Nurses entering their own eletronic MARS? ?

[Pride/hardwork17]

I am writing because I am trying to make sense of something my organization has started and the nurses are conforming to (for lack of choice because we need our jobs)- my Organization (an impatient facility) is implementing a new system that we, nurses, have to take the orders from the charts, imput it in the computer (that doesn't interface with the Pharmacy software) and then start giving medication from there. There is no safety net. Pharmacy never sees our eMARS as their system doesn't interface with ours. We feel this is a recipe for disaster. In the past (for as long as I've been a nurse -about 20 years) Pharmacy always genereated our MARS. We no longer have the extra "set of eyes" looking at the orders even if we had to review it afterwards (which is the normal process). Anyone has a light to shed on this mess? Thank you!

[esrun00]

This is like a step back. About 10-15 years ago we used to hand write the mars and it was never reviewed by pharmacy, but pharmacy reviewed the order. Do you work for a large facility? All I can say is wow, med error waiting to happen.

[Flo., BSN, RN]

That is so unsafe. The pharmacist is another safety net to prevent med errors. Why would they eliminate this crucial step. Well I know why, its the money but all it would take is one death from a med error for all their savings to go away.

[tyvin, BSN, RN]

Defiantly going back wards as had been said way back when we use to hand write all our MARs and the pharmacy never saw it. The extra steps that are now in place are there for safety reasons as so many mistakes happened prior. In the end it is all about money ... be careful.

My question is if pharmacy never sees the orders how do they fill them? I mean who is originally transcribing the order?

[DeeAngel]

Nothing like setting everyone up for medication error!. They have just taken a huge step back into the stone age of medication management.

"my Organization (an impatient facility) is implementing a new system that we, nurses, have " Best misspelling EVER. lol

[nrsmela]

We do this at my facility, but the mars are handwritten by the nurse. Pharmacy never sees our MAR although they do see the initial order. A step we had to minimize error was having another nurse co-sign the MAR when it was initially copied or when it was recopied. Still there were a few times when orders were not changed or meds never got recopied. Sure was a pain! and night shift usually got stuck recopying a whole bunch of meds once the mar was full for that particular med. There has to be a better way!

[Old.Timer]

It's their pitiful attempt to fool others into thinking they have complied with EMR requirements.

[rnmi2004]

Check out this article... http://www.ahrq.gov/downloads/pub/advances2/vol4/Advances-Miller_93.pdf

Especially this bit:

"Administering medications prior to a pharmacist review increases the risk of medication errors.3-5 The Joint Commission Standard Medication Management 4.10 (MM.4.10) states that a pharmacist must review all medication orders before dispensing a medication, removing it from floor stock, or removing it from an automated storage and distribution device.6 Exceptions include situations in which a licensed independent practitioner controls the ordering, preparation, and administration of the medication and urgent situations, when a delay would harm the patient."

[imintrouble, BSN, RN]

Happening here too. The way I see it, they will be eliminating ward clerks and possibly a pharmacist or two. All this while making the nurse be responsible for one more thing. Nurses who are already overwhelmed with understaffing.

[ICURN35]

I can't see the Joint Commission okaying such a system. This is a very unsafe practice.

[marshmallowstar, BSN, RN]

Check out this article... http://www.ahrq.gov/downloads/pub/advances2/vol4/Advances-Miller_93.pdf

Especially this bit:

If it's like the Psych hospital I use to work at Pharm reviewed the ORDERS but not the MAR. Pharmacy was off campus so we would fax them a copy of the order sheet at the time they were entered into the MAR. So the concern is a transcription error while taking off orders, not necessarily an inappropriate order.

To the original poster, is the MAR ever reviewed against the orders by someone other than the nurse taking off the order? At the psych hospital it was part of night shift to compare the orders and mar to make sure they were transcribed correctly.

From stories I've heard from older nurses this was common practice to have nurses take off orders to the mar and a copy of the order would get sent to pharmacy. It does defeat the purpose of having an eMAR if the MD isn't writing their own orders on the computer and if it doesn't cross over to pharmacy. Maybe it's a concern you can bring up to practice council? to the DON? How does pharmacy feel about it? Maybe you can get some of them on your side too? At the very lease a second set of eyes needs to confirm that the order and mar match.

[Stephanita]

Have you spoken with your local governing body about this? I'm not sure if you're LPN or RN, but you pay licensing/registration fees for resources and help!

If this is a patient concern, which it sounds like it is, I would be on the phone ASAP.