EMAR down, no paper Mar?

benegesserit · Oct 1, 2016

In theory... we have a computer connected to a UPS which doesn't rely on network access which we can use to print out paper copies of the MAR. Not useful if there was an EMP that knocked out all electronics or something, but fine for most situations.

In practice, I'm not sure much of anyone knows how to use it, and I'm not sure how well the system has actually been tested. The times I've been there and the network has gone out, we've just waited it out (which may mean meds being delivered a bit late, but it's never lasted more than a few hours).

Ideally, perhaps we should be printing out a copy of all current orders nightly or something, though that's a heck of a lot of paper. I think trying to maintain a set of paper MARs, while maybe ideal, is going to be prone to error and neglect.

I think the important thing to remember is that you are not alone. Barring very unusual and unlikely situations (you're the only nurse working in a small SNF on a mountaintop and get snowed in? You have really really horrible management who won't come into work in the event of an emergency that threatens patient safety?) you will have other people there to help with decision-making. Unless you somehow have no backup, you should not be making unilateral decisions in this situation.

Giving meds by memory is a bigger concern, IMO, than "if it wasn't documented, it wasn't done". You can always document on plain old paper, but memory is fallible (or simply doesn't know about a recent change in orders).

But for the sake of thought experiment... I would verify the instructions on the med card with a practitioner and document on paper, or at least get a blanket order to give according to directions on the med cart. And then hope the cart was well maintained. If I were truly all on my own with no backup and no endpoint in sight, like if it was a zombie apocalypse and I was the only non-zombie staff person remaining, defending my residents against the zombie hordes and still managing to give them their meds... I'd just go by the instructions on the med card and hope State would take extenuating circumstances into account on their next survey. Though undoubtedly we'd run out of supplies before then.

purplegal · Oct 2, 2016

We actually had an instance where the power ran out, and our computers shut down for part of a shift.

I was lucky because I had written down all of my medications the night before as well as the treatments to provide so I was able to check them off.

Fortunately the computers did come back up, so I was able to chart everything at the end of my shift.

But if they hadn't, I might have just left my report sheet behind to show what meds I had given and cares I had provided.

CapeCodMermaid, RN · Oct 2, 2016

If your computers go out, you should have a policy that states what to do. We had all computerized medical records and only twice in 3 years had to print out the MAR. Please DO NOT give meds from memory. It is a dangerous practice that could lead to the loss of your license. If I had no MARs and no computer, honestly I would call all the docs and get an order to hold all the meds until the computers came back on. You know they all take way too many meds anyway!

Dawnkeibals · Oct 2, 2016

Thank you for the comments on this. I faced this situation recently and felt lost. I really like the idea to call the provider to get all meds on hold. The system was still down when my shift ended. I did not give meds from memory, I hope this never happens again! :no:

caliotter3 · Oct 2, 2016

I would imagine that you could get a single order from the facility medical director to preclude calling all individual providers. Should work for the time being.

sacyyl220 · Oct 8, 2016

That is why you should have a detailed report sheet, kind of like the ' kardex /rand cards ', we used to use . The EMAR going down does happen ! They are supposed to have a paper back up system, where you would transcribe like the olden days, and also a ' read only ' computer for patient information .