When to enter meds on MAR

loriangel14, RN · Apr 21, 2008

I just graduated last year and we were taught to initial as we pour each med. If a med is refused we put an R in the MAR and circle it. We also document refusal of meds.

husker_rn, RN · Apr 21, 2008

We document them on the MAR before we can note that the order; noting indicates everything is done and handled. Thta's our fcility's slant on it.

OldMareLPN · Apr 21, 2008

Great, great, great.

Dot when you pull the med, initial when you gave the med.

Perfect.

flashpoint · Apr 22, 2008

I have no issue at all with initialing when you pour...I do have a major issue with sitting down and signing everything at the begining or end of the shift. We use a bubble pack system and we have a lot of problems with blanks on the MAR, so the DON started having us initial the bubble packs too...takes twice as long and is a pain in the neck. :)

CapeCodMermaid, RN · Apr 22, 2008

You'd better check with your pharmacy consultant. I seem to remember some reg about writing on the pill cards. At one place where we had lots of blanks on the MAR, we'd have to swap books with another nurse and check each other's books for blanks.

Nascar nurse, ASN, RN · Apr 23, 2008

My surveyors expect to see pour, pass, chart. Considered falsifying records if charted before actually administered. They said it is the MAR - meaning "adminisration" record not the MPR "poured" record. Turned into another big stinking nightmare. URG!

sfn2008, RN · Apr 23, 2008

How many people in these LTC's actually NEED a nurse to do the med pass? How many patients in the hospital NEED a professional to do a task that they do for themselves at home (and very well I might add). What do you think the percentage is of patients that actually need nurses to hand them their routine meds?

OK, I am thinking outside the box again. But.. hey.. we have a nursing shortage for a reason... technology is out there making the Super Market check out fast and efficient.. but who is out there trying to keep nurses at the bedside?

Passing medication is not what makes me a Registered Nurse. RN's go to College to learn critical THINKING skills.. and yet our day is filled with tasks that many of our patients can actually handle better than we can.

Are there any places in the world that THINK OUTSIDE THE BOX?

CapeCodMermaid, RN · Apr 23, 2008

How many people in these LTC's actually NEED a nurse to do the med pass? How many patients in the hospital NEED a professional to do a task that they do for themselves at home (and very well I might add). What do you think the percentage is of patients that actually need nurses to hand them their routine meds?
OK, I am thinking outside the box again. But.. hey.. we have a nursing shortage for a reason... technology is out there making the Super Market check out fast and efficient.. but who is out there trying to keep nurses at the bedside?
Passing medication is not what makes me a Registered Nurse. RN's go to College to learn critical THINKING skills.. and yet our day is filled with tasks that many of our patients can actually handle better than we can.
Are there any places in the world that THINK OUTSIDE THE BOX?

I run a 135 SNF. At any given time, there are fewer than 15 people in the building who score a 0 on the cognitive section of the MDS. The majority of them take more than 10 medications a day--many of them new medications which have parameters associated with them. These people would not be able to take their medications safely.

I'm not disagreeing with you in theory....that's why many states allow for med techs. Massachusetts does NOT. And with the raising awareness of the potential for catastrophic results from medication errors, I don't think we will have them any time soon.

And, given the fact that many of these patients see the doctor only once every 60 days and then for only a brief time, I would say this gives the NURSE plenty of opportunity to use her critical thinking skills and not just blindly pass out the medications.

Maybe in the future, we'll all have bar codes on our foreheads and we can scan ourselves and have the correct medications come down a tube. But for now, and since the last time I used one of those bar code scanner at the supermarket that mistakenly indicated my 1/4 pound of snap peas cost $102.00, I'll stick to having nurses pass meds.

flashpoint · Apr 23, 2008

How many people in these LTC's actually NEED a nurse to do the med pass? How many patients in the hospital NEED a professional to do a task that they do for themselves at home (and very well I might add). What do you think the percentage is of patients that actually need nurses to hand them their routine meds?
OK, I am thinking outside the box again. But.. hey.. we have a nursing shortage for a reason... technology is out there making the Super Market check out fast and efficient.. but who is out there trying to keep nurses at the bedside?
Passing medication is not what makes me a Registered Nurse. RN's go to College to learn critical THINKING skills.. and yet our day is filled with tasks that many of our patients can actually handle better than we can.
Are there any places in the world that THINK OUTSIDE THE BOX?

LOL...most of our residents are not mentally capable of setting up and taking their own medications...the few that might be would have difficulty opening bottles, measuring liquids, etc. Having a system to keep medications safe from our wanderers would be pretty challenging too...and letting residents administer their own medication would just increase the risk of noncompliance. The number of people who end up in the hospital (or the nursing home) because of medication noncompliance is huge and all the technology in the world isn't going to fix that.

I think there is a lot of critical thinking involved in administering medication...you need to assess mental status, vital signs, moods, etc...it is far more that just looking at a MAR and finding the right pill.

JB2007, ASN, RN · Apr 23, 2008

I critically think every time I pass a med and if I am not I am not doing my job properly. I have to know why I am giving a med, the possible side effects, what meds should not be given together, ect. Also, I have to know what I need to be assessing for due to the multiple meds that all of my residents take daily. In addition, I have to be able to do all of this very quickly because I have 30 residents to pass meds to in 2 hours. I am a RN too and this is part of what I learned in school.

sfn2008, RN · Apr 24, 2008

LOL...most of our residents are not mentally capable of setting up and taking their own medications...the few that might be would have difficulty opening bottles, measuring liquids, etc. Having a system to keep medications safe from our wanderers would be pretty challenging too...and letting residents administer their own medication would just increase the risk of noncompliance. The number of people who end up in the hospital (or the nursing home) because of medication noncompliance is huge and all the technology in the world isn't going to fix that.
I think there is a lot of critical thinking involved in administering medication...you need to assess mental status, vital signs, moods, etc...it is far more that just looking at a MAR and finding the right pill.

True, there are many that NEED a professional to administer medication and deliver treatments. And there is definatly a need to protect one patient from the medication or treatment of another. I agree to this.

My question was "what is the percentage of those that don't NEED the professional" for the med administration or treatment.

Over the years I have encountered patients that are more than capiable (sp) of administering their own medication while admitted to an acute care or long term care facility. Good grief, there are patients that are fully able to walk to a PIXIS-type machine and have their medication drawer open for them.

My point is that unless we start to find some better ways of doing some of the tasks that have been "traditionally" assigned to nurses, we are not going to have anyone at our own bedside when the time comes.

flashpoint · Apr 24, 2008

True, there are many that NEED a professional to administer medication and deliver treatments. And there is definatly a need to protect one patient from the medication or treatment of another. I agree to this.
My question was "what is the percentage of those that don't NEED the professional" for the med administration or treatment.
Over the years I have encountered patients that are more than capiable (sp) of administering their own medication while admitted to an acute care or long term care facility. Good grief, there are patients that are fully able to walk to a PIXIS-type machine and have their medication drawer open for them.
My point is that unless we start to find some better ways of doing some of the tasks that have been "traditionally" assigned to nurses, we are not going to have anyone at our own bedside when the time comes.

Whether or not our patients NEED someone to administer their medication, it is a service that should be provided and should be expected. As a nurse, I wouldn't want my patients administering their own medication...I want that control...I want to know exactly what they take and exactly when they take it and exactly how they take it...if they are accessing Pyxis on their own or picking their own pills out of a box in their room, I lose that control.

There are certainly things in nursing that need changing, but I don't think that nurses administering medication is one of them...maybe we need to administer fewer medications (we have a resident who gets 22 pills every morning) or we need more medication in alternate forms (crushed pills taste terrible), but we still need to do it. Even with medication aides, I still try to stay very on top of what my residents are taking. I can't imagine that the task of adminstering medications is going to prevent people from going to nursing school or staying in the field.