or is in the room that has it's own scanner, or used the handheld scanner. We would check Name and birthdate with the patient, scan the med and verity this on the computer and the give the med.

    Hope this helps.

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