MAR how should it read?

[newrnontheblock, ASN, BSN, MSN, APRN]

MAR (paper chart) reads:

Medication name 10mg

1 tablet

Medication sticker from pharmacy reads:

medication name 5 Mg

2 tablets

I understand I'm supposed to pop out two tablets becasue the dosage is not sufficient to equip 10 mg with one tablet but shouldn't the MAR say the correct number of tabs and doesn't this promote med errors? Sometime the med orders do change and the old pharm card could be wrong as well. Looking for thoughts on this. I'm orienting at a new facility and made the mistake of popping only one tablet instead of two, yesterday I took the correct dosage of this medication but did the same thing on another order that was 600 mg and the tabs were only 200 each. How can I make sure I stop making this mistake? I'm sure once I know the residents and the meds I will not make it with them but I am afraid I will keep doing it. I know I'm supposed to check the dosage ect, but just hoping someone has any good advice. Perhaps I'm not cut out to be a nurse.

[Rose_Queen, BSN, MSN, RN]

I'm surprised, especially with a lot of the medication shortages and what pharmacy is able to supply, that a MAR even states the number of tablets.

It should read: Name of medication, dosage, route., frequency.

Example:

Tylenol 650mg PO every 8 hours.

Pharmacy can provide Tylenol regular strength as 2x 325mg tablets or as Tylenol arthritis pain as 1x 650mg tablet. Neither would conflict with the order as what matters is the mg given.

Best way to stop making this type of mistake is to verify the dosage, not the number of pills.

[WKShadowNP, DNP, APRN]

I'm surprised, especially with a lot of the medication shortages and what pharmacy is able to supply, that a MAR even states the number of tablets.

It should read: Name of medication, dosage, route., frequency.

Example:

Tylenol 650mg PO every 8 hours.

Pharmacy can provide Tylenol regular strength as 2x 325mg tablets or as Tylenol arthritis pain as 1x 650mg tablet. Neither would conflict with the order as what matters is the mg given.

Best way to stop making this type of mistake is to verify the dosage, not the number of pills.

Exactly.

My MIL was given twice the amount of Zoloft because the nurse at the rehab facility saw two tablets. Instead of checking the dose she gave two tablets of the pills supplied. (Ended up with 200mg instead of 100mg). This was many years ago. Thankfully nothing worse that anxiety occurred. MIL even questioned the nurse who basically told her not to question her, she knows what she is doing.

That's a pet peeve of mine. If my patients ask me a question or point something out, I'm almost always grateful. It's not a dictatorship. Oh, you usually do it this way, we can try that if it works better for you [as long as it is safe and reasonable].

[caliotter3]

When using paper MARs in home health, we have always adjusted the MAR entry to coincide with the med form on hand, with the appropriate order. When it is understood that there are two dosage forms available for some reason, then there would be two MAR entries with the word OR written between them. All of these adjustments have a corresponding doctor's (clarification) order to back them up.

[newrnontheblock, ASN, BSN, MSN, APRN]

Your right, I will try to ignore the count and read the dosage only.

[WKShadowNP, DNP, APRN]

Your right, I will try to ignore the count and read the dosage only.

Not necessarily. It can all be good information. The nurse checking off the orders and transcribing to the MAR may make a mistake and the person administering the medications may misread it. Every bit of information on the MAR is important so read it carefully to ensure the 5 Rights are present.

[CryssyD]

If I encounter such a situation, I usually write (or place a sticker saying same) "check dosage" on the card, to alert nurses that ordered dose and available dose differ.

[MunoRN, RN]

A legal order to administer a med must have the ordered dose in order. 2 x 5mg does not have the actual ordered dose (10mg) anywhere in the order and essentially just encourages a med error by containing distractors. While technically (2x5) is the same as 10, so is ((6.824/5)+15-1.3648-5).

[VANurse2010]

I'm of the opinion that orders that list the number of tabs, caps, etc. are not appropriate for the health care setting where nurses or other authorized staff are administering medications. Those formats, which are very common in LTC, *do* encourage medication errors. Those types of directions are meant for people taking medications at home, not in a health care environment where supply dose and orders consistently change.

[SleeepyRN]

The way we enter meds is like this:

Ok, so we have an order for hydralazine 25 mg.

When we enter it into the computer, we do NOT select "Hydralazine 25 mg," which IS an option, but that is telling pharmacy to specifically spend 25 mg pills.

We select Hydralazine tablet.

Then underneath, we enter dose: 25 unit: mg

This allows the pharmacy to fill the med how they see fit, really eliminating med errors.

Hydralazine wasn't a good example. Of course they will send 25 mg tablets.

But it helps tremendously with other medications.

[madwife2002, BSN, RN]

Moved to Patient and medication forum

[canigraduate]

So, your order reads 1 tablet, and the med pack reads 2 tablets. Your five rights do not list number of tablets, they list the dosage.

You need to do your 5 rights 3 times. This will take out a lot of the room for error.

1) When you read the order

2) When you pull the meds

3) Before you hand the meds to your patient

The best thing is to ignore the number of tablets, like you said, and pay attention to the dose.