MAR how should it read?

[newrnontheblock]

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.

[SleeepyRN]

Quoting yourself using the same poor example does not help. If there is only one form of the medication (i.e. 25mg tablets)

The Lasix example was better in that there are 10mg and 20mg tablets available. My question might have been better worded if I said, "Does Pharmacy change the order every time they send a different combination of tablets. Do they have one order for three 20mg tablets then change the order if they were to sent one 20mg tablet and one 40 mg tablet?"

I wasn't quoting anyone specifically with that post. In writing, I can see it sounding condescending, which was absolutely not my intent. I was genuinely confused.

I was too tired to think of a good example, quite honestly. But the point remains the same. When receiving orders, write the dosage.

And it appears from a previous post of yours that we agree. That we should enter the dosage.

[morte, LPN, LVN]

CapeCod, do you know if CT is the same?

[CapeCodMermaid, RN]

I only know the regs in Massachusetts for long term care. Assisted Living has different regs. I've worked in a few places that got cited by the DPH on annual survey for having the MAR read one thing and the blister pack from the pharmacy read something else. It's a pain for sure, but so is writing a plan of correction...or giving the wrong dose.

[kbrn2002, ADN, RN]

I had a talk with my hospital Pharmacy just last week. They rewrote the medication order of Methadone 20mg to Methadone 10mg = 2 tabs. What an easy way to set someone up to make a mistake. I asked the patient to confirm that she takes 20mg.

I want the doseage. Let me do the math.

The Pharmacist didn't even take responsibility, blamed the computer.

Blaming the computer may actually be valid. Depends on the program used for order entry. There are several programs available and the one we use, PCC, is geared toward LTC nursing. It is very difficult, if not impossible at times to to enter a med order without the dose attached to the initial order entry, so the order might read Methadone 10 mg because that is the option that automatically pops up. At that point the options are to 1] find the med entry for methadone that does not have the dosage attached and manually enter 20 mg. This is not an easy option to find if you are not very familiar with the quirks of PCC. 2] Use the Methadone 10 mg option that pops up and manually enter "20 mg" in the drop down menu, which then makes the order read "Methadone 10 mg, give 20 mg" which can be a little confusing but it is definitely a better option than "methadone 10 mg, give 2 tablets." Unfortunately the give 20 mg option is also not always easy to do without knowledge of the weird quirks in PCC. Oddly enough you need to access yet another drop down menu to show all doses and find the right option for your order to make more sense. Kind of crazy to need to use a drop down menu within a drop down menu to change the dose from the default tablets to mg. This is not only confusing but time consuming if you are entering multiple orders.

[NurseBevJeanAnne]

We just admitted a pt on methadone. he takes 80mg/day. Methadone is 10mg tabs

the order should say Methadone 10mg, take 3 tabs in the morning, 2 tabs at noon and 3 tabs at night to total 80mg/day