Transcript Medical Administration Record

Medical Administration Record
MAR
What is a MAR?
It is a legal document
It is good for 24 hours
It shows all of the medications that a patient is taking
Dr.’s orders are transcribed on to the MAR
The Five rights are all taken into account in filling out the MAR
1. Right Patient
2. Right Med
3. Right Dose
4. Right Time
5. Right Route
First thing to fill out on the MAR
Date
Page number of how many
Shift times - For our Testing purposes: 0700-1459
Patient Information
1500 -2259
2300-0659
Adding Medications PO
Doctor’s order - Alprazolam 0.5mg PO TID
If you have a dose that is NPO after midnight you still put the time
down on the MAR the nurse that is going to administer this dose will
circle the time on the mar and indicate that the dose was not given.
You can clip a note with the instructions that the pt is NPO after
midnight if you want.
Adding Medications IV
Doctor’s Order : Zosyn 3.375mg IVPB Q6H
This is incorrect! the Dosage form should be left blank!
Adding Medications PRN
Doctors Order: Ondansetron HC 4mg PO Q8H PRN for n/v
Note: there are no times on a PRN order
PRN orders are always at the bottom of the MAR
Adding Insulin
Doctor’s Order: Reg Insulin, ac/hs sq, sliding scale BS -100 /10 = unit
Insulin always starts at 0730 on our MAR whether ac tid and hs or am
Only regular insulin is on a sliding scale
Only regular insulin can be administered by IV
Look at the dose and ask if it is reasonable < 12 ask the pt if they are resistant
a sliding scale may also look like this:
under 150 = no insulin
151-200 = 2 units
201 -300 = 4 units
301 – 400 = 6 units
401 + call the doctor
Adding a skin Patch
First Day – we will only have one day and it needs the date and time we put it on
Doctors order: Nitropatch 0.4mg transdermal patch q72h
A PO medication that has a stop
date
Doctor’s order - Alprazolam 0.5mg PO TID X 6 days
Times you need to know
Medication distribution schedule
q day 0900
bid
0900 1700
TID
0900 1300 1700
QID
0900 1300 1700 2100
HS
2100
insulin times
0730 1130 1630 2100
Q4
Q6
Q8
Q12
Every 4 hours from the start time
Every 6 hours from the start time
Every 8 hours from the start time
Every 12 hours from the start time
What if something is wrong?
Is the Doctor’s order missing something ?
look for the 5 rights on the medical order
Is the Rx for the right patient?
Do you have the correct medicine?
Is it spelled correctly?
Is there a correct dose?
Is the method correct and listed for the medication?
Do you have the correct times listed? are they on the order?
Is the patient allergic to this medication? If so STOP write on the back of the MAR that
you verified with the patient, checked the armband, and pharmacy for d/c
If you are missing any of these things STOP
Do not put it on the front of the MAR instead place it on the back with the reason that it
needs clarification
If you make a mistake
Draw one line through it and write you initials and the word error
Make sure you sign the bottom of the MAR and place your initials in the space provided.
Heparin Administration
Sub q
Sites need to be at least one inch apart
needs to be at least two inches from the umbilicus
Don’t aspirate
Don’t massage the injection site
use a tuberculin syringe
Change the needle between drawing the injection and
administering the injection
Rotate sites for injections
insert the needle 45-90 degrees depending on the size of the
patient
use needle size 23, 25, or 26 gauge ½ or 5/8 inch needle
Insulin Administration
always check blood sugar
needed supplies
alcohol
2X2
lancet
Test strip
let pt pick the finger
wipe with the alcohol
let it dry
milk it before you poke it (bring blood to the area)
one poke; stick on three
wipe first drop away with the 2x2
second drop on test strip
give gauze to pt to hold on finger
check parameters with facility to see if you need to retest.
do three if you get different numbers on your second test.
look at expiration date on the insulin bottles
Make sure the insulin you have is
what is ordered
Insulin Continued
look at the blood sugar and the MAR and make sure of what our dose is going to be
look at big letter
pop the top
wipe off the top with the alcohol pad
take insulin syringe
draw all air needed at one time
inject N insulin or cloudy first ALWAYS!!
inject air into regular or Clear ALWAYS!!
draw Regular first ALWAYS!!
check with another licensed person
the needle must still be in the bottle
re-wipe off the top of the N insulin(cloudy)
Draw the Cloudy second ALWAYS!!
Have it checked with another licensed nurse
Do not remove the needle till after checked
recap needle using the one handed technique placing your non dominant hand behind
you
Insulin Final
Check pt. armband
Ask about allergies
go give to patient subcutaneously at a 45 degree angle
watch pt. know what time to be worried when the regular peaks
Know what time the N is going to peak
Regular insulin is the only one that can be given IV
Always use an insulin syringe
25, 26, or 27 gauge ½ or 5/8 inch
type
Onset
Peak
Duration
Rapid acting (Humalog, Novalog) 5-15 min
1-2hrs
3-4hrs
Short acting(Humulin R , Novolin R, Regular) 30min-1hr 1-3hr 6-8 hrs
Intermediate acting (NPH, Humulin N) 1-2hrs 7-15hrs
24
I.M Injection; Dorsogluteal site
•Dorsogluteal site - upper outer quadrant of the buttocks
•can hold 3 ml
•avoided in clients younger than 3 and non
ambulatory
•Divide the buttock into four imaginary quadrants
•Palpate the posterior iliac spine and the greater
trochanter
•Draw an imaginary diagonal line between the two
landmarks
•Insert the needle superiorly and laterally to the
midpoint of the diagonal line.
•IM Needle sizes 20,21,22,23 1 1/2 or 2 inch 3 or 5 ml
Intramuscular : Ventrogluteal Site
•Uses the gluteus medius and gluteus minimus muscles in the hip for injection
•Advantages
•no large nerves
•no large blood vessels
•usually less fatty
•cleaner – no fecal contamination
•Location
•Place the palm of the hand on the greater trochanter and the index finger
on the anterior superior iliac spine
•Move the middle finger away from the index finger s far as possible along
the iliac crest.
•Inject into the center of the triangle formed by the index finger, middle
finger, and iliac crest.
•3ml max
Intramuscular: Rectus Femoris Site
•Location: The anterior aspect of the thigh.
•May be used for infants
•client must be sitting or supine
•Middle third of the thigh
•3ml
•ONLY for PEDS for adults use the vastus laterales
Intramuscular: Vastus Lateralis site
•Uses the vastus lateralis muscle, one of the muscles in the quadriceps group of
the outer thigh.
•desirable site for infant shots
•good for thin or poorly developed clients
•Location
•placing one hand above the knee and one hand just below the greater
trochanter at the top of the thigh.
•Insert the needle into the lateral area of the thigh between where your hands
were located.
•3ml
Intramuscular: Deltoid Site
•located in the lateral aspect of the upper arm.
•least used intramuscular site
•Smaller muscle only takes 1ml
•risk of damaging the Radial nerve
•Location
•have the client lie down, sit or stand with the shoulder well exposed
•Palpate the lower edge of the acromion process
•draw and imaginar line at the axilla
•inject in the area between these tow landmarks
Common sizes of syringes and
needles
Intradermal (tuberculin) 1ml calibrated in 0.01 mL or in minims 25-27gauge ½ to 5/8 “
Subcutaneous 1,2,2.5,3 mL calibrated in 0.1mL 23,25,26, ½ to 5/8
Insulin, given subcutaneously 1mL calibrated in units 25,26,27 gauge ½ to 5/8”
Intramuscular 3 or 5 mL calibrated in 0.2 mL 20,21,22,23 gauge 1 ½ or 2 inch