Getting it on the MAR: How hard is that?

purplemania, BSN, RN · Dec 3, 2003

what we are currently doing is: MD/RN writes order then places copy in pick up tray. Pharm tech makes rounds q 1-2 hrs (must phone in STAT order, then place copy in same tray). Next rounds pharm tech brings meds ordered. Two people must note order (RN/UC or RN/RN). By 2300 new MARS arrive to floor for 24 hr checks. We found that faxing created errors. We are planning to have MARS and MD orders on computer within a few months, so this method will change.

cannoli · Dec 3, 2003

It should work your way if everyone does what they are supposed to do.

Where exactly or with who exactly is the process breaking down?

nursemouse · Dec 3, 2003

I suspect the problem is with the process itself, since we're having breakdowns in multiple areas involving multiple people. I'm new here, so I'm still trying to figure things out. Right now, we're looking at best-practices (and who knows best practice better than Allnurses!). Thank you for the help.

unknown99, BSN, RN · Dec 3, 2003

What we do at the hospital that I work at is the same--doc writes order, clerk faxes itto pharm, and puts it on the MAR and Kardex, and in the computer sent to the appropriate departments. The nurse responsible for the patient who has the new orders then makes sure it was all done. Plus, at the end of every shift (8 hr), the nurse has to do a chart check and mark it in red. Very little errors are made checking every shift instead of every 24 hours.

Rapheal · Dec 4, 2003

Doc writes order or nurse receives verbal order- nurse faxes it to pharm- nurse transcribes onto MAR. Some things get missed or are wrong. Many times due to physician handwriting or nurse or pharm error. I wish we had a system in place for a double check by another nurse. Our nurses would scream if we needed to do this because we are so time-limited and we have so many consulting docs that new orders keep coming in.

moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS · Dec 4, 2003

We have charting at the bedside and flags. When a physician makes new order, they put out the red flag so that the HUC's know they need to do something with it. They tear off a backing and send the orders to pharmacy. They write the meds on the MAR. Pharmacy picks up the backings fairly frequently. THe HUC when done with the chart puts out the yellow flag for the RN to check. The RN verifies the orders and signs off the orders and the MAR. The NOC nurse verifies the MAR and if there are any discrepancies, Pharmacy gets a communication note. Generally, the process works fairly well.

nursemouse · Dec 4, 2003

I'm seeing some really great and innovative ideas that I can take back. Thank you so much for your help, everyone. Please, keep them coming!!!

P_RN, ADN, RN · Dec 5, 2003

Doc/NP writes order then turns page diagonally so the end sticks out the side of the chart.

Doc/NP lays on desk or hands the chart to the unit secretary. (You HAVE to train the new ones to do this.)

Secy puts the charts in order and tears the 2nd and 3rd backs off each order (3 part order sheet).

Secy puts the backs into a tube and sends to pharmacy within 10 mins of receiving the order(STATS take precedence over routines of course)

Secy inputs computer orders, writes order #s on the order sheet so chg nurse can verify in computer.

Secy writes meds on MAR and puts the chart in a cart next to charge nurse desk.

Charge nurse verifies each order in computer and on MAR and initials ordersheet and each med on MAR.

STAT orders are passed on verbally to the nurse involved. Otherwise the new orders are posted on message board the nurses check frequently.

24 hour chart/MAR checks done by RN about 2 am when new MAR arrives from pharmacy by tube system. Old and new are compared and discrepancies are fixed and pharmacy generates new MAR. 1 MAR per day per patient. (may have several sheets though)

Works well.

pwp1289 · Dec 5, 2003

we are all computerized and order goes right to pharmacy--it is then verified by pharmacy for correctness of dosage,route etc and then verified by rn--when med arrives from pharmacy (we carry very little floor stock) --and that could take 1-2 hours--it is given by med nurse--and that is even computerized using bar coding and "laser guns" just like supermarkets!!!!! we are an almost 'paperless hospital'

Tweety, BSN, RN · Dec 5, 2003

We do it the same way you do. Secretary transcribes it, charge nurse checks it, and a 24 hour review double checks it.

But we have problems too, sometimes we're too busy to be focused enough. Sometimes we're too relaxed to be detail oriented.

Don't have any advice though.

rollingstone · Dec 5, 2003

Docs put all orders in the computer and our MAR is on the computer as well. We don't use the fancy bar code scanners yet. I have used this system before (Bridge Medical) at a different facility and it was excellent.