I need help...holes in MAR

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Hi everyone,

I need to come up with a solution for ending each month with "holes" on the MARS and TARS. We have tried the shift to shift check system (oncoming nurse checks off going nurse), we have tried to have the unit manager (me) check the records daily and call the nurse at home to come back in and sign (that didn't work because I would get busy with other issues and didn't always have time to check), we have tried disciplines, we have tried re-education....nothing has worked thus far. I need any suggestions you may have. Part of the issue is that I don't have consistent staff on my unit due to staff shortage however, the nurses that float to my unit should be consistent with their work. Can anyone offer some help? Thank you in advance (tomorrow I'm in the hot seat in morning report....please save me!)

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Yes. Create a more accommodating environment for regular nurses who want to stay at your facility. Consequently, with regular staff, your problems will be solved.

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One of the facilities that I worked at had the night shift nurses do audits and write down discrepancies on a sheet. The nurses were required to correct the records and sign off on the discrepancy list. This idea was scrapped when the night shift personnel complained because they were being bullied by the other nurses. Some of the noc nurses could be encouraged to help out others by not "finding" or listing mistakes. Of course this caused hard feelings for those whose every little boo boo was written up. In theory, it was a good idea. Someone has to audit the charts. But nobody enforced that it be done in a fair manner.

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Specializes in LTC.

We have an "audit" system at work where 2nd shift, or the unit coordinator checks a certain area (i.e. mars, narc sign outs on the back of the mars indicating success or failure of the meds, tx books, skin books, cond. of the carts, outdated meds, etc.) on a given day of the week. Usually it's one issue per day that's audited. Then the person(s) responsible for the check fills out audit slips and are put on the unit bullitin board (stapled shut for privacy, though we all know what they are) for the next time we work. If the person working happens to be a float, the audits are put in their unit's in-box and they are expected to come to the unit and correct their shortcomings. My unit coordinator will hunt them down if they don't come! The only exception is the u.c. ALWAYS does the mar checks herself. She has a paper that has a column for who, date, pt, discrepancy, and an area for us to initial off when we've completed the task that she keeps in front of the mars. We always know to check the front of the mars to make sure we've caught everything. Fortunately, none of us get "bullied" for it because we know if we've missed something, we are responsible for fixing it. I've only been on this unit for about 6 wks and it's amazing how after a few audit slips I have become much more detailed in my work, busy or not. The other unit I worked on didn't have that system in place, and the mars, etc., looked like swiss cheese compared to this unit! It does work, for us at least. The audits for the day are kept in a separate folder labeled for each day of the week, and has become part of the daily routine when we come in. None of them take more than maybe 10 min. a day to do, which also helps keep things up to date. My personal favorite audit is the cart. We check once a week to make sure insulins are not outdated, bottles aren't sticky, there are no loose meds in the bottom, etc. I have never seen such clean and well organized carts! All in all it makes for a much smoother running unit. Good luck with what you decide and stick to your guns. People typically will resist change for awhile, but after a few audit slips they'll see that you are serious and would likely begin to comply.

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Our infection control nurse, an LPN of 30 years, does the task of checking the MARS and writing up nurses who leave them.

I try to remind the nurse who relieves me on my days off to fill her holes - but sometimes there are so many - I just can't do it. It's frustrating.

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It would also help tremendously if those little squares weren't quite so little...

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Thank you. I am starting an audit tonight for night shift to do just as you have suggested...review the MARS and TARS and fill in the audit. From there I will be able to keep up on the holes (I hope). I also am having the nurses check the off going shift and they are not to take keys until there are no holes. Realistically, that can't always happen but I think with nights doing the double check, I hope at the end of May the MARS and TARS will look better. Thank you again

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deleted

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Is is the same repeat offenders or all around problem? Cant your med records person do the audits?

How about having someone from corporate or who does mock surveys come in and do something....or a legal person? We had someone present a case senario that used as an example a family lawsuit and what was involved in the investigation. Boy was that an eye opener for some!

Now that I'm working the floor, I still take the few minutes at the end of my shift and review my books (MAR TAR) and fill in any that was missed.

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There would be no "holes" issue if people would give the nurse 15 minutes of peace when signing the MAR. It's the whole "oh you're sitting down -- you must have free time" factor that causes me to miss signatures.

Actually, signing the MAR and TAR after the med pass and treatments IS the problem. If the nurses would sign the MAR and TAR as the give the meds and do the tx. then holes wouldn't even be an issue. At our facility, believe it or not, there are a few nurses who never have holes and they are the ones who sign as the give.

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Specializes in LTC, assisted living, med-surg, psych.

The policy at my ALF is "pour-sign-pass": you prepare the meds and sign the MAR, then do your med pass. Since I instituted this practice a year ago, we've had very few gaps in the MARs/TARs, and I can usually get away with spot audits weekly now, and full audits monthly. I fill out audit sheets for each med aide and have them fix the errors (or document why a med/tx wasn't given), then return the sheets to me. If they have more than five 'holes', I have them do a full audit on themselves; if there are more than just a few in the entire MAR, I do an educational write-up. The result is better compliance, more efficient use of both staff and nurse time, and a deficiency-free survey. Works for me!

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Actually, signing the MAR and TAR after the med pass and treatments IS the problem. If the nurses would sign the MAR and TAR as the give the meds and do the tx. then holes wouldn't even be an issue. At our facility, believe it or not, there are a few nurses who never have holes and they are the ones who sign as the give.

This works out well if there are no interruptions. When you answer three phone calls and help transfer a resident to their wheelchair between the time you do the dressing change and the time you get back to the TAR, you miss things. An uninterrupted med and treatment pass makes a huge difference.

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