What "isn't" on the MAR

[ocean.baby]

I have worked many LTC facilities in my time. The ones that have their MARs printed from pharmacies seem to have the meds and treatments on them, the last one that I worked at then made their own pages for behaviors or insomnia or whatever the problem is, a sheet to record side effects, a sheet for blood sugars, etc.

Yet the nursing homes that print their own MARs tend to have all of the physician's orders on them, i.e., weights, showers, admitting PPDs, code status, etc. that the meds are buried among the other items on the MAR.

This is in California. I am trying to help them clean up the MARs in their facility. Any suggestions?

Thank you!

[invisiblewounds]

Even if the facility is printing their own MARs, the meds should not be "buried". There should be med sheets, then treatment sheets, PRNs, etc. If all the med sheets are first, they're not buried. The pharm company that provides our MARs printed everything mixed up. We had to call numerous times to get it fixed.

Physical or mental...one way or another...future "wound" nurse.

[bluegeegoo2, LPN]

In some facilities I have seen 1st shift meds/tx highlighted in blue, 2nd shift green, and 3rd shift pink to make it much easier to pick out who needs to do/admin what and when. It helped to have a visual aid so that we didn't waste precious time reading through all of the "fluff" on the MAR/TAR. They didn't highlight the whole order, just the admin times.

[misstrinad]

Scheduled meds should all be on their own sheets, then prn meds, then tx. I like all the diabetic orders on their own sheets put in the front but I've found other units prefer to leave their diabetic orders hidden in the back. On my unit we hand write the diabetic sheets so that we have space to legibly write bg numbers. We used to do an additional flow sheet because the bg numbers were being crammed into one little box and no one could read that, and if a Dr wanted to see the bg over a month period then you had to sit and rewrite everything or the flow sheet would end up with tons of blanks so we converted over to putting it right on the Mar.

[kiszi, RN]

In some facilities I have seen 1st shift meds/tx highlighted in blue, 2nd shift green, and 3rd shift pink to make it much easier to pick out who needs to do/admin what and when. It helped to have a visual aid so that we didn't waste precious time reading through all of the "fluff" on the MAR/TAR. They didn't highlight the whole order, just the admin times.

I worked in a facility that did this as well, but I didn't like it. The reason is that, if a time inadvertently is missed when the color-coding is done, that pt could go without a med for days before someone caught it. What was helpful at that same facility was having a separate book just for meds and another one for treatments and such. Pharmacy should not be printing meds and txs on the same sheet.

[Forever Sunshine, ASN, RN]

Our MARs are medications and fingersticks. The TAR is kind of a smorgasbord of stuff. Things like weights go in the chart and behaviors/intake/bathroom go in the CNA's books.

I think the MAR should be meds only. Too much other stuff risks meds to missed.

[caliotter3]

Meds first: scheduled, then PRN, alphabetically. TAR separately with all that extra stuff. Use some kind of system, such as starting w/ bathing, weight, different types of precautions, then group: everything dealing with the GT, etc. You only need to have someone enter it on the computer once, then maintain. Monitoring for side effects should follow the med.