Holes in MARS

No. No. No. And you've got to be kidding.

I wish I were. This is what they are doing. How should I handle this? The last manager that objected was let go for "other" reasons. Any suggestions on how to handle this would be greatly appreciated.

Do you have any suggestions on how to improve better documentation and prevent this prevelance of holes in the MARS/TARS.

At my facility, when we find holes we let the nurse know. We are supposed to be getting them done within 24 hours, but this is not always possible with Baylor weekend and pool nurses. If there is an ongoing issue, they get an education write up. If it continues..they get an actual write up. Three of these and they are fired. Charge nurses, Supervisors and others regularly check the books.

Are there 2 nurses on the floor? Have them swap MARs and check each other's book before they go. You should never sign for something you didn't give/do yourself.

We did that at our last facility and the problem we ran into was overtime and nurses complaining about how much longer it took with shift change. I really like the idea of writing a list of nurses with holes and using it as an evaluation tool for documentation. Thanks for sharing.

We did that at our last facility and the problem we ran into was overtime and nurses complaining about how much longer it took with shift change. I really like the idea of writing a list of nurses with holes and using it as an evaluation tool for documentation. Thanks for sharing.

You could go the severe route...by that, I mean, say for the next six months. The unit managers, Don, SDC and yourself do daily walking rounds, checking MAR for wholes. As you go through the MAR, one of you records, the room number, med and time med was not given. You do this floor by floor. Then all staff responsible is called immediately to come in that day, to correct their missing entry. You can do a full audit at this time, to make sure PRN's are documented with outcomes, FSBS recorded and proper intervention taken, INR are followed up and flushes, IV written properly. This may take management a hour or two to do daily, but is worth it when staff becomes more diligent with these duties.

Or you can at the end of the month, leave the MAR in the med room, with a command, that nurses check for holes and fill them with in a few days. Those wholes not filled will be treated as not given and a medical error write up will follow.

Another thing you can do, is have the unit managers responsible for their own unit. Since unit managers are so busy, you will see a change in a hurry. They won't want to be responsible for this and will stay on their staff until it becomes second nature.

As for agency, they should go back immediately, or just don't call them back. Good agencies demand their nurses go in right away.

The first instance is a lot of work, but it works. Staff will respond to management going through their books daily and will start doing, what they should have been doing all along. Peace!

Hope this helps.

*edit- just wanted to add, narcotic book should be checked weekly or monthly too. Because even though count may say correct, a number of things could be going on and you can also find missed narcotics this way. Or even cross outs and date changes. We would check narcotic book naturally, if a hole was found where a narcotic should have been given. This way, you will know for sure, if it is just a hole, or was a missed med.