Monthly MAR/ TAR order checks

noc4senuf · Oct 9, 2008

We compare the current MARS with the new MARS and any orders over the last month. This also requires that it be done by two separate nurses. Double check.

Liddle Noodnik · Oct 9, 2008

How do you do yours?
Do you check all new sheets and compare them to the orders in the chart or do you just compare them to the current MAR/ TARS?
They seem to be doing the last option.....not a good idea, esp if there are errors on the current mars and tars.
What I was taught and what I do. You look in the chart for the current orders and then compare them. I also look at the labs etc to make sure that they are getting done or if they need ordered (Ie..dilantin levels q 3 months, lytes etc for pts on lasix) Seems like things are getting missed because they are not doing things this way.
I was told that I "take to long", but you wouldn't believe the errors that you find when you actually look at the orders, duh?
How much time is allotted for these checks?

Hi Michelle, I had the same experience! People were only comparing the new MAR's to the old ones - but YES there were a number of errors that they failed to catch by failing to check them against the orders! I was so disgusted that they couldn't see my rationale. This was a number of years ago. To this day I still see the face of that DON whose conclusion to the matter was that I was "lazy and inefficient" - that was her explanation for how long it took me. I did try to explain but she would not listen. ARGH. I hate that it still burns me. What is ironic is that I was also doing the assigned monthly progress notes for other people when my own were completed each month - so was doing double the work in THAT regard too!

Lord help me to forgive the sneer on that woman's face LOL!

Just stick to your guns hon. I recently had to leave a different job that had seemed perfect for me - because they did not adhere to state standards on medication admin., and would not see my point and change their practices.

ARGH, again. Now I am job hunting again.

Take care good luck and I hope this works out for you!

Vito Andolini · Oct 9, 2008

Just quietly do what you know is right.

Make a list of all the errors you find and show it to DON and whoever is complaining about you being too slow.

What a ridiculous and sorry thing it is that those in charge either don't understand or refuse to admit they understand why MAR's should be checked against original orders. I wonder if the Administrator or owners or licensing authorities would be interested. Be prepared for a big battle, job loss, etc. if you take it over DON's head.

Keep a record for yourself, as the one you show the boss will probably get "lost". Tell no one you have a copy. Repeat: it's your little secret. Keep it in a hiding place at work, not your locker, not at home, not your purse. But keep it. Why? Might need it later on, for whatever reason, like suing them for wrongful termination or something like that. Keep a log, too, on who was notified, when, about what, and their responses. The log is a secret, too, got it?

CoffeeRTC, BSN, RN · Oct 9, 2008

Vito...I already do that. :up:

I just wasn't asked to do them any more. A few years back it was one of our cites and in our plan of correction that two nurses will double check them (It should be standard practice anyway) Well...now the floor nurses "should be able to check them" in addition to the regular every day duties. What a joke. We are already getting OT trying to get done with the basics. Just wondering if I was crazy or not.

infectionRN · Oct 9, 2008

Your right, they need to be checked against the current orders. Sometimes it can take up to 1.5 hours to complete one re-cap. My facility pays overtime to do these so they are not rushed and in turn a decrease of med errors are seen.

NurseExec · Oct 9, 2008

Here's what we do:

1. The desk nurse takes off the days orders and during the transcription process, updates both the computerized order system and hand updates that month's POS/MAR/TARs.

2. The night shift nurses check each chart and make sure the POS/MAR/TARs have been updated to the most current telephone orders (redlining).

3. Every day, the unit managers take the previous day's orders and check that the POS has been updated.

4. We print one week prior to the end of the month. I have extra nurses come in and do nothing but changeover. They check the new POS against the old ones (which have ALREADY been checked 3 times), then check the new MAR/TARs against the current ones. Any changes that need to be made are given to the desk nurse, who updates the computer.

5. The desk nurse, for that week, transcribes orders to the old MAR/TARs/POSs as well as the new ones.

We miss a few things here and there, mainly times, and lines for BP and so forth. We have a very low med error rate.

I couldn't live without my desk nurse--if she's doing her job correctly, then everything flows from that.

southernbeegirl, BSN, RN · Oct 10, 2008

checking new mars against old mars is insane. i dont understand that rationale. we call it "mars" but we are also putting the new month's POS on the chart. shouldntwe start with that?

i agree...do what you know is the right thing to do. you have no control over others.

Daytonite, BSN, RN · Oct 10, 2008

how do you do yours?

do you check all new sheets and compare them to the orders in the chart or do you just compare them to the current mar/ tars?

i always compared them against the chart. the chart is the original source of orders. if someone made an error in transcription it is only going to be carried over if you merely compare the new sheets with the current mar/tar

they seem to be doing the last option.....not a good idea, esp if there are errors on the current mars and tars.

you are absolutely correct and it does take a little more time to do. things get missed and errors merely get perpetrated when the original source is not checked.

i was told that i "take to long", but you wouldn't believe the errors that you find when you actually look at the orders, duh?

believe me, i know.

how much time is allotted for these checks?

we started doing them 10 days before the change over day. i did the charts with the least changes first. i saved the new admits and charts that i knew would have a lot of changes for last--or i didn't marked them as completed until the day before the change over although i may have worked on them days earlier.

something else i did, and i've gotten a lot of criticism for this on this forum before, is do daily order checks during the month of the patient charts just like we did daily in the hospital. it doesn't take long to do. just flip open each chart and check to see if there are any new orders and if they have been signed off. in ltc you get to know these patients, so a new drug or treatment order sticks out and only takes a few moments to check out on a mar or tar. that saves some time for the end of the month check and also helps to pick up mistakes earlier. watch for drugs being transcribed as either wrong dose, wrong number of times a day or totally missed.

caliotter3 · Oct 10, 2008

When our checks were being "done" by each station's charge nurses, there were numerous mistakes and omissions. Then an RN was rehired to be the house supervisor. She took over this responsibility. I watched her. She went to the charts and checked against the original orders. She was thorough and caught many mistakes that had been overlooked for months.