MARS missed signing

MacNurse · Sep 1, 2005

UUUhhhhhh.....I don't think that that's particularly a good thing, and I don't think it even remotely qualifies as good nursing practice to do that :uhoh21:

Could we get some more details? Like,are the meds actually being given? Why are they not being signed when given? How often is this happening? What's your role in this organization?

Me and my licence (when I finally get one) would be fleeing a place like that.... :uhoh3: :stone

DusktilDawn · Sep 1, 2005

i don't work ltc, but on the mars at my facility there is an area at the bottom of the sheets for signatures and your initial. when i am going through my mars at the beginning of my shift i sign and initial the bottom of the pages and later when i give the medications i cross off the time and place my initial next to the time immediately after administration.

as a nurse you should document the administration of the medication immediately after you give it.

is this a common practice and is it legal?

it shouldn't be and nor is it legal. :nono:

how can anyone possibly remember if they gave a med that long ago?

there is no way you could be 100% sure what you did 20 days ago or even 1 day later if you did not document it at the time it was done.

btw welcome to allnurses mar326

CoffeeRTC, BSN, RN · Sep 1, 2005

Google ...Ronald Regan Atrium nursing facility. Interesting read on a nursing home adm that was charged and found guilty for medicare fraud and lots of info on nurses falsifying documentation. Serious stuff.

I check all my books at the end of my shift, however, on occcasion that I miss one and find it the next day, I will fill in my block.

dinkymouse · Sep 1, 2005

We sign out each med with our initials. They come in blister packs so you know if it's been given. You also know if someone on the prior shift or day didn't sign out because there is a blank spot. We are generally good about leaving a note on the book so they get signed quickly. I also go through mine at the end of the day and make sure the blister packs match.

CapeCodMermaid, RN · Sep 1, 2005

This seems to be a common problem in LTC. Could it be that it's because we're giving 20+ each to lots of patients? We had such a problem with blanks we used to switch MARs at the end of every shift and check each other's books for blanks. It's gotten better but we still have to re-check at the end of every shift.

Bird2 · Sep 1, 2005

It should not be considered common practice. Every hole can be considered a med error. Since it is easy to forget on occasion even after double checking it might be a good idea for the next nurse to notify the nurse that forgot to sign out a drug so they can get in asap to fix it.

LPN01112005 · Sep 2, 2005

I'd say it is a common practice, but I wouldn't go as far as to call it legal. I sign off as I punch my meds from the bubble pack. If for any reason I'm unable to give the med, I just circle it and document the reason for not giving it. There is an RN at my facility who monitors MARS for holes every few days, and if we have any, we get a note to fix it. If you consistently get notes about holes in your MAR, you get written up. Our facility has now taken pharmacy documentation so seriously that they are listing each unit's percentage of errors BY SHIFT and posting it for all to see. LOL.

MDSlady · Sep 2, 2005

We have electronic charting in our LTC facility. If a nurse has forgotten to sign a med or tx, they can go in and "change" the MAR. Their initial will show up with a line under it, indicating that the entry was done late.

The DNS usually will go through kardex's during morning report and find out who hasn't signed and go to them to have them sign.

healer_energy · Sep 2, 2005

I think it is an endless problem with no real solution, although I thought having another nurse check them over is a good idea. But then who has the time? I think the environment make a great difference. As long as residents, staff and family feel free to interupt or demand that meds are given out of turn, there are going to be mistakes, I think. No-one respects the med nurse. Or is it so boring that you welcome a distraction? And that endless locking and unlocking, it drives me crazy!

And on the demented wing with 37 residents you have the choice of taking the cart out and enduring the teeth grinding, slurping or just plain nosiness of the residents or standing in the nurse's station avoiding people's feet and trying to ignore the teeth grinding, slurping and bellowing of the residents fixating on you just outside the station. And then they put the worst in chairs right there so you can "watch them". :angryfire Not to mention being telephone operator and message taker.

Oh yes! they started on the signing the cards business some months ago. I was all gung ho and I was able to prove I was not at fault twice because I signed. Then I noticed how much time was added to the med pass so I couldn't get done in time for the next meal. Then I was admonished for a med error and it even got onto my evaluation. "I know you gave the med because you signed the card". :imbar After that... poof went all my efforts. I noticed that most others seemed to stop about that time. I'm not sure why.

I know one thing I have done to help myself is that I never mark the MAR with straws or whatever for the next med pass. I make myself go through everything completely so that I double check myself. I think that helps. But it is amazing how complete blocks of shifts and residents go unsigned. What are people doing?

Well, that's my 2 cents

Sonya

dian57 · Sep 10, 2005

We had a serious problem with MAR/TAR and flowsheet omissions at my facility. As the CCC of a 40 bed unit, it was not uncommon for me to take several hours reviewing the previous month's documents and search out the staff for missing initials.

Our facility instituted two checklists, one for the nurses, one for the CNA's. The MARs/TARs/flowsheets are checked during each shift, the checklists are attached to the house reports and supervisors notify staff of blanks. If a staff member is not scheduled to work within the next 48 hours, they are called back to work to fill in their omissions.

We have very little problem with omissions at this point, especially with the price of gas.

geriRN1993 · Sep 15, 2005

Hi, I am wondering how other Long Term Care places handle missed signatures on MARS and treatment book. Our nurses go back and mark them sometimes 20 days after they gave the med or treatment. Is this a common practice and is it legal? How can anyone possibly remember if they gave a med that long ago?

I am a DON in a nursing home and find that missing signatures is a serious problem for all shifts but especially the dayshift. They have 2 medpasses, 2 meals, and appointment scheduling and distractions through out their day. I have not seen any evidence that the missing signature implies a missed med so I have approached this matter in this way. If a nurse has missed signing, I will check the card that the med for that date is actually gone, then I leave them a note for them that they need to initial. I keep records of the nurses that I leave notes to and follow up a few days later to see that it has been done. In actuality, a missing signature is considered a med error. Every time. I am trying to find other ways to lesson their work load during their respective shift. I have hired a ward clerk who makes the appointments and transportation for them for one. Our med dispensing systems helps me to monitor "who" is committing a "true" med error. Another thing, I have repeatedly inserviced nurses on med pass techniques and keep driving home the basics. Triple check med, dose, and patient; pass the med; ensure consumption; and document in the MAR. If they are consistent with the practice of med pass this will lessen the error rates dramatically. Be sure that your DON is aware of the missed signatures.