med error or flawed entry

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Specializes in LTC.

just wondering...

recently noticed several medications on the med cart not match what is on my eMAR...

such as

eMAR might say tylenol 650mg 1 tablet q6hrs...but what I have on hand is 325mg tablets & I must administer 2 tablets to get ordered 650mg dose.

or it might say medication XYZ 10mg, and what the pharmacy sent is 1/2 tablets of 20mg tablets..still the right dose...

I guess the question is...in preparing for survey, and as risk manager...does the eMAR have to match exactly to what I am passing or is it okay as long as the appropriate dose is being administered. If it needs to be changed, any suggestions avoid recurrence....and for wording on the order to stay in compliance.

thanks in advance

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Specializes in LTC, Psych, Hospice.
just wondering...

recently noticed several medications on the med cart not match what is on my eMAR...

such as

eMAR might say tylenol 650mg 1 tablet q6hrs...but what I have on hand is 325mg tablets & I must administer 2 tablets to get ordered 650mg dose.

(2) 325 mg Tylenol equals 650 mg. My guess is that since 325 mg is a more common dose is why that's what is on the cart.

or it might say medication XYZ 10mg, and what the pharmacy sent is 1/2 tablets of 20mg tablets..still the right dose...

I've seen many orders written as "XYZ 20 mg give 1/2 tab BID"

I guess the question is...in preparing for survey, and as risk manager...does the eMAR have to match exactly to what I am passing or is it okay as long as the appropriate dose is being administered. If it needs to be changed, any suggestions avoid recurrence....and for wording on the order to stay in compliance.

thanks in advance

Hope that helps.

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just wondering...

recently noticed several medications on the med cart not match what is on my eMAR...

such as

eMAR might say tylenol 650mg 1 tablet q6hrs...but what I have on hand is 325mg tablets & I must administer 2 tablets to get ordered 650mg dose.

or it might say medication XYZ 10mg, and what the pharmacy sent is 1/2 tablets of 20mg tablets..still the right dose...

I guess the question is...in preparing for survey, and as risk manager...does the eMAR have to match exactly to what I am passing or is it okay as long as the appropriate dose is being administered. If it needs to be changed, any suggestions avoid recurrence....and for wording on the order to stay in compliance.

thanks in advance

Tylenol does come in a 650 tablet, the tylenol arthritis extended release. so you have a potential error there, and yes the wording must match. the problem i see most often is for lasix...it come in 10/20/40/60/80.....to get 30 you would need a 10 and a 20, OR 3 halves of a 20....you don't necessarily know what you are going to get from the pharmacy till it comes. If you get the 3 halves, the order wouold read Lasix 20 mg tab, give three half tabs to equal 30 mg. If you get 10s and 20s you need to separate lines on the MAR one for each, including the fact that each was part of a dose. good luck

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Specializes in LTC.

thanks for the replies

I have a lot of work to do. The administrator has sort of put me in charge of getting the MARS cleaned up.

I found about 40 of this type of error on 1 med cart in 1 shift (I don't usually work the cart)

thanks for the clarification...I guess the first thing I should do is sit down with my list and talk to pharmacy and find out what they can send...make sure all of the orders are right...

URG!

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thanks for the replies

I have a lot of work to do. The administrator has sort of put me in charge of getting the MARS cleaned up.

I found about 40 of this type of error on 1 med cart in 1 shift (I don't usually work the cart)

thanks for the clarification...I guess the first thing I should do is sit down with my list and talk to pharmacy and find out what they can send...make sure all of the orders are right...

URG!

lol, good luck!

the pharmacy may not always send the same thing for the same order, as in my lasix example, Omnicare will send 3 1/2 tabs (cheaper, I think) but if they are short of 20 they may send a 20 and a 10 or 1/2 of a sixty....so the original posting of the med on the mar may not reflect what you get....and will have to be updated when you receive the med.

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WHen I worked Assisted Living, the pharmacy did our MAR's, and they were always written as per community prescription, ie Tylenol 2 325 mg tabs twice daily as needed. LTC: pharmacy will begin doing our MAR's when we switch over to E-Mar this month, HOWEVER the kicker is, only for the meds they supply...so we still have to input the OTC's. We anticipate lots of tinkering is going to be needed. Are the pharmacies giving any guidance on this issue? FOr years, it has been written as the total dose to give, then it's up to the nurse to supply that dose, in as many tabs is needed, however I haven't liked that system since I saw how more accurate the Assisted Living MAR's are. I would think that best practice is WHAT you are actually going to give, BUT a surveyor during med pass audit will say if you give that long acting Tylenol 650 mg it is NOT the same as Tylenol 2 tabs of 325.... Suggestions?

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Specializes in Gerontology, Med surg, Home Health.

If you're not giving what's on the MAR or EMar, you could get cited. APAP 325 mg tabs, give two tabs to = 650 mg every four hours by mouth as needed for pain. Do not exceed 4000 mg in 24 hours.

if you need to give two different doses to equal the ordered dose, you have to have them in two separate boxes.

And your pharmacy consultant should have caught this.

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WHen I worked Assisted Living, the pharmacy did our MAR's, and they were always written as per community prescription, ie Tylenol 2 325 mg tabs twice daily as needed. LTC: pharmacy will begin doing our MAR's when we switch over to E-Mar this month, HOWEVER the kicker is, only for the meds they supply...so we still have to input the OTC's. We anticipate lots of tinkering is going to be needed. Are the pharmacies giving any guidance on this issue? FOr years, it has been written as the total dose to give, then it's up to the nurse to supply that dose, in as many tabs is needed, however I haven't liked that system since I saw how more accurate the Assisted Living MAR's are. I would think that best practice is WHAT you are actually going to give, BUT a surveyor during med pass audit will say if you give that long acting Tylenol 650 mg it is NOT the same as Tylenol 2 tabs of 325.... Suggestions?

...and the surveyor would be correct...

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If you're not giving what's on the MAR or EMar, you could get cited. APAP 325 mg tabs, give two tabs to = 650 mg every four hours by mouth as needed for pain. Do not exceed 4000 mg in 24 hours.

if you need to give two different doses to equal the ordered dose, you have to have them in two separate boxes.

And your pharmacy consultant should have caught this.

....and if you want to give APAP for fever, that must appear as well....

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Specializes in LTC, ER, ICU, Psych, Med-surg...etc....

Your medications need to match the order/MARs. If you have two different drug strengths it must be reflected on the MAR that you are giving two different strengths to total the ordered dose. You must have the medications kept separate from each other as well. The order needs to reflect the same and be approved by the physician to administer this way.

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Specializes in Med/Surg, Geriatric, Hospice.

Can't you just clarify it to say 'Tylenol 650mg po Q6h PRN pain? Why do you have to write the tabs in there.. doesn't matter HOW you get the dose as long as you get there.

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Specializes in LTC, Psych, Hospice.
Can't you just clarify it to say 'Tylenol 650mg po Q6h PRN pain? Why do you have to write the tabs in there.. doesn't matter HOW you get the dose as long as you get there.

Now, that's how our orders are written. Guess that's the difference between hospice and LTC.

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