MAR: An overview€¦ · Transcribing Orders to the MAR •Accurate transcription is important for safe medication administration practices *Transcription errors cause medication

MAR: An overview

The Scarborough Hospital

January 2016

Contents • What is a Medication Administration Record (MAR)

• MAR layout

– Hand-written MAR layout

– Computerized MAR layout

• How to print a patients MAR

– From NUR

– From EDM

• Nursing Responsibilities

– Verification

– Transcription

– Documentation

Medication Administration Record…

a.k.a. the MAR • “Official record of all medications prescribed and

administered to a patient” (Medication Documentation and Administration Record Policy)

Different types: • Computer Generated MAR (cMAR)

– Printed from Meditech once daily in evening

– Covers 24 hour period 2330h-2329h

– ONLY medications that have been entered by Pharmacy will be reflected on the MAR

– MAR must be verified

– New orders must be hand-transcribed, until the next print

• Hand Written MAR – In ICU and ED – with some exceptions

• Varying Medication Records – Used in ED, PACU, OR, FMC, and during CPR

MAR Layout – Hand Written

MAR

Hand-written MAR layout – First Page

Place patient

information label

here - Ex: Purple, Test

G0001567

STAT and

One time doses - Found on first sheet of MAR

Signature boxes - All providers who administer

medication must print their

name, sign their signature and

their initials

Date, Allergies - Always ensure to write the

correct date range

Hand-written MAR layout – Medications

Each order is verified

by 2 nurses - Both nurses initial the

MAR upon transcription of

the original order

- MAR is not

to be used

unless verified

by two nurses

**Covers up to 7 days of

medications** Scheduled Meds - 2nd and 3rd page

PRN Meds - 4th page

MAR Layout – cMAR

Patient Identifiers,

Date/Time, Allergies - Always ensure the right

date/time was printed

Verified by - Nurse must sign off the

MAR after verification of

orders

- MAR is not to be used

unless verified

STAT and

One time doses - Found on first sheet of MAR

Scheduled Meds - Administration time

indicated

cMAR layout - First page

cMAR layout – PRN medications

PRN medications - Show up after

scheduled meds

No scheduled times - Must document time of

administration

cMAR layout – Final Page

Final page - Signature boxes

- All providers who

administer medication

must print their name,

sign their signature

and their initials

How to Print the cMAR

Printing the MAR:

From Meditech NUR… method 1

1) Select “OE Registered Nurse Menu”

2) Select “Print MAR”

Printing the MAR: From Meditech NUR… method 2

1) On “Status Board”, highlight the patients name.

2) From the

menu on the

right click “Print

Report”.

3) Select “OE Registered Nurse Menu”

“Rpts Scheduled to Print Automatically” “Print MAR”

Printing the MAR:

From Meditech EDM (in emergency department) 1) From the main ED tracker select option: “OE”

2) Select “Rpts Scheduled to Print

Automatically” “Print MAR”

Printing the MAR: For the entire ward

“INP” - to indicate inpatient Use F9

look-up to

select unit - ex: 3D

medicine,

printer will

already pre-

populate

Select appropriate date -Recall: MARs start at 2330 and end at 2329 the

following day…

- Enter “T” for next (tomorrows) MAR

- Enter “T-1” for current (todays) MAR

Leave these blank… - You can F9 for other

options if you need a

blank MAR or to change

printer

Printing the MAR: For an individual patient

“INP” - to indicate inpatient

Type

patient

name into

field, hit

enter - Select

appropriate

patient

Leave these blank… - You can F9 for other

options if you need a

blank MAR or to change

printer

Select appropriate date -Recall: MARs start at 2330 and end at 2329 the

following day…

- Enter “T” for next (tomorrows) MAR

- Enter “T-1” for current (todays) MAR

Nursing

Responsibilities…

** For more detailed information on the nursing responsibilities

review the “Medication Administration and Documentation” Policy**

Verifying the MAR What do I need for proper

verification?

• Today’s MAR

– ending at 2329 tonight

• Tomorrow’s MAR

– starting at 2330 tonight

• Patient’s Chart

– to check for new orders or changes

** In order to ensure a MAR truly

reflects all current orders you MUST

use these three items during your

check**

How to Verify the MAR 1. Compare each MAR entry on the new MAR to the previous MAR

– Indicate an entry is correct with a checkmark next to the entry

– Highlight any important comments/details on the MAR

2. Cross-reference to the patient’s chart to ensure all new and existing orders were

– Entered correctly by Pharmacy

– Transcribed and signed off correctly by nursing staff

– Sign the chart to indicate orders were reviewed

How to Verify the MAR (continued)

3. If there is a medication missing from the new MAR:

– Transcribe it and have it checked according to policy

– Ensure the yellow backing has been sent to Pharmacy

– Send an OE message to Pharmacy indicating the

discrepancy

4. When verification is complete:

– Sign the “Verified by” line on the first page of the cMAR

Transcribing Orders to the MAR

• Accurate transcription is important for safe

medication administration practices

*Transcription errors cause medication errors*

• Process: – Transcribe order to MAR

• This may be done by a Unit Clerk or a Nurse

• Transcriber must sign-off order sheet and initial the

MAR

– A nurse must review the order and transcription

• This must be done by a Nurse

• Nurse must sign-off order sheet and initial the MAR

Documentation • Always document the actual time of administration

– If the dose is late or missed

• Indicate the reason on the MAR, contact MD if necessary

• Adjust the timings of future dose’s to prevent over-medicating and maintain

appropriate dosing intervals

• Always document immediately after giving the medication, to

keep the chart up to date

• Always remember to sign the signature section at the end of the

MAR

• Ensure your writing is legible

Important Variations in Documentation • Use the “Anticoagulant Record” to document anticoagulants with

varying dosing (i.e. Warfarin, Heparin infusion)

– Do NOT signature on the MAR

– Computerized MAR will prompt you to look at the record

– See TSH’s “High Alert Medications” policy

• Narcotics are documented on both the MAR and on the Narcotic Sheet

– See TSH’s “High Alert Medications” policy

• Some medications require an “Independent Double Check”

– 2 signatures required during administration

– See TSH’s “Independent Double Check Medication

Administration” policy

For a comprehensive review, see “Medication

Documentation and Administration Record” policy

• Review the following policies on iConnect: – “Medication Documentation and Administration Record”

– “High Alert Medications”

– “Independent Double Check Medication Administration”

• Speak with your CRL and/or Pharmacist

• See iConnect’s “Medication Safety Practices” page

Questions?