23.1

CHAPTER 23

MEDICATION RECORDS IN THE NURSING HOME

23.2

NURSING HOME

Medication Records in the Nursing Home

1. MAR’s, TAR’s & PRN Sheets 2. Monthly Summaries (Recaps or Physician Order Sheets) 3. Who produces these documents? 4. How are med sheets kept current? 5. How does the Pharmacy get notified of order changes? 6. The month-end process used to review new med sheets

7 Who is responsible for the accuracy of new med sheets?

8. How to avoid the biggest opportunity for med errors and omissions

9. The Importance of the position of med orders on the Med Sheets

(1) PRN’s first or last (2) Organizing Ancillary Orders (3) D.N.R. Orders or Living Will Statements

10. What happens to medical records after the end of the month?

23.3

NURSING HOME The Consultant Pharmacist should be looking for the following issues when they review the MAR, TAR and PRN documentation.

The administration times for each medication in use Does the daily number of doses administered match the written order (Ex written order is for TID but doses are being charted at 8am & 8pm) Identify all medications that have been discontinued since the first of the month

Do nurses use a standard process to document discontinued medications

Are all changes in an existing order documented as a new order (Ex. If a dose goes from TID to BID has the nurse dc’ed the TID order and written a new order for BID?) Identify all new medications started since the first of the month

Have all new orders written during the past month been documented on the MAR Doses of medication held and the reason they were held

Do nurses use a standard process to document “held doses” and has the prescriber been notified Charting omissions that may compromise the effectiveness of the therapy The use of PRN doses for the patient and the effectiveness of each dose

Do nurses use a standard process to identify administered PRN orders that need additional

documentation (ex the effectiveness of the dose) Doses that are being crushed or administered through a tube. Is it acceptable that these

medications are being crushed? Is there a liquid alternative?

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23.5

23.6

23.7

23.8

23.9

23.10

NURSING HOME ELECTRONIC MEDICATION RECORD COMPANIES (eMAR) Creative Strategies (Accuflo –formerly eMedPass) www.creativetrategies.com (888) 339-7050 Daverci solutions www.daverci.com (503) 726-1420 Integrated Informatics www.ii-i.com (770) 643-6755 ext 227 MED e-care www.mede-care.com Toronto Ontario (416) 686-8592 QuickMar www.quickmar.com (888) 340-9866

23.11

SAMPLES OF eMAR PRODUCTS

DAVERCI

23.12

QUICKMAR