Handwritten MAR's?

OMG! I thought the hospital where I did one of my last clinical rotations was the only one left. I can't tell you how many "almost med errors" I had. Not only were they hand written (very poorly by several of the secretaries), they had 5-7 days worth of meds on one sheet. They used prothonatary codes for number of caplets or tablets and often never wrote the actual dose of certain drugs. It would say Tylenol ii. (Was it ii 500 mg tabs or ii 200mg tabs?) They also kept track of controlled substances with a locked drawer (with a flimsy lock) and binder of slips for each drug and numbered sheets for each dose. These also had to be handwritten.

I told my instructor that the MAR's frightened me and she looked at me like I was crazy for being so concerned. I was seriously nervous during every med pass for that rotation. (Being rushed through so that she could get to her smoke break before the cafeteria closed also didn't help. ) I could have very easily had something major go wrong. It's only by the grace of God that it didn't.

The unit that I took my current job at has everything on the computer and I couldn't be happier.

We use them in my hospital and although I do very little floor nursing I'm still comfortable with them. Ours are also in a 5 day format. I did have experience with computerized daily MARs all through nursing school but didn't dind the adjustmant hard at all, I think I liked ours better but can't remember why. It may have been the computer program used at the other hospital? I'm sure it was 'very new' at the time! When my floor had secretaries, they were generally very good and filled out the info reliably, other time the RN was responsible for her own orders. Chart checks done nighlty rarely found a med transcription error and if the kid was still there after 5 days the night RN usually copied the new sheets.

Those narc sheets though? I'm glad to be rid of them! The one time that I will say "yeah, Pyxis!" Pink for parenterals and blue for orals (?) and by 7:30 am, I wasn't in the frame of mind to be counting, let alone copying the sheet for the next day. My dyslexia would take over and I'd put the wrong count in the wrong box and the inevitable phone call aound 9 when I was asleep. :uhoh21:

The only handwritten MARS we have are the ones made for a new admission.

We also have handwritten MAR's at my hospital, but are going computerized within the next year. I don't mind the handwritten MAR's-- they're what I've always known, but the handwriting can sometimes be pretty bad. If I run into something that could be misread, I just recopy it.

I'm told that our new system will involve barcodes and it sounds pretty cumbersome/time-consuming from the little I've heard about it so far. We'll be scanning the barcode on our ID badges, scanning the barcode on each med, then scanning the patient's ID bracelet's barcode before administering a med. Anyone else out there have a system like this?

I love our Pyxises, too. Great to not have to count narcs the end of every shift. The only hassle is that we have to sign a slot in a book at various times during the day which I think means that there are no Pyxis irregularities at that time. (On 3-11 shift, its 1500, 1900, and 2300.) Our managers are always on us if every time slot isn't filled in. They always seem to find a way to add more work even when something new requires less work. :stone

We handwrite the first one on admission, then they are generated from pharmacy. The only thing that is handwritten after that are new meds until the pharmacy runs a new one for the next day and it shows up from the computer. Its not bad, you just have to be careful.

I came from a facility where our MARs were computerized. Now I am at a facility where there are handwritten MARS. It is so hard when someone has bad handwritting, or the ward clerk does not transcribe the med or procedure correctly.

Give me computers any day.

We must be living in the dark ages in NY!!! Of all the places I worked (and that's quite a few), I've only used them twice: One was generated by pharmacy, and the other was via the computer. That one was okay, but the first was a bit of a pain. It was in a LTC, so it was for the entire month. So any time there was a change (which was quite often) it had to be written in. They automatically put in the times, so you'd have to rewrite it if the times needed to be changed, and it got to be pretty messy, IMO. So there ended up being pages and pages of MARs, some of which only had one med left.

I guess when you're used to the 'old fashioned way", it's not such a big deal (as long as it's legible, and correct, of course).

I'm told that our new system will involve barcodes and it sounds pretty cumbersome/time-consuming from the little I've heard about it so far. We'll be scanning the barcode on our ID badges, scanning the barcode on each med, then scanning the patient's ID bracelet's barcode before administering a med. Anyone else out there have a system like this?

Is it called MAK? Sounds just like what we use at my hospital, which is the MAK. I love it. you have your MAR, which says what times your meds are due. Go to PYXIS, get meds. go to MAK machine (it rolls up and down hall). Scan your badge (easy and quick) select your patients. it pops up w/ the meds due in the next hour. you select one and scan the med. It reminds you if you need to cut the pill in half, or need to give 2 pills to equal the dose. if you don't give a med, you have to put "not administered" and tell it why.

then you go in room, scan pt bracelet and give meds. it really helps prevent errors, in my opinion, if used correctly, and it is not that time consuming.

I have worked at several hospitals with handwritten MARs and it is quite dangerous. I have seen so many mistakes with them.

And the MDs should know how to look up pain med usage on the computer (yes, if wishes were horses....)

Is it called MAK? Sounds just like what we use at my hospital, which is the MAK. I love it. you have your MAR, which says what times your meds are due. Go to PYXIS, get meds. go to MAK machine (it rolls up and down hall). Scan your badge (easy and quick) select your patients. it pops up w/ the meds due in the next hour. you select one and scan the med. It reminds you if you need to cut the pill in half, or need to give 2 pills to equal the dose. if you don't give a med, you have to put "not administered" and tell it why.

then you go in room, scan pt bracelet and give meds. it really helps prevent errors, in my opinion, if used correctly, and it is not that time consuming.

I'm not sure what it'll be called. It's supposed to be implemented in the next 6 months and what you quoted from my post is all I know about it so far. I know management and the committee working on computerized MAR's has considered various methods to hold our meds like either our own individual rolling cart or a "wall-a-roo" (I have no idea if this is the right word for a fold-down medication station attached to the wall in or outside the patients' room.) We got these computers on wheels when the hospital went to online documentation in 2003-- a medication cabinet with drawers was supposed to fit and eventually be added. But the computers are so big and unwieldy alone, without med drawers, that they're difficult to wheel and maneuver into small, semi-private rooms. I hope we get something like the MAK system you described. What we have right now are meds dispensed in individual, small, opaque cellophane, sealed, flat "bags" with a barcode and name of med on them, placed in one of 10 drawers in our med carts. Beyond that preparation for the future, I haven't the foggiest idea what's coming.

I realize computerized meds are a safer method, but it's hard not to get caught up in stress when time-consuming procedures keep being added to our already heavy workloads. Hopefully it'll be better than I imagine.

I have been told I have a nice handwriting, but that does not mean other nurses, especially those working on HS shift, can read my writing well. I have and do work where some hand written MARS are necessary. I hate it. I always check, recheck and recheck again prior to giving meds, especially cardiac meds, insulins, and narcotics if the order is handwritten. I just do not want to overdose or underdose patients when giving these important meds.