Chapter 12

Question 1

• form used to document medications a client has received and is currently receiving
• Legal documents
• can be viewed and charted on the computer
• essential info is common to all of them although there is no standardized form (name of each medication, the dosage, route, and frequency)

Answer 1

Medical Administration Record (MAR)

Question 2

• 6th right of medication administration
• must be accurate
• all meds must legally be documented
• should follow the administration of medication and include not only medications administered but also documentation regarding refusals, delays in administration, and responses to medication administration (adverse effects)
• prevent under or over medication

Answer 2

Documentation

Question 3

1) dates-usually includes the date the order was given, the date the med is to be started, and when to discontinue it
2) medication information-meds full name, dosage, route, frequency, standard abbreviations
3) time of administration-based on desired administration schedule stated on the order. Placed on the med record and converted to time periods based on the institutions time intervals for scheduled or routine medications
4) initials-initials of the person transcribing the med into the MAR and person administering the med, written under the signature section to identify who gave the med
5) special instructions (parameters)-relating to the medication should be indicated on the medication record
- legends
- area for charting to indicate when a med is omitted or a dosage is not given
- area where nurse can document reason for omission
- injection codes so the nurse can indicated injection site for parenteral meds
- space for charting info (pulse, BP; if relevant to medication)

Answer 3

Essential Components on a med record

Question 4

• after administering meds, the nurse MUST record their initials next to the the med was administered
• should be done immediately after meds are given, prevent forgetting to document, could result in giving the pt another dose
• No documentation=not administered

Answer 4

Documentation

Question 5

• contain essential information that is common to all and their purpose
• MAR is used to determine what meds are ordered and the dosage, route, and time at which each is supposed to be given
• verified with prescribers orders
• info common to all MARs
  
  • name of client and pertinent data related to the client
  • medication (dosage,route)
  • time/frequency desired for administration
  • place to indicted allergies
  • a place for date, initials of the person who administers med, and a section to identify the name of the person administering the med

Answer 5

Explanation of MARs

Question 6

• unit dose drug dispensing system (UDDS)
• has decreased med preparation time because the meds are prepared daily in the pharmacy and sent to the unit
• dispensed in individual dosages as prescribed (single dose of med)
  
  • package is labeled with generic and trade names
  • may be labeled with the clients name and barcode
• meds are placed in a client identified drawer in a large unit dose cabinet at the nurses station
• dispensed in the most ready to administer form possible to minimize opportunities for error
• in the computerized version, each dosage for a client is released individually and recorded automatically
  
  • used for monitoring controlled substances and other items in the unit

Answer 6

Unit Dose System

Question 7

• Automated dispensing cabinets (ADCs)
• supplied by the pharmacy daily with stock medications
  
  • controlled substances are also kept in the cart, and the system provides a detailed record indicating which controlled substances were used and by whom
• nurses uses a security code and password to access meds in this system
• most common types: Pyxis Med Station system, Omnicell Omni Rx, and AcuDose Rx
  
  • omnicell is a mobile med system
    
    • allows the nurse to retrieve all meds that are needed by the client without making trips to an ADC
• overrides eliminate verification of meds by the pharmacy=error

Answer 7

Computer-Controlled Dispensing system

Question 8

• can reduce med errors by 65-86%
• verifies that a client receives the right dosage of the right med by the right route at the right time
• requires each client wear an ID with a unique barcode to identify the individual
• each medication must have a barcode
• allows overrides in cases where meds need to be administered in an emergency
  
  • bypasses the important step of order verification by the pharmacist

Answer 8

Barcode Medication Delivery

Question 9

• software system
• automate them med administration process and improve accuracy and efficiency in documentation
• comprises the computerized prescriber order system, the barcode administration system and the eMAR, and the pharmacy info systems

Answer 9

Computer Based Drug Administration (CBDA)

Question 10

• counterpart to the barcode medication system that acts as a stringent safeguard to ensure that the right client receives the right medication, the right dose, by the right route, and at the right time
• checks the meds against the clients history and lab results
• computer verifies and confirms that the nurse is administering correctly
• alerts the nurse to any conditions that should be checked before administering the med

Answer 10

eMAR