End of Month Changeover

CoffeeRTC, BSN, RN · Aug 25, 2008

Ours come printed from the pharmacy and then we will check them. After a few cites from the state for med errors that occured due to change over, a policy was made that two nurses did checks on them.

This worked out great for many yrs. What happend was a nurse on days (she had and easier assignment and would have time0 would do the first check. Another nurse (me at times) would be scheduled to come in in the evenings and do the double checks. Any new orders after that (normally the second check was done a day before the change) the floor nurse would be responsible for adding it to the new ones.

morte, LPN, LVN · Aug 25, 2008

1) the process needs to start on the 1' of the month , not on the 25...

2) all orders need to be accurately processed thru....either the pharmacy or in house, promptly

3) best done by person for whom it is the only job they are doing that shift

4) definetely have a second check

5) usually i have seen a sign go up "editing has begun, place all new orders on both the current month and next month"

6) make sure all nurses who are writing orders, KNOW HOW....

7) if you are doing them in house, why not reprint the ones with correction, looks much more professional and is easier to follow

i am an agency nurse, and if i had a buck for every chang over/flip night i have worked........lol

8) make your expectations clear, with consequences for lack of due diligence..

a few months ago i discovered an error that had been going on for 7 or8

MONTHS!!!! the patient hadnt received an ordered monthly med for that long!!!! try explaining that to a doc!!!

bluegeegoo2, LPN · Aug 26, 2008

Our unit secretary will do the first checks. The second check is done on nocs, over a few days if needed, by the noc nurses. On "change-over" noc, they schedule an extra nurse whose job it is to check for the last time. S/he has the whole shift to ensure all orders have been carried over correctly. I'm not on nocs anymore, but I sure don't miss doing MAR/TAR checks! That is a lot of work and even more responsibility.

SuesquatchRN, BSN, RN · Aug 26, 2008

The biggest process flaw I see is in waiting for the end of the month to reconcile the MAR's to the system. Every order should be verified for accuracy the day after it is entered into the system and should be correct before the MAR's are printed.

I've been yelled at for "wasting too much time" on this. And I stopped, and the very first month a critical med wasn't given to a patient for a week because it wasn't in the system and was missed when transcribing by hand.

NurseExec · Aug 27, 2008

I appreciate everyone's input, it's given me some great ideas. Just for clarification, we enter orders as they are received, and they are doublechecked against the POS/MAR the next day for accuracy. The problem is mainly on my short term rehab unit, which generates 60-80 orders a day. I may put a different system in place for that particular unit, since things change so rapidly day to day. Thanks again!

familychick, BSN · Aug 31, 2008

I've worked at many LTC facilities. The last one where I worked had a pretty good system for changeover. Pharmacy sent the new MAR/TAR's around the 25th. Each unit had an extra nurse come in for one day to do nothing but check the new ones against all the new orders that were written for each resident for the month. The Rehab to Home unit needed more than one day, so the unit manager would assign noc's to do some.

evilolive07, BSN · Nov 27, 2008

My facility has made it clear that night shift nurses are primarily responsible for doing editing. I did about 20/32 edits one month, and had one Psychotropic that didn't get carried over. Of course I heard all about that one.

To make things worse, not all nurses transcribe new orders to the current monthly sheets. I know that it can be hectic on days/evenings, but it would be so much more efficient if the RN/LPN taking the order could transcribe it to all necessary areas (MAR, TAR, order sheet in chart, care plan, etc.)

My one wish would be to have charting done electronically. It would be quicker, hopefully less error-prone, and it would save the harm done to my hands by opening and closing those damn HEAVY THICK charts all night long!

PsychNurseWannaBe, BSN, RN · Nov 29, 2008

We put up a sign that double charting is in progress. I hate MARS/TARS days. They don't give us extra people and some of the MARS are just screwed up. The final over view comes from PM shift since it needs to be done by midnight.

I wish there was an easier way. How out dated to have how many people look at them; attempting to catch mistakes on what? 150 to 200 MAR sheets, if not more.

sls0703 · Jan 31, 2009

We do use a computerized med pass system, so we dont have much in change-over...when an order is put in or d/c'd in the computer it is pretty much done. We do have 24 hour chart checks though to make sure everything is put into the computer as an order is received. We print out our Recap sheets monthly the week they are to see the doctor and double check for errors on stop dates and such then also. I will admit though we dont have a rehab unit.

mlolsonny · Feb 10, 2009

Our medical records nurse (MRN) goes through the MARs and TARs 2-3 x throughout the month and we put a highlighter dot (not yellow- which indicates d/c meds) next to the changes that have been checked in the computer for accuracy. That way, at the end of the month, the check is much quicker. TARs, BS/Insulin records, Neb Flowsheets, ADL Flowsheets, Restorative Flowsheets, PRN MARs are printed during the last week of the month, with MARS being printed usually the day before the last day of the month. MRN does the first check, and another nurse does the second check. Either MDS or AM or PM charge nurse does the second check.

Last month's MARs/ TARs stay in the MAR for at least 5 days for double checks PRN.