When do I initial the M.A.R.?

TheCommuter, BSN, RN · Sep 11, 2010

You're really supposed to initial the M.A.R. after the patient/resident has successfully taken the medications. If you initial it beforehand, the patient/resident might do any number of things such as refuse, act combative, have swallowing issues, or simply not take them. If you have initialed the M.A.R. and the patient doesn't take the medication, you'll have to go back, circle every initial, and document why it wasn't successfully taken. Also, the patient might take all of his/her medications with the exception of the Colace because, "My stools are runny today!"

However, the vast majority of my patients/residents take their medications without resistance, so I admit that I initial the M.A.R. as I am pulling the medications to save time.

caliotter3 · Sep 11, 2010

When the resident takes the med. The MAR goes with you from room to room and you sign it after the resident has taken the med. Anything else is also charted at this time.

Joyfull77 · Sep 11, 2010

I wonder if the standards are different from nurses and medication aides, because in our facility, you are supposed to sign then give the medication. If you gave the medication and didn't sign for it, and you forget to go back and sign it, its a med error. If residents refuse a pill, you sign and circle even if they didn't take it. I always sign first then give the medication due to the fact that I have to prepare residents' medications in the medication room, and then go to the residents rooms to give the medication; the med cart doesn't leave the med room.

Midwest4me · Sep 11, 2010

i learned 25 years ago to always sign after giving the med and that's what i do. i have 40+ patients who come to my med room door and it can get hectic; each clamoring to get theirs as fast as possible but i always take the time to sign each person's meds out immediately after giving them. they may not like waiting for me to sign off the previous pt's meds, but oh well, that's policy!

flashpoint · Sep 11, 2010

It depends on your facility's policy. Some places require that you sign them out when you put them in the cup...then circle or cross out the initial if the resdient / patient doesn't take them for some reason. Other places, you initial after they are taken...and still circle or initial if they aren't taken.

One place I worked (this was a hospital, so different MARs than LTC), you wrote the time and your initial in the box when you prepared the meds, then crossed out the time to show they were taken.

NamasteNurse, BSN, RN · Sep 11, 2010

you are documenting that you ADMINISTERED the medication. (MAR= Medication ADMINISTRATION record) you can't say it was administered until AFTER the patient takes it.

Summer Breeze · Sep 11, 2010

I take a pencil and just make a small 'dot' on the medications that I have drawn out. That way I double check myself and know 100% that I took out all of the meds I need for that specific time. Once my patients take their meds, I go back and initial.

I wouldn't sign off the medication if I didn't administer it, so I think its best to do it after the med is actually given.

Forever Sunshine, ASN, RN · Sep 11, 2010

My short term memory loss kicks in during a heavy med pass. So I have to sign it out then pop it from the card. I know my residents meds and what they get on my shift. And I always go by the mar if they increased/decreased any doses or dc'd meds. If a resident refuses.. I circle my initials.

If the state or someone was watching you, you have to sign after administration.

chloecatrn · Sep 11, 2010

If the state or someone was watching you, you have to sign after administration.

If you have to change how you're passing meds because someone's watching you, you're doing it wrong. Someone mentioned a pencil dot to show that they poured a med or popped a med, then signing when the resident takes a med. That's a good trick... it doesn't acknowledge that anyone took anything, just that you prepared the med.

The answer is that the MAR signifies that your meds have been administered. If your facility's policy is anything different, make sure you have that policy IN WRITING, and have your very own hot little copy of that policy in case it comes back to bite you in the tuckus someday.

kids · Sep 11, 2010

It's going to depend on State and facility rules, ask your DoN or SDC.

In school in the hospital clinicals I was taught to sign after the patient took the med.

In school in LTC/SNF facility clinicals I was taught to sign as the med was placed in the cup.

I've done it that way in front of surveyors in 2 States without so much as a raised eyebrow.

There can't be any holes in the MAR, if the patient doesn't take the med you still have to circle your initial and document the reason.

Forever Sunshine, ASN, RN · Sep 11, 2010

If you have to change how you're passing meds because someone's watching you, you're doing it wrong. Someone mentioned a pencil dot to show that they poured a med or popped a med, then signing when the resident takes a med. That's a good trick... it doesn't acknowledge that anyone took anything, just that you prepared the med.
The answer is that the MAR signifies that your meds have been administered. If your facility's policy is anything different, make sure you have that policy IN WRITING, and have your very own hot little copy of that policy in case it comes back to bite you in the tuckus someday.

So you are telling me that when someone is watching you pass meds you don't change a thing from when you are doing it on your own?

I pass meds for 25 sometimes 50 patients. With that patient load. I need all the time I can get. I tried the dot trick when I first started. It is do-able but too time consuming when you have a heavy patient load.

Everyone has their way of passing meds. I feel comfortable with the way I do it. But if someone was watching me I would sign after administration.