When to enter meds on MAR

[OldMareLPN]

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

[sfn2008, RN]

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.

I disagree. I don't identify with the control issues. I feel we should identify and meet NEEDS. Let me ask, how many times would you have liked to just sit and TALK to your patient because you knew that that is what they NEEDED, but you couldn't because you had to pass meds or fill out paperwork? And when you have been able to squeeze in the time to just hug or comfort a patient, hasn't that felt like validation for why you became a nurse?

To me nursing is about patient education, (Granted in a LTC that is not might not be appropriate for ALL the patients, but maybe for SOME), quality of care, critical thinking skills and assessment skills. As a nurse I would want my time to be freed up to do more of where our expertise (sp) lies..

[sunfire1725]

I have also seen nurses signing for all their meds given and treatments at the end of their shift, I have never seen the RN's doing this, only the LPN's. I thought maybe that was the way they were taught to do it in school. I know that when I went to school we were not taught how the meds should be signed out. So I always checked the MAR and the med and then signed it out, but I found that this wasn't correct. The post about putting a dot for a reminder makes sense to me, but I don't have enough time to finish passing meds and treatments with signing for and it when it is popped from the blister pack, let alone going back and signing when the meds are actually taken by the resident. It seems like I would never get done with passing meds to 30+ residents, treatments, dressing changes and supervising the whole facility. So to be clear the legal way to sign meds out is to dispense them and sign after the resident has taken them? The way I do it, if I get called away from my cart ( which happens all the time as a supervisor) I can lock up the med cup and I know where I left off in the MAR because my initials are not present. If I don't sign for them and get called away, how would I know where I left off?

[CapeCodMermaid, RN]

Sunfire-Far be it from me to tell you how to practice, but if I were you, or you were in my building, I would tell you that unless it is a true emergency---a code, a huge fall with a major injury---I wouldn't interrupt the med pass. The chance of making a med error increases with every interruption.

[CoffeeRTC, BSN, RN]

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?

Are you kidding me??? This is posted in the LTC forum, so I will address it as a LTC med pass. Take a look around a LTC, most of those people cant open a milk carton, have feeding issues, memory or psych issues, comples medical problems, multiple meds....so yesss. A nurse is needed.

As far as the think outside of the box.....yeah. Critical thinking is lacking at times, but do they teach that in school?

[flashpoint]

I disagree. I don't identify with the control issues. I feel we should identify and meet NEEDS. Let me ask, how many times would you have liked to just sit and TALK to your patient because you knew that that is what they NEEDED, but you couldn't because you had to pass meds or fill out paperwork? And when you have been able to squeeze in the time to just hug or comfort a patient, hasn't that felt like validation for why you became a nurse?

To me nursing is about patient education, (Granted in a LTC that is not might not be appropriate for ALL the patients, but maybe for SOME), quality of care, critical thinking skills and assessment skills. As a nurse I would want my time to be freed up to do more of where our expertise (sp) lies..

I don't really think my desire for control is an issue...it is a necessity. When something goes wrong with one of my residents, I am the one who had better be very aware of what medications they take and when they take them...and I had better be certain that they have taken them (or not). If they are given control of their meds, I honestly don't know if they have taken them or if they are sharing them with a roommate or if they are dosing appropriately or whatever.

I would love to have more time for the actual caring part of the job, but sometimes we can only do the best we can. The thing that would help out most at my facility is reducing the amount of medication that our residents take...we give a HUGE amount of medicine every morning (even after doing reviews and reductions). A lot of our residents would be able to function at home (with help from Meals on Wheels, LifeLine, home health, etc) but can't because they are unable to manage their medications.