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by Sharkbait251 Sharkbait251 (New Member) New Member Nurse

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 just started at a facility and my RNsupervisor authorized a LVN to remake an MAR since it was only the second of the month and only her and I had worked. She had intentions of having me go back and just reinitial when I came in however I was off for a week. When I came back (after all the other nurses of the facility worked) somone had initialed my initials for me on the days that I work . I reported the incident to my RN supervisor via phone . She told me she was going to follow up with me . When I reached out to her again she stated she had no way of proving who did it and I should avoid leaving MARs blank to avoid this from happening and said she would have a staff meeting regarding “MAR ediquete” I, however did not leave the MARS blank, she authorized another LVN to restart one . I am not sure what I am supposed to do . Especially since nobody was held accountable, if this occurs again and something happens I could be held responsible. I don’t know what I’m supposed to do .  

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kbrn2002 has 25 years experience as a ADN, RN and works as a RN Supervisor.

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Sounds like you are still on paper MARS. I don't envy you!  Was the original Mar that you did sign off on retained by medical records? If not, that's a big no-no! If it was retained your original initials are still valid. Check with your DON for further instructions on having your initials stricken out from the replacement MAR since you were not the person who actually signed off on it.  If you are in LTC it might not be a bad idea to request that meeting with the administrator as well. I can't imagine they'd be thrilled at somebody forging your initials on a legal document like a MAR. I am no legal expert by any means but I would think that having duplicate MARS with the same initials on them that don't match might cause a problem in some circumstances. I wouldn't normally suggest going over your RN supervisors head right to the  DON but it sure doesn't sound like your supervisor is handling this correctly. 

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Address the situation in writing and give it to the DON and keep a copy for yourself.  You want your side of the story to be there in case this turns up on your performance review (and things like this do).

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Ruby Vee has 40 years experience as a BSN.

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3 hours ago, Sharkbait251 said:

 just started at a facility and my RNsupervisor authorized a LVN to remake an MAR since it was only the second of the month and only her and I had worked. She had intentions of having me go back and just reinitial when I came in however I was off for a week. When I came back (after all the other nurses of the facility worked) somone had initialed my initials for me on the days that I work . I reported the incident to my RN supervisor via phone . She told me she was going to follow up with me . When I reached out to her again she stated she had no way of proving who did it and I should avoid leaving MARs blank to avoid this from happening and said she would have a staff meeting regarding “MAR ediquete” I, however did not leave the MARS blank, she authorized another LVN to restart one . I am not sure what I am supposed to do . Especially since nobody was held accountable, if this occurs again and something happens I could be held responsible. I don’t know what I’m supposed to do .  

Did the person who signed the new MAR for you put a signature on the appropriate line of the MAR?  Paper MARs have a space for you to place your initials with your signature for purposes of identifying the "RV" who initialed the MAR.  If the MAR clearly states it was recopied (which used to happen when we spilled coffee or lunch on them, for example, and once when the LPN I was working with set one on fire with his cigarette) and the person who initialed your meds wrote something to the effect of "stated as given by R. Vee, RN on 1/2/19" and then signed their OWN name, and the reason they're signing for you, you're probably OK. Any legal nurses here that can verify that?

Electronic charting has an option for "given by other".  You then enter their name and credentials and sign your name.  It's useful during a code, for example when one person is pushing meds and another is recording.  Or when the provider buzzes in and pushes a med that your unit doesn't allow the RNs to push.  It is also useful for someone who goes home without signing their MARS.  The charge nurse calls them at home (ask me how I know this) and then initials the meds as given by other and writes a little note to say she called that person and they said they gave the med.  

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I have seen that duplicate MARs (or other documents) are annotated at the top of the form to show that they are a duplicate of the original, usually with the added info as to why, who, when the duplicate was made.

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19 hours ago, Ruby Vee said:

Did the person who signed the new MAR for you put a signature on the appropriate line of the MAR?  Paper MARs have a space for you to place your initials with your signature for purposes of identifying the "RV" who initialed the MAR.  If the MAR clearly states it was recopied (which used to happen when we spilled coffee or lunch on them, for example, and once when the LPN I was working with set one on fire with his cigarette) and the person who initialed your meds wrote something to the effect of "stated as given by R. Vee, RN on 1/2/19" and then signed their OWN name, and the reason they're signing for you, you're probably OK. Any legal nurses here that can verify that?

Electronic charting has an option for "given by other".  You then enter their name and credentials and sign your name.  It's useful during a code, for example when one person is pushing meds and another is recording.  Or when the provider buzzes in and pushes a med that your unit doesn't allow the RNs to push.  It is also useful for someone who goes home without signing their MARS.  The charge nurse calls them at home (ask me how I know this) and then initials the meds as given by other and writes a little note to say she called that person and they said they gave the med.  

They wrote my initials on the bottom and left a signature line blank . I myself on a separate box signed and wrote my initials next to it and a discrepancy between the two can be easily noted  I gave the medication on my shift . But The original copy I believe was destroyed . I understand why a new one was made but my concern is more so what to do in regards of another’s person feeling okay initialling my initials without my knowledge or concent. I just happened to notice . Nobody informed me of the matter until after i brought it to my supervisors attention

Edited by Sharkbait251

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On 1/19/2019 at 7:56 PM, Sharkbait251 said:

When I reached out to her again she stated she had no way of proving who did it and I should avoid leaving MARs blank to avoid this from happening and said she would have a staff meeting regarding “MAR ediquete”

🤔 Geez. Sounds unlikely that this will be taken for the serious issue it is.

The re-make of the MAR was not handled correctly at all; it is not appropriate for anyone else to represent your initials or signature (although I understand the signature wasn't forged, the initials shouldn't have been either). There is a proper way to very clearly note that it is a re-copied page and the name of the person who originally administered the meds - - and that notation should be signed by the person who re-created the MAR, with their own name.

I would document this via an email to your supervisor, beginning with, "As you know per our conversation on [date], [describe incident/circumstances as you discovered them]...." and "I understand from our conversation that you plan to remind staff of the proper way to handle this situation in the future. Please let me know how the current (re-created) MAR is going to be corrected. I am requesting that it have an addendum stating that my initials were placed by another employee in order to reflect that fact that I had previously administered and signed off the medications on the original MAR."

Send this to supervisor and CC yourself at both your work and non-work emails.

This is in no way legal advice and I don't know what others would do; this is just what I would do. I guess I would be prepared for the possibility that it might not make the supervisor very happy.

If she approached me again in person with any more laissez-faire attitude about this incident, I would calmly state that I remain concerned and that I do not authorize any other employee to represent my signature or initials in any circumstances.

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KatieMI has 6 years experience as a BSN, MSN and works as a Internal Medicine.

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You are supposed to get out of there ASAP. 

It is like that little dry cough when flu is about to start. Today they named re-initialing MAR for a person who did not know about it "MAR etiquette". Tomorrow it will be re-initialing in narcs journal. One day after tomorrow, someone will know that X Norco pills disappeared to nowhere and there is a signature of him or her in journal, and he or she was not even working that day. 

Been there, saw that. Playing with signatures is a dangerous symptom of corners which must be left as they are being cut. Document, then run. Run for your life. 

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ResponseNurse1987 has 10 years experience as a LPN and works as a Helth Informatics Specialist and Senior Staff.

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If MAR was recreated for whatever reason, the dates prior to that rewrite are not transcribed onto the new one. The new MAR should begin from the date that the person rewrote it

(I.e> MAR rewritten on 1-21-19 should only reflect does given on or after 1-22-19).

At my last facility, and prior to the electronic record, we wrote on the top of each MAR "transcribed on: date" OR "Re-Written:Date:Time:Signature:Initials. This will let others know who rewrote it, why, when, and on what date.

At no point should MAR's be back dated or back logged. This is a BIG NO NO. Ultimately, someone is going to be on thin ice because they wrote in your initials for dates/doses that had already been given from what I can tell. I understand not wanting holes in the MAR, but, at no time should someone be given permission to insert your initials into a form unless that person is you! I would suggest keeping copies of your communications with supervisory staff, and date/time them, along with their response(s). Why did they have to re-write the MAR to begin with? Also, refer to your facilities policy/procedure manual. All of the info you need should be there regarding your facility specific policy on MAR and med reconciliation. I am not familiar with LTC, only ER and MedSurg, but, I can tell you that what you said happened would NOT fly in a hospital setting. LTC's are at higher risks for litigation as is simply do to the demographic being served and their families. As long as you reported this off, you should be fine, but, how do you know it won't happen again? Also, if they did this with an MAR, what would stop them from doing it with your documentation or assessments? I would say RUN TO A NEW JOB.....THEY ARE EVERYWHERE!!! You may land in a much better spot when you do!

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traumaRUs has 25 years experience as a MSN, APRN and works as a Asst Community Manager @ allnurses.

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Agree with all of the above: this is a BIG issue and one that needs to be resolved correctly. I would continue to follow up on this and really like the official letter to the DON with you keeping a copy of it. This is especially important if you gave narcotics or other controlled substances

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