Regulations re: MARS

[kstec, LPN]

I just started at a new LTC facility and I'm wondering if what they are doing is necessary. When we get orders from the hospital for a new admit we of course have to write them all out on the POS, but my question is do you really have to write all the meds on both sides? The one side that says meds and the other side that says orders? The reason I bring this up is because this facility not only makes you write the meds on both sides oif the POS but also write out T.O's for all the orders. Why do you have to fill out a T.O. when it's not a T.O., it's a written order from a MD upon transfer. Isn't sending the POS to the MD to sign sufficient? I discussed this with the ADON and he explained that's just the way it is. I called the pharmacy who is owned by the same coorporation and they said they wished we would just write the meds on the med side and other orders on the orders side. I would think that the more you duplicate the orders the more room for error and of course a complete waste of time, that you could be spending with your residents. Also this facility has computer charting. Well you do all the admission paperwork on paper and then turn around and enter it in the computer. Also, a big waste of time. When I asked why it is duplicated they explained that there is a better statistical tracking with the computer entry. I'm just wondering why there is so much darn paperwork. Somewhere is the scheme of things I would like to be a nurse rather than a secretary. I don't even think secretaries even do as much writing as we do. How can I find out what is regulatory per state? I live in Illinois, so if anyone understands what I'm talking about, please help me. I'm trying to figure out a way to spend some time with my residents rather than just the 2 minutes I give them to adminster meds and do txs. It's a beautiful facility, but the one complaint they have gotten reported on repeatedly for is neglect. Gee I wonder why, probably because the nurses are sitting behind a desk filling out way to much paperwork, and heaven forbid if you don't. I'm feeling a little like damned if you do, damned if you don't. Thanks for letting me vent.

[CapeCodMermaid, RN]

First....careful with the word neglect. If you say you are neglecting your patients because you are too busy filling out paper work it won't fly.

Each facility makes its own rules above and beyond what the state requires and each facility thinks THEIR way is the one true way. Try having your pharmacy consultant talk to the powers that be. I can't believe you have to write one thing so many times and then enter it into a computer. The more copying you do, the higher the chance of mistakes.

We had the same issue and we talked the boss into changing the way we did things when one admission just to write out the meds took more than an hour and we used to get 3 and 4 a shift!

[kstec, LPN]

I wouldn't say neglect to the powers that be, but in my heart that's what I feel I'm doing by spending half my shift doing paperwork. I'd much rather be doing a more in depth assessment with my residents and doing more hands on than hands on a pen or computer keyboard. I'm going to try and talk to someone and see if something can be done to alleviate some of the extra, I feel unnecessary paperwork. Like I've said before if I wanted to be a secretary, I'd of chosen that as a profession, but I chose nursing so I could take care of people. I've only been a nurse for almost two years and let me tell you it's not all its cracked up to be. The patient part is wonderful, the politics and coorporate stuff is for the birds. Oh well enough venting again. Thanks for your reply.

[lexibear99, LPN]

I also work in a nursing home in Illinois and our procedure is the same. New admit, meds on left side of POS, meds and all orders tec on right side of POS, TO for all of this and then to top it off we don't have computer so we have to handwrite all the meds again on the MAR! All of this doesn't stop mistakes from being made, I found a pain med left off of a MAR at the last changeover, thankfully it had only went 2 days but still...

[makes needs known]

In NYS there is alot of paperwork, but we have two nurses for 40 pts. So one gets to do all the paperwork. The other one gets to do all the meds. We have a little competition going on to see which one of us is going to go crazy first.

[morte, LPN, LVN]

entering med orders twice is a bunch of...... i am sure you know what. Just begging for errors. and what is this TO business? that is fraud out and out. unless you take those orders BY telephone. now if the physician writing the orders, doesnt have admitting privileges at your institution, you actually do have to contact house doc to "ok" the orders, at that time it becomes either TO or FO.....