I am a new nursing instructor. I was never taught to always check every order for every med I give. I just told all my students that if they have a MAR with a med that is a reasonable dose, the patient doesn't have an allergy to it, all the seven rights are addressed, there seems to be an appropriate reason to give that med to the pt, all the assessment parameters are met and...... the MAR is signed be the previous RN to say they have checked it against the doctors order------------then it is ok to give that medication. I told them that if they have any concern about a med on the MAR to inspect further and start by looking at the doctors order. That said, if everything seems in order and the night nurse has signed off on the MAR then it is ok to give it.
Then, in the instructors meeting I was told in no uncertain terms it is basic nursing expectation to check the MD order for every medication, by the same nurse that gives the med. That does not ring true to me. In a world with 30 hours a day in it perhaps, but I have never seen anyone practice that way. why would we have the practice of checking MARs and signing that we checked them then if it is an expectation of the next nurse to go back to the doctors order anyways???
so, two questions.
Is it legally or standard of practice wise an expectation that the same nurse who gives a med must check each med on a MAR against the MD order before giving it themself?
Is it your practice to always check every med you give with the doctors order or do you administer meds based on a complete and RN checked MAR without looking at the MD order unless you have concerns?
I check every med, and it's time consuming but I think it's worth it when you catch errors. . . but now since ya'll are saying you don't i don't know if i should be.. it would save time
So what do the other instructors recommend you do when you no longer have paper charting?
Our docs enter orders directly into the EMAR system. The pharmacist verifies it, and it pops up in the EMAR. There is no order to verify...the EMAR is, in fact, the order.
Your fellow instructors are so far from reality, I'm curious as to what else they require of their student nurses? Sharpening needles after hours? Do they only allow unmarried women of good moral character into the program? Do their students also sweep the unit twice a day and take turns carrying in coal once a day to feed the furnace?
I love all your posts but this one is the absolute best especially >>>> If you ever leave nursing go into standup comedy I will attend every single one of your shows.
We have EMARs now, but before that, we had to go back and verify the orders with the new MARs that came from pharmacy or our handwritten ones. It was a royal pain, but if they are handwritten MAR's better safe than sorry.
Electronic charting has made it so much easier! Doc writes an order, we acknowledge it, do our check with our med book to make sure the dose and interval are right (as does pharmacy) and there it is on the MAR.
We do 24 hour checks still to make sure things are done and acknowledged.
It is unrealistic to check every med by the physician orders. I will verify the order if I am the first one to give it or it's a questionable order.
The first nurse signs off these orders, the pharmacy checks it again, and then it is checked during the 24 hour chart check. Even though it is possible to miss things and mistakes are made but I could not imagine checking every order.
It is good practice to teach them to do so, knowing along the road they will take shortcuts. I mean I can count on one hand the nurses who feel pedal pulses on ambulatory pts in for appendicitis, but should we teach them to check...absolutely.
Along the way people learn to take shortcuts, I will check the order for meds that have not been given before and of course any new orders, and above all ANYTHING THAT DOESN'T MAKE SENSE.
My biggest pet peeve is the loss of rational thinking, if a pt admitted with r/o valley fever, all labs WNL, and an order for Golytely pops up on my emar to be given or for a post-op knee with hx of renal transplant surgery patient an order to discontinue her transplant medications you better believe I will be calling whoever necessary to sort this out and get a rational (both slightly altered but real cases from this WEEK).
Specializes in Critical Care, Cardiology, Hematology,.
i remember in school having to go through and checking off the MDs orders. but now at my job they taught us the the EMAR is the one and only thing we should go by, interesting
While I was In clinicals our instructors had us check the orders with the MAR before giving the meds.
I have a job where I have the same patients and medications every day. I checked the orders when I first started and now I only check them if we get something new.
Each Month I check all the orders and make sure the MAR matches.
I have found many mistakes, for example meds that should be discontinued or decreased/increased may not have been noted on the MAR.
Seriously, I can think of one patient who has been on our floor for nearly a year now. She has tons of meds - at one point, her 0900 pills almost filled a 30mL medicine cup. Her chart has been thinned several times, including her orders. Even without checking MD orders, sorting through her pills takes a good 10-15 minutes (and that's if you know her meds - if you weren't familiar with some of them, add extra time to look them up!). If you checked her meds against MD orders, you'd never get anything done...literally.
So for patients on 30 different meds that have been there for 3 weeks you are supposed to go back and look up every original order? That's nuts. Nobody would ever get any work done.
According to nursing standards, YES, you are supposed to check the chart for medication orders each shift to make sure that the MAR is correct.
Does this happen every time, everywhere? Absolutely not.
Is it the correct procedure? Absolutely. When you write on the chart that you have done a chart check (whether an entire check or for meds only), you are stating that you have checked the MAR against the entire chart.
Our charts are thinned frequently, so we don't always have the original order on hand to check the meds with.
I don't think it is feasible to check every single drug against the MD order every single time. It would take hours to just find the original orders in some charts. It would be nice if more information was required on the MARs though (normal dose range, pt indication). It would be easier to spot errors.
If your chart has been thinned, as per a doctors order (Required), then you should also have an updated Med Reconciliation Form with all of the current medications, checked yes or no, with a doctor's signature. This is a substitute for the original order as an update to the patient's medication list and would keep you from having to find the original order.
I can't believe some of the stuff I'm reading here. People not checking charts because some pharmacist checked off on it, as if the pharmacist is responsible for giving a patient a med, original orders taken out of charts and not updated...yeesh.
The midnight shift is responsible for chart checks where I work, and that is a 24-hour check. In LTC, nurses often have 30 or more residents. When do they have the time to check 30+ medical charts for every single order before the med pass?
Plus, I've never heard of a state inspector failing a med pass because the nurse didn't check every med on the MAR against the orders in a resident's chart before starting the med pass.
>>>> If you ever leave nursing go into standup comedy I will attend every single one of your shows.
NursingIs4CoolPeople
80 Posts
I check every med, and it's time consuming but I think it's worth it when you catch errors. . . but now since ya'll are saying you don't i don't know if i should be.. it would save time