Ever hear of such a thing?

[LatinGirl]

We have a new DON and a new administrator at our facility and as such they are implementing new policies and procedures. Our DON sent out a memo last week informing us that the new procedure for documenting dietary orders on the MAR is to do so in pencil and when the order changes to erase and right the new order in pencil again. We have refused to do this and have called the BON for advice, but have not gotten a call back as of yet. This DON seems to think that his policies...not just this specific one, but all... supersede(sp?) anything the BON may say. What are your policies in regards to documenting dietary orders?

[SonorityGenius]

on MAR sure his policy may work..

To cover your license just document the diet ordered in Nurse's notes from old order to new order and elaborate on exactly what was specified and by whom

[LatinGirl]

Thx for your reply. I guess I just don't like the idea of erasing anything on a MAR.

[tyvin, BSN, RN]

Something like that shouldn't fly where you are; at least I've never heard of such a thing. The MAR is a "legal document" and is treated as such. That means there's no erasing and it should be in permanent black or blue ink pen. When something is changed a single line is drawn through and that is all. This is to facilitate the reading of d/c'ed material for any differing amount of reasons one being if it did go to court. In the end the MAR is a legal document period.

[noctanol]

when i was in school, they taught that every a nurse wrote (legal) had to be in black ink, period. i dont know if the DON is correct or not. Has anyone suggested just getting a new paper and writting in the new order, after all this is a legal document. as the 1st response says, if the DON is a smart*ss, just document, in ink, in your progress notes, might be time consuming but you never know what will happen in the future.

[ChristineN, BSN, RN]

Where I work we always put the new orders on the Karedex, and highlight out the old orders. Obviously the old orders are still legible through the highlighter.

[LatinGirl]

We discussed the point of the MAR being a legal document with the DON, but his attitude about it is this is the procedure and that's how it will be. I do not agree with him and so have been writing in the dietary orders in blank ink just like any other order. He said that nurses who do not comply with the way he wants it done are considered insubordinate. Oh well.....just will have to be insubordinate then.

[gentlegiver, ASN, LPN, RN]

We discussed the point of the MAR being a legal document with the DON, but his attitude about it is this is the procedure and that's how it will be. I do not agree with him and so have been writing in the dietary orders in blank ink just like any other order. He said that nurses who do not comply with the way he wants it done are considered insubordinate. Oh well.....just will have to be insubordinate then.

the way I see it, you can be insubordinate to the DON, or the BON. I would do what the BON says, which I have always been told is document everything in Black INK. You never know if someone will change the order and leave your name on it. Then you are legally responsible.

[Hospice Nurse LPN, BSN, RN]

I've never heard of such a thing! I'll be interested in what your BON has to say.

[classicdame, MSN, EdD]

we never use anything but pen in the hospital. We do not put dietary orders on MAR however. That is for meds only.

[scoochy]

In the state where I live, it is the Dept. of Public Health that conducts state inspections, audits records, etc. The DPH writes the regulations for LTC facilities. If an inspector/state surveyor got "wind" of erasing a legal document, there would be consequences, i.e., a citation issued upon the facility. This citation can range from a documented deficiency to a monetary "punishment."

Diets have to be entered as MD orders. If the order in a resident's chart is not consistent with what is written on an MAR, this will be discovered. Auditors/inspectors are astute individuals; they KNOW how to discover discrepancies.

Oftentimes, state surveyors will gear their inspections toward specific depts. If it happens to be dietary, a practice of erasing diet orders on MARS will be discovered; you can be certain of that.

Furthermore, should they see that a diet order is written in pencil (YIKES!) on the MAR, nurses will be questioned re: this practice. Look out....

My suggestion: if you have yet to hear back from the BON, I would contact whatever agency it is that conducts inspections of LTC facilities in your state and pose your question/concern to said agency.

[canesdukegirl, BSN, RN]

I also work in NC, and this is what I found:

North Carolina Board of Nursing

Look at the "Physician Orders" part of the position statements. Since you are asked to document diet orders on the MAR, the BON's statement is rather clear...we cannot alter an order. Documenting in pencil is altering an order.

Your DON is out of his freaking mind.