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MAR Transcription and Verification Refresher: For Nursing Staff. Presenter name(s)

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(1)

MAR Transcription and

Verification Refresher:

For Nursing Staff

(2)

Outline

• Importance of Correct Transcription

• Nursing Responsibilities:

– Orders and Transcription

• Standard Medication Times

• Correct Transcription Examples

• MAR Verification

• Learning Activity: “Correct or Incorrect?”

• Resources

(3)

Why is this important??

• Transcription errors…

– Can result in medication errors

– Can be harmful to patients

– Can increase length of stay and morbidity

– Can have disciplinary consequences for health care

practitioners

– Can create more work for everyone involved

Let’s do it right the first time, and prevent any of

the above outcomes!!

(4)
(5)

Review the Order

Review the order

• Is the order complete? • Is it appropriate for your

patient?

A complete order

includes:

• Order date (and time) • Client name • Medication name • Dose in units • Route • Frequency • Prescribers name, signature and designation

Do I have all the information I need to carry out this

order safely?

Purple, Test G0001576 12/12/1973 F

(6)

Verify the Patient Identity

• Use

2 patient

identifiers

to

verify that the

order sheet and

the MAR belong

to the same

patient.

Purple, Test G0001576 12/12/1973 F

(7)

Transcription: Nursing Responsibilities

• Depending on the patient care area, an

order can be transcribed

to a MAR by:

– A Unit Clerk

OR

– A Nurse

• If someone other than the primary nurse

transcribes an order, the primary nurse

must:

1. Verify the transcription against the original order

2. Sign off the order sheet and MAR prior to giving the medication

(8)

If the Unit Clerk Transcribes the Order

1. Unit clerk will:

– Transcribe the order to MAR

– Indicate on order sheet with an ‘M’ next to the order

** Unit Clerk’s DO NOT sign off order sheets or initial the MAR

2. Primary nurse must: Verify transcription against original order sheet

– Initial the MAR entry to confirm verification – Sign off order sheet

Order is now active, and ready to be carried out by primary nurse!

M M M M M M 18/01/16 @ 0845 --- Fprince RN

(9)

M M

M M

18/01/16 @ 0845

---

Fprince RN

(10)

If Another Nurse Transcribes the Order

1. First Nurse will:

– Transcribe the order to MAR, and initial the transcription – Indicate on order sheet with an ‘M’ next to the order

2. Primary nurse must: Verify transcription against original order sheet

before giving the medication

– Initial the MAR entry to confirm verification – Sign off order sheet

Order is now active, and ready to be carried out by primary nurse!

M M M M M M M M 18/01/16 @ 0845 --- AChanxe RN

(11)

Order is now active, and ready to be carried out by primary nurse!

If the Primary Nurse Transcribes the Order Him/Herself

1. Transcribe order to appropriate section of MAR

– Include date, time, and initials

– Indicate appropriate medication times – Start and stop dates, when available – Time of first dose

– Any special instructions

2. Verify accuracy of your transcription with the original order

– Indicate ‘M’ next to the order on the order sheet

– Sign off the order sheet with signature, date and time

M

M M M

(12)

It is Important to Remember…

• As self regulated professionals, primary nurses do not require their own

transcriptions to be verified prior to giving the medication

• However: having another nurse verify and co-sign your transcription will prevent medication errors, help protect the patient from harm, and promotes safe

nursing practice and critical thinking

When you sign off an order and a MAR, you

are accountable for the accuracy and

appropriateness of the order.

When in doubt, consult another nurse, the

(13)

Transcription to a cMAR

Indicate the dosing times based on TSH’s Standard Medication Times Policy

(use ‘Staggered Medication Times’ chart for antimicrobials!)

Start and stop dates, when provided Special instructions Date, time and one or two sets of initials Indicate date/time of first dose

(14)

Selecting the

Appropriate

Medication

(15)

Standard Medication Times

• A key component of transcription is documenting WHEN the medication

should be given.

– Especially important with antimicrobial therapy and times of consecutive doses

• Want to ensure patient’s do not get doses too close together or too far apart

– Optimize the therapeutic effects of the medications!

• TSH has a “Standard Medication Times” policy with specific directions for

dose timing and dose staggering

FREQUENCY STANDARD MEDICATION TIMES DAILY/QAM 0900 QHS 2200 BID 0900, 2100 TID 0900, 1400, 2200 QID 0900, 1200, 1700, 2200 With meals 0800, 1200, 1700 AC meals 0730, 1130, 1630 PC meals 0830, 1230, 1730 Q2H 0200, 0400, 0600, 0800, 1000, 1200, 1400, 1600, 1800, 2000, 2200, 2400 Q4H 0200, 0600, 1000, 1400, 1800, 2200 Q6H (IV) 0600, 1200, 1800, 2400 Q6H (PO) 0600, 1200, 1800, 2200 Q8H 0600, 1400, 2200 Q12H 0900, 2100

(16)

Staggered Administration Times Chart:

For Antimicrobials

Use this table to determine the times for

the 2nd, 3rd, and

4th doses of an

antimicrobial agent!

- Will get the patient on to standard times by the 4th dose - Will maintain therapeutic effects of the medication Example… Time of 1st Dose Q6H Q8H Q12H

2nd dose 3rd dose 4th dose 2nd dose 3rd dose 4th dose 2nd dose 3rd dose 4th dose

0000 0600 1200 1800 0600 1400 2200 1000 2100 0900 0100 0600 1200 1800 0600 1400 2200 1200 2100 0900 0200 0600 1200 1800 0600 1400 2200 1200 2100 0900 0300 0800 1200 1800 1200 2200 0600 1200 2100 0900 0400 1200 1800 0000 1200 2200 0600 1800 0800 2100 0500 1200 1800 0000 1400 2200 0600 1800 0800 2100 0600 1200 1800 0000 1400 2200 0600 2000 0900 2100 0700 1200 1800 0000 1400 2200 0600 2100 0900 2100 0800 1200 1800 0000 1400 2200 0600 2100 0900 2100 0900 1400 1800 0000 1600 2200 0600 2100 0900 2100 1000 1800 0000 0600 1600 2200 0600 2100 0900 2100 1100 1800 0000 0600 1800 0000 0600 2100 0900 2100 1200 1800 0000 0600 2200 0600 1400 2100 0900 2100 1300 1800 0000 0600 2200 0600 1400 0000 0900 2100 1400 1800 0000 0600 2200 0600 1400 0000 0900 2100 1500 2000 0000 0600 2200 0600 1400 0000 0900 2100 1600 0000 0600 1200 2200 0600 1400 0600 2000 0900 1700 0000 0600 1200 0000 0600 1400 0600 2000 0900 1800 0000 0600 1200 0000 0600 1400 0800 2100 0900 1900 0000 0600 1200 0200 0800 1400 0900 2100 0900 2000 0000 0600 1200 0600 1400 2200 0900 2100 0900 2100 0200 0600 1200 0600 1400 2200 0900 2100 0900 2200 0600 1200 1800 0600 1400 2200 0900 2100 0900 2300 0600 1200 1800 0600 1400 2200 0900 2100 0900

(17)

Examples of Correct

Transcription by

(18)

Prescriber Re-orders a Medication

• Has the dosage changed? • Has the route changed?

• Has the frequency changed?

If ALL the answers are NO:

• Cross out existing start/stop date and initial • Indicate date of re-ordering, and new stop date

(19)

Prescriber Changes an Existing Order

1. Cross out existing order on MAR

– Draw a line through order – Indicate order changed – Indicate date and time – Indicate your initials

2. Transcribe order

– Initials

– Indicate date and time of transcription

– Indicate date and time of first dose

(20)

Discontinued Medication: Ex. 1

1. Cross out existing order on MAR, and indicate:

– D/C = discontinued – Date and time – Initials

2. In the time box corresponding

to the time of D/C indicate:

– D/C = discontinued – Draw a line and initial

Be sure not to cross out existing signatures

Ensure to indicate in the appropriate time box so that if record is

(21)

Discontinued Medication: Ex. 2

1) Cross out existing order on MAR, and indicate:

– D/C = discontinued – Date and time

– Initials

2) In the time box corresponding

to the next dose indicate:

– D/C = discontinued – Draw a horizontal line – Date and initials

Be sure not to cross out existing signatures

Ensure to indicate in the appropriate time box so that if record is

(22)

Discontinued Medication: Ex 3 Written MAR

…Follow the same

principles…

1. Cross out existing order on MAR, and indicate:

– D/C = discontinued – Draw a line

– Date, time and initial

2. In the time box

corresponding to the time of D/C indicate:

– D/C = discontinued – Draw a horizontal line – Date, time and initial

(23)

KEY POINTS TO REMEMBER

• During transcription and verification, you are checking that:

– The order is complete and appropriate for your patient

– The order has been transcribed or entered in the computer correctly

• Always check standard medication times or staggered medication times charts to ensure right TIME is indicated on MAR

• Be sure not to cross out existing signatures

• Ensure to document the D/C in the appropriate time box so that if record is examined it is evident when the D/C order became active

The patient’s chart is a legal document, and YOU are

accountable for ensuring accuracy when you sign!

(24)
(25)

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

(26)

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

(27)

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:

(28)

Resources

Have questions?

• Speak with your CRL, or PCM for more information

• Check out more resources on iConnect and LMS

– “Medication Documentation and Administration Policy”

– “Medication Orders Policy”

– Medication Safety Review LMS Module or power point

– Transcription for Unit Clerks power point

References

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