Questions re: MAR's

[natalie]

I work in a small hospital that has does not have the resources to purchase up-to-date computerized order entry software. We've switched over to computer physician order entry regardless, with our old system, in an effort to reduce medication errors.

Can anyone post what their MAR's look like? The major concern we have is the inability to look at a med sheet and follow the medication trends of a patient over time. We print our's out every 24 hours and the MAR is for that period of time only. There is no history of what the patient has taken in previous days. Is this just something we have to get used to? For instance, Coumadin history. Also, a nurse on a busy med/surg floor comes on at 3pm and has a blank MAR. (That's the 24 hour time the new MAR comes out.) She has no idea when the last pain meds were given (unless told in report, but with more than 10 patients it's easy to go unreported)without shuffling back to the chart and looking up the last MAR sheets. Also impacts many other meds given. If they were delayed due to tests in xray, etc., the nurse coming on with the blank MAR can't see this. A scenario that could occur is-a patient receives their cardiac meds at 2pm due to NPO/tests. If these are BID meds, they could possibly receive their 2nd dose at 4pm. How do you get around these potential errors?

Thanks for any info.

[P_RN, ADN, RN]

Our MAR printout was delivered at 3am. The night nurse carefully reviewed the new one against the old, and made any needed corrections. Any discrepancies were sent back to the pharmacy and then hand written on the new MAR.

We also kept 2 days MAR in the book. That is today and yesterday. That would give you the info about what time and what med they took.

For coumadin we kept a PT/INR sheet in the main chart and filled it out for the doc making rounds...We gave a LOT of coumadin. The coumadin order was then transcribed to the MAR as a one time dose. The pharmacy knew that it was a one time order so it didn't get put on the next day's MAR.

All orders had to be re written post op by the doc. The MAR went with the patient to surgery and to any procedure such as a myelogram etc.

Down at the bottom of the MAR were ALLERGIES, DX, HT/WT. Patient's name.

We had great success with this MAR. One MAR for prn's, IVF, meds, minibage stc.

[MQ Edna]

Our MARs are like folders and we use all 4 sides. There are two pages for regular meds, one for PRNs and one for IVs. We just initial when we give the med. I believe there are 10 days on them. So we all know who has been getting what and when, and if they had been on something that had been discontinued. Oh, I forgot, there's even a section for SS blood sugars, what they were, how much they were covered with, and where the insulin was administered. I really like it and feel it gives great continuity of care.

Laura