no dose to give written on MAR anymore?

[SDALPN]

The agency I'm with has now announced that they won't be putting the ML's to give on the MAR. They will put the dose on the MAR in whatever form that is (mg, mcg, gtts, etc). I think that will lead to major med errors and possibly become life threatening...leading to lawsuits from families. We were told its corporate and the whole company will be doing it. But I'm wondering if its only local or even just our office.

We all have run in to that nurse that we know couldn't do the math! What if that nurse gives a wrong dose at the end of their shift and then you are the next nurse? The patient is overdosed. Or maybe doesn't get enough of a seizure med and has a seizure. Of course, you don't know what the nurse did. You can only respond to the situation you've been put in to. What if the nurse before you gets scared because s/he can't do the math and fails to give the med at all? Of course, the nurse before you has documented that the patient was stable or VSS prior to leaving their shift. 30min later the med has had time to start taking effect. Now the office is saying the child was fine when the other nurse left and is now questioning you. What about emergency meds? I'd rather calculate them ahead of time and have the ML's to give written down so I don't have to do a calculation in an emergency. That could waste valuable time. If the nurse is slow at calculations, then what?

I feel very confident doing med calculations. But I'm human and could make a mistake. Even with the ML's to give on the MAR I do the math to make sure its right. I've caught others med errors doing that.

Opinions?? If this sounds familiar, please post. I'm curious if this is agency wide or just local. I'm not going to mention agency name at this time.

[Isabelle49]

Why do you think they are doing this? Are data entry persons they ones that calculate the amount and enter it? I would think if the nurse wrote it on the MAR to be data entries, it would be ok??

[SDALPN]

The case managers do the MAR's. The case managers are all RN's. Then the MAR's are sent to the home.

[caliotter3]

I do the MARs for my cases. I put both, and always have. Ex: 20 mg (10 ml). I also include the units of measure and both the generic and most common (or applicable) trade name. I never get criticized for making the MAR this complete. Apparently your agency does not believe it is paying out enough in lawsuit settlements, so they are going to rectify the situation at the expense of field nurses.

[caliotter3]

BTW, our pharmacies usually put both entries on their prescription bottles even if the original (as per the 485 or actual prescription from the doctor) does not list both. I check the math and so far have not found a mistake made by any pharmacy. When you transcribe from the prescription label you usually don't go wrong.

[SDALPN]

I can think of a few cases I'm on that the bottle says different from what the amt given is. Usually because we received a new order from the Dr. and the order was never sent to the pharm by us or the Dr.

Caliotter, I'm like you. I write both drug names and mg/mL's.

I just see this being bad news though! I'd love to hear the rationale of this from the person who came up with the great idea. I'm sure they've never worked a day of pt care in their life and never met some of the nurses I've met.

[caliotter3]

If these are going to be preprinted, I would pen in the amounts following the preprinted order. If they don't like it, they could go deal with a wet rope. That is how I see it. You are definitely right about doing the math in the beginning when you aren't under pressure and have time to recheck it. I have checked math with another nurse on the case to make sure. When the prescription changes but the pharmacy label hasn't caught up, I always line through it, initial it on the bottle, and write, "see MAR". We were taught to do something like that when I worked in a facility. If the bottle or box did not have some indication of the new prescription, the inspectors would ding us. "See MAR" covers it all and doesn't take too much room to write on the label.

[SDALPN]

See MAR is a great idea! NEver thought to do that :) I will be doing that from now on. Thanks!

I guess the bright side of this is it probably wont take long to go back to the old way. A lawsuit or 2 will end it.

[caliotter3]

Only problem is that it sometimes takes a good amount of time for a lawsuit to develop. The majority of my clients act like they have never taken a peek at our documentation in the field chart, and some of them have even stated that they don't give a hoot about the paperwork. The paperwork doesn't get important until the lawyers demand that it be produced.

[Alex Egan, LPN, EMT-B]

My agency has started to do this and I think it's an accident waiting to happen. It's ok for the normal stuff but I have some renal patents on sodium and potassium and that math is a little more challenging. I'm actually leaving my agency for this and other issues. It's yah at or get continuously written up for writing the give Xml on the MAR. Although I'm starting with a company that doesn't believe in treatment records, and I'm also not feeling fantastic about that.

[caliotter3]

Particularly frustrating when they throw TAR and MAR entries together on the MAR sheet or someone goes through the trouble of writing something useless on the sheet but leaves off all the important stuff or refuses to initial anything that they don't find "important".

[Adele_Michal7, ASN, RN]

Sounds like an awful practice. I don't understand the "why" behind it. Another thing you could do is make a chart (a dollar store marker board would work well for this) with the meds and their "correct" ML doses. :)

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