MARS missed signing

Jubei · Sep 23, 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?

That's common. I've worked in a lot hospitals both acute and long term and even super nurses forget to sign their initials or place a "0" for complaint of pain, etc. You know how many square boxes there are in a med and tx book binders you gotta sign?

Post me a reply if you know of a nurse who hasn't forgoten to sign a box once and a while in a long term facility.

The worst non-signature occurance occurs when we get fresh sheets for the month. Alot of nurses tend to follow the previous alternate shift nurse and ppl miss certain orders. I've done it numerous times. You just have to focus if you are the first nurse to sign the sheet.

sbic56, BSN, RN · Sep 23, 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.

I agree this helps and is my practice, too. I think the geniuses who decided to set the standard of teaching to not sign until after meds have been passed, never really passed meds on a busy unit.

southern_rn_brat · Sep 23, 2005

We have included checking for blanks on the MARS in the chart checks nightly on 11-7 so that we can keep up with it daily.

CapeCodMermaid, RN · Sep 24, 2005

Yesterday a patient said she hadn't gotten her Keflex at 6am. One of the day nurses found a Keflex in a cup in the med cart. The med had been signed off as given. When I asked the night nurse she said she couldn't remember but if the patient said she hadn't gotten the med, I'd have to believe the patient. "But you signed off the med as given" I said. "Oh," she said, "We always sign all the meds at the beginning of the shift and then hand them out when they're due."

:angryfire :angryfire :uhoh3: She is no longer employed at my facility.

Jubei · Sep 25, 2005

Yesterday a patient said she hadn't gotten her Keflex at 6am. One of the day nurses found a Keflex in a cup in the med cart. The med had been signed off as given. When I asked the night nurse she said she couldn't remember but if the patient said she hadn't gotten the med, I'd have to believe the patient. "But you signed off the med as given" I said. "Oh," she said, "We always sign all the meds at the beginning of the shift and then hand them out when they're due."
:angryfire :angryfire She is no longer employed at my facility.

That's sheer stupidity. If you're going to sign a legal document, you better give the med or circle your signature and explain in the back of the sheet why you didn't give it (of course antibiotics should be given at all times).

Jubei · Sep 25, 2005

That's sheer stupidity. If you're going to sign a legal document, you better give the med or circle your signature and explain in the back of the sheet why you didn't give it (of course antibiotics should be given at all times).

On a side note: The resident was alert too!?

dummy.

Jubei · Sep 25, 2005

dumb NOC nurses.

CapeCodMermaid, RN · Sep 25, 2005

Yes, the resident was alert. I'm now left wondering what else she signed off as done but didn't do....this was the first time in my nursing career that I actually yelled at another nurse. I've asked questions before...I've given them a look (my co-workers call it the eyebrow look and from what I gather, it strikes fear in the hearts of the staff nurses :coollook: ), but I never yelled at anyone until she said to me she always signs off her meds at the beginning of the shift. What are people thinking these days? Of course, when I made a med error I not only wrote myself up, I came up with a plan of correction for the problem. These are people's lives we're dealing with.

crystalclear · Sep 26, 2005

This is a very stressful topic to me being a new grad and just starting my first job. I've experienced this problem already. It is very easy to get side tracked with all the walk-ups, pain med requests and falls. I hope things will get better for me when I develop a routine, at this point one med pass is running into the next so I'm standing say about 7hours before I get a break(I work 7a to 7p) and it is easy to get your mind on your meds, feet and your back. The ability to always remeber to(go back) and sign the MAR is extremely difficult.

CoffeeRTC, BSN, RN · Sep 26, 2005

This is a very stressful topic to me being a new grad and just starting my first job. I've experienced this problem already. It is very easy to get side tracked with all the walk-ups, pain med requests and falls. I hope things will get better for me when I develop a routine, at this point one med pass is running into the next so I'm standing say about 7hours before I get a break(I work 7a to 7p) and it is easy to get your mind on your meds, feet and your back. The ability to always remeber to(go back) and sign the MAR is extremely difficult.

It will all come together. This isn't the "right" way, but at the end of my shift I will sit down and review my MAR and TAR and sign anything that I missed.

Daytonite, BSN, RN · Sep 26, 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?

1. It's not "legal"

2. Yeah, how can you remember after 20 days what you did or didn't do? Good point.

3. Yes, this is very common practice (but you didn't hear it from me or anybody else!) shhhhhh!

I was responsible for verifying and reconciling each new month's MARs and TARs were correct before putting them out for the nursing staff to start using on the first of a month. I took the pile of the previous month's sheets and was directed to give them to the DON or the ADON. They would go through these sheets and fill in the blank signatures with their own. The ADON was supposed to check these sheets regularly and "remind" those of us who had missed a spot to fill it in. I worked in several nursing homes over the years and this was a common practice in all of them. It was also common to sign off the MARs and TARs in one sit down rather than signing them off as you go. Most common reason is because the nurses know the meds and treatments by heart anyway. Some of us would put stickys on pages alerting others where their initials were missing, but not everyone helps each other that way. However, this is wrong and these sheets should be checked every time a med is given or a treatment done because orders do change and things do get missed.

preciousmofo · Sep 26, 2005

We used to assign a nurse on every shift to check all the MAR's before anyone left, so if something wasn't initialed, he/she would ask the person while they were still there and that nurse could sign it, and if it was a med that was missed then they worked on documenting an omission and notifying the MD if needed.