When to enter meds on MAR

LPN01112005 · Apr 19, 2008

At our facility, the med order goes on the MAR at the time the order is noted. Meds are taken from the Emergency drug box on each unit for the doses that will be due before the nightly pharmacy delivery. If the order is for a med not readily available in the Emergency drug box then either there has to be an emergency delivery by the pharmacy or one of the Unit managers has to go to a local pharmacy to pick up the doses that will be due before our facility pharmacy delivers. This requires communication between our local pharmacy and the facility pharmacy, however and we avoid having to do this. Sometimes, the MD or NP will give the order for the med to start when delivered from the pharmacy. We are not ever allowed to write med unavailable on the MAR, and we most certainly cannot just leave holes! Nor or we able to show a lag time between the time the order is noted and the time it goes on the MAR. That's a tag for sure for not following MD orders.

We try to get all MD orders in to the pharmacy before 3:00 p.m. to ensure that the meds will be delivered that day, however sometimes that isn't possible especially in the case of new admits and readmits, so these are called in to the pharmacy as soon as the orders are verified and they will usually be delivered with that night's delivery. Every nurse in the facility has a list of drugs available in the Emergency drug boxes and Emergency narcotic boxes and if the order is for a drug unavailable it is the noting nurses responsibility to alert the MD that we do not have this med on hand and get further instruction. I'm not saying this always happens, but this is facility protocol. Sometimes, nurses are just lazy and they "borrow" a med from another resident, which everybody knows is a big no no. But yet still it happens a lot. Then, when the pharmacy consultant catches that "now" orders were not taken from the e-box, the offending nurse gets all defensive when HER error is brought to her attention. It never ceases to amaze me, the indignance you see in some people who are being held accountable for imporoperly doing their jobs.

Medication errors of this sort are a topic of discussion at EVERY nurses meeting we have. I, for one, get tired of having to listen to the same gripe at every meeting we have and wish that all nurses would just note orders and carry them out properly, ALL the time. This is one of the easier "problems" that we as LTC nurses face. I just don't understand why it is one of the hardest to get the nurses to correct.

loriangel14, RN · Apr 19, 2008

Where I work the orders are entered on the MAR as soon as they are received. We area a small complex continuing care hospital that has no pharmacy so we have to wait until the pharmacy from the big hospital we are affiliated with sends them up(usually the next day). If a med is due you can mark in N/A or borrow from another patient on the same drug. We have a form we fill out stating what we borrowed and from whom.

SuesquatchRN, BSN, RN · Apr 19, 2008

The first is proper, the second covers their butts.

suzanne4, RN · Apr 20, 2008

A medication can be placed on the MAR when the order arrives for it, but the dose is not charted until given. And I am talking about the drug being placed there and only that.

Charting before it is given is actually illegal and can make one subject to being considered as falsifying documents.

Borrowing from another patient is also actually not something that should be done as those meds were ordered specifically for that patient and then you would be considered dispensing a medication.

Does not matter what is done in your facility, but it needs to be legal and meet the requirements of the Board of Pharmacy as well for your state.

Please be very careful with what you are doing, working in LTC is one of the areas of the highest loss of nursing licenses occur.

suzanne4, RN · Apr 20, 2008

When is the proper time to enter meds on the MAR. One unit enters the meds when the order is received, thus documenting the meds aren't there usually for a day when the pharmacy delivers.
The other unit enters the meds when they are physically delivered, thus there MAR 'looks' clean.
Which is the proper/SOP?
Thanks,
Primum non nocere

Meds should be listed on the MAR when the order is obtained, unless it states that it is to start the next day. And even then it is listed and then filled in to start on sucn and such a date.

It is the responsibility of the facility to obtain the meds, but for a nurse to withhold posting of it on the MAR to suit the facility is actually not legal.

This is one way to lose a license. And the facility will not back one up on this. You need to cover your license.

OldMareLPN · Apr 20, 2008

"It is the responsibility of the facility to obtain the meds, but for a nurse to withhold posting of it on the MAR to suit the facility is actually not legal.

This is one way to lose a license. And the facility will not back one up on this. You need to cover your license."

Thank you for your information, precisely what I thought.

Thanks,

PsychNurseWannaBe, BSN, RN · Apr 21, 2008

OK...than I have a question.

Where I used to work nurses would do their med pass and then sit down at the nurses station and flip through and initial everything... I thought that was wrong to do that. Is it ok to wait until the end of the med pass to initial everything in one sitting?

I have been reading several posts about this and I think I might be doing it wrong because I didn't think the way I mentioned it above was correct. How I do it is I use the MAR and pop out the medication. I then would flip through the MAR(again) and initial as I re-confirmed that I truly have that medication in my cup to have the patient take. They take the meds and I move on. If they don't take the med, then I circle my initials, which at my facility means the patient refused.

Now I am confused... trust me it doesn't take much to do that. :lol2:

suzanne4, RN · Apr 21, 2008

Signing your name on the MAR means that you gave it, not that you have it in the medicine cup. What happens if you get called away to an emergency and then the med is not given but is charted as it has been.

This is considered falsifying a legal document and not acceptable practice.

The MAR should never be signed until the meds are actually taken by the patient. I would not wait to get back to the station to chart because when you have a large med pass, it is easy to forget something.

From the last statistics that I have seen, the area with the most lawsuits as well as chances for losing a license are in the area of Labor and Delivery, the next area is LTC.

With all of the increased in investigations going on now in different facilities, not a good thing to be doing. Chart the meds on each patient as you go along. Otherwise what happens in the state pays a visit? What will you do then?

PsychNurseWannaBe, BSN, RN · Apr 21, 2008

Well state did show up. They followed a very experienced nurse. I was looking at her MAR and said…what are these dots where you would initial? She said it was her way to check that she has the med but she is not to sign until after giving them. She then initialed over the dots.

I didn’t think it was a good idea to wait until a med pass to initial the MARs all at once. I figured it was too easy to forget something. I am very thankful I came across this post and now I will change how I do that part of the pass.

Now to go back on topic:

Whenever I get an order for medication. I place it on the MAR before the med shows up. Regardless if the med shows up, it is still an order.

flashpoint · Apr 21, 2008

If we get the order after 1700, we ask the doctor to order that it can be initiated the next day...if it needs to be initiated right away, we call the pharmacist at home. It doesn't look good if we have to chart that a medication is unavailable, but it is much better than not putting something on the MAR right away.

We all know that it is inappropriate to sign the MAR before the med is given...it is also inappropriate to wait and sign everything at the end of the shift. I will never understand why we don't just try to do things right all the time so we aren't fumbling to do things right when state is there.

CapeCodMermaid, RN · Apr 21, 2008

I've worked at several places with several different pharmacies and they all say there are two correct ways of doing the med pass: Pour, Give, Chart OR Pour, Chart, Give. As long as you are consistent you're okay. I used to pop the pills into the cup,initial as I popped, then give the meds. If the person refused, I'd circle the initial and write the reason for refusal on the back. If some of the meds had parameters, I'd pop them in a separate cup. I've seen nurses initial everything after the pass was done and I've seen them initial everything before they started the pass....yikes.

As for writing the meds on the MAR, we write them when we get the order. If we know it's an unusual medication we'll add "start when available" to the order.