This can't be right!?

  1. So I work in LTC and State recently came to our facility and one of the things we got "tagged" on was holes in our MAR's and TAR's. My facilities plan of action recently has been to add a sheet in the MAR that the incoming nurse must sign off that all holes are filled in the MAR's and TAR's by the offgoing nurse. If for some reason you sign off that all of the holes are filled in and the Unit Manager finds the hole the ONCOMING nurse gets written up!! So now you have people just filling in holes with other peoples initials in order to avoid getting written up. So basically I am responsible for the prior nurses medications and treatments being signed off, even though I wasn't even there to know if this has been completed!! WTH!?!?!?
    Someone please tell me I'm not crazy and this is so wrong!
  2. Visit wishinguponastarLPN profile page

    About wishinguponastarLPN

    Joined: Aug '09; Posts: 222; Likes: 174
    LPN; from US
    Specialty: Rehab, LTC


  3. by   xtxrn
    I only signed my own work....NEVER someone else's - that's falsification of records. Bad thing to do......
  4. by   wishinguponastarLPN
    Exactly! So when we asked what are we supposed to do, they say do not take the keys until you check both the MAR and TAR! Well I have 4 MAR and TAR books to look at because I have 26 patients and there is a book for the EVEN side of the hall and a book for the ODD side of the hall. Do you know how long that takes? Plus getting report and counting narcs. It really doesn't make any sense. Anywhere else I've work the Unit Manager checks the books and if there is a hole they go to THAT NURSE.
  5. by   mazy
    In our facility the night nurse audits the MARs and TARs and hands in a report of holes to the charge nurse the next day. Nurses with holes are required to come in within 24 hours to fill them in. Holes are not a huge problem, people make sure to get them filled in before leaving -- no one wants to have to come back.

    Your system doesn't sound very efficient, it sounds like someone in third grade came up with this idea.
  6. by   Mulan
    Why can't the off going nurse check for her own holes?
  7. by   xtxrn
    Quote from Mulan
    Why can't the off going nurse check for her own holes?
    Sounds like they may be in her head
  8. by   xtxrn
    If everybody would just sign the MAR and TAR at the time they are giving the meds or doing the treatment, it wouldn't be an issue. It's a huge set up for state deficiencies, JCAHO deficiencies (if your LTC is JCAHO), and if there's a lawsuit, the MAR or TAR gets blown up to about 4x6 feet, and the holes pointed out as gross negligence.

    If someone gets sick during the shift or has some other emergency (had a nurse one time that got a call from the police that someone had attempted to break into her house with her kid there- neighbors overseeing, but not in the house)....she didn't have time to recheck her MARs....and she didn't need to because she'd signed off when she'd done something- the rest of us just picked up where she left off, and there was no issue (and her kid was fine- but needed mom to be there).

  9. by   mazy
    Working with paper MARs and TARs is a very unique animal, and even the best of us can miss things. I sit down at the end of my shift and go through them with a fine tooth comb and I always find holes in my documentation, even though I try to be very conscientious about signing. Not only that, but even when I go through them at end of shift, double, triple check everything, I still end up coming back the next day to find that I've still got the odd and random hole.

    It just happens. If you've got a nurse who is just flying by the seat of her pants and isn't being careful, or if it is an unusually hectic night, holes can be a huge problem. It also really depends on the facility. In some facilities the patient load is so heavy and there is so little support, and management is so boneheaded -- as it sounds like the OP's facility, holes can be a huge out-of-conrol problem.
  10. by   Liz, RN
    I don't understand their logic behind writing up the oncoming nurse!!! Seems fishy!!
  11. by   DeeAngel
    I would let JACHO know that is happening.
  12. by   leslie :-D
    this is a dangerous, illegal, and STUPID plan.
    the DON (or whoever it's delegated to) needs to find which nurses were scheduled for what day/shift, and get them in to initial their holes.
    that is the only way to do this correctly and safely.

    sorry op, but i can understand why your facility would get dinged.
    and they have it coming, too.

  13. by   GLORIAmunchkin72
    "Working with paper MARs and TARs is a very unique animal, and even the best of us can miss things. "

    The same can happen with electronic Mar. You can click on the little squares but if you forget to save they come up blank, and sometimes you click on 'save' but you did it too quickly or didn't punch the key hard enough and you get the same results so we have to constantly check and recheck...
  14. by   prettymica
    My LTC has the same policy. I don't sign those sheets nor am I filling in someone else's holes. I have enough things to do like vitals, skin sheets, bolus feedings, dining room duty, med pass, monthly summaries, and charting. A few weeks ago they were supposed to write up every nurse who left holes in the MAR. It was nearly every nurse that works there. So basically nothing happened