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Info ⬇

Medication administration records (MARs) are legal records that contain the same information as the medication order with the addition of the specified times for administration. After an order is generated electronically, it is (typically automatically) uploaded to a special form within the patient's electronic medical record that is used for documentation of drugs given to the patient and is called the electronic medication administration record (eMAR). Handwritten medication orders are manually entered onto the eMAR or transcribed onto a paper MAR according to agency protocol for transcription of medication orders. Transcription is the process of copying or entering orders onto the MAR or eMAR and includes the assignment of times for administration. The person responsible for transcription depends upon agency policy and may be a nurse, pharmacist, secretary, or pharmacy technician. Figure 4-5 depicts the transcription of the medication orders from the form in Figure 4-4 onto a MAR, while Figure 4-6 shows orders on an eMAR.

This MAR indicates that ampicillin was given at 0600, gentamicin was administered at 0800, and acetaminophen was given at 1000 by Sharon Schultz, RN, on January 8.

A medication administration record of Cityville Hospital.

The form depicts the address of Cityville Hospital at the top center, name, date of birth, M R number, diagnosis, allergies, and week ending date below them. Below it, a blank table depicts order date, scheduled medications, times, 1 forward slash 06 2023, 1 forward slash 07 2023, 1 forward slash 08 2023, 1 forward slash 09 2023, 1 forward slash 10 2023, 1 forward slash 11 2023, and 1 forward slash 12 2023. Row 1. Order date: 1 forward slash 08. Scheduled medications: Ampicillin 1 gram I V q 6 h. Times: 0600, 1200, 1800, 2400. 1 forward slash 08 2023: S S. Row 2. Order date: 1 forward slash 08. Scheduled medications: Gentamicin 120 milligrams I V q 8 h. Times: 0800, 1600, 2400. 1 forward slash 08 2023: S S. Below it, a blank table for P R N medications depicts Order Date, Medication, Date, Time, Route, Reason, Result, Initials. Row 1. 1 forward slash 08, Acetaminophen 650 milligrams P R q 4 h p r n fever greater than 101.5, 1 forward slash 08, 1000, P R, Temp 102.4, 101.3 at 1030, S S. Below it, a blank table depicts Initials, Signature or Title, Initials, Signature or Title, Initials, Signature or Title. Row 1. Initials: S s. Signature or Title: Sharon Schultz, R N.

To access details regarding the administration of furosemide on the eMAR, such as the name of the individual who administered the medication or the patient's blood pressure at the time of administration, the user hovers the mouse over the identified site on the eMAR.

A medication order of Bartlett, Jones L.

The order reads, M R N: 007703700, Account: 0087043241256, blank space for language, date of birth: 9 forward slash 13 forward slash 1955, and age 68 years. Below it, the date and time are as October 17, 4:45 A M to October 18, 8:45 A M. The left panel depicts selected check boxes for scheduled, unscheduled, P R N, continuous infusions, future, discontinued scheduled, discontinued unscheduled, discontinued P R N, discontinued continuous infusion under time view. The right panel depicts a table with 4 columns. The column headers read: Medications, 10 forward slash 17 forward slash 2023 10:00 A M, 10 forward slash 17 forward slash 2023 4:45 P M, and 10 forward slash 17 forward slash 2023 6:00 P M. The upper section of the table is labeled, Scheduled and comprises 4 rows. The lower section is labeled P R N and comprises 4 rows. Row 1 reads, furosemide, furosemide oral solid, 20 milligrams equals 1 tablet, P O, Tablet, B I D, Routine, 10 forward slash 06 forward slash 11, 18:00:00, 20 milligrams, blank space, 20 milligrams. Row 2 reads, furosemide, Complete forward slash SS, blank space, blank space. Row 3 reads, Systolic B P, Pre-administration, 124, blank space, blank space. Row 4 reads, Diastolic B P, Pre-administration, 78, blank space, blank space. Row 5 reads, acetaminophen, acetaminophen oral solid, 650 milligrams equals 2 tablets, P O, Tablet, Q 4 H R, P R N Pain, 09 forward slash 29 forward slash 11 11:15:00 For Pain Level 1 to 3, blank space, 650 milligrams not given within 7 days, blank space. Row 5 reads, acetaminophen, blank space, blank space, blank space. Row 6 reads, Temperature, Pre-administration, blank space, blank space, blank space. Row 5 reads, Pain Score, blank space, blank space, blank space. Note: e M A R documentation points to 78.

As shown in Figures 4-5 and 4-6, the MAR/eMAR provides a place for documentation of medications given.

LEARNING ACTIVITY 4-5 Complete the MAR for Kevin Dunbar, depicted in Figure 4-7, as follows:

Medication administration record (MAR) to be completed for Kevin Dunbar (see Learning Activity 4-5).

A medication administration record of Cityville Hospital.

The form depicts the address of Cityville Hospital at the top center, name, date of birth, M R number, diagnosis, allergies, and week ending date below them. Below it, a blank table depicts order date, scheduled medications, times, 1 forward slash 06 forward slash 19, 1 forward slash 07 forward slash 19, 1 forward slash 08 forward slash 19, 1 forward slash 09 forward slash 19, 1 forward slash 10 forward slash 19, 1 forward slash 11 forward slash 19, and 1 forward slash 12 forward slash 19. Below it, a blank table for P R N medications depicts Order Date, Medication, Date, Time, Route, Reason, Result, Initials. Below it, a blank table depicts Initials, Signature or Title, Initials, Signature or Title, Initials, Signature or Title.

1. Enter this medication ordered on 5/5: heparin 5,000 units SUBQ q12h (0800, 2000).

2. Enter this medication ordered on 5/6: Maalox 30 mL via GT q6h (0600, 1200, 1800, 2400).

3. Sign the medication sheet with your initials as if you had given the medications on the day shift (0700–1500) on 5/8.

Order Error … Case Closure
Administration of multiple doses of Tylenol instead of the single dose that was intended resulted in delays in evaluation and treatment. Delaying evaluation of the cause of this child's fever and resulting treatment delays could have adverse effects. When taking telephone orders, the nurse should:
  • Ensure that all of the components of medication orders are included.
  • Follow the process for taking a verbal order: Document the order, recite the order back, and verify that the order is correct.

The nurse should have questioned the medical doctor (MD) regarding frequency. Had the nurse asked, "Did you want the Tylenol given q4h prn fever greater than 101?" as was presumed, the physician would then have clarified that it was to be a single-dose order. Then the nurse should have recited back the order back for verification, saying something like, "Oh, so you want Tylenol 325 mg PO now one time only and notify MD for persistent fever … is that right?" The MD would then reply, "Yes, that's correct!" This exchange reveals that the nurse correctly interpreted the order.

Chapter Summary ⬆ ⬇

Chapter Summary

Learning Outcomes

Points to Remember

4-1 Interpret common medical abbreviations.

See Tables 4-1, 4-2, 4-3, and 4-4.

  • Frequency abbreviations:
    • ac/pc: before meals/after meals
    • bid/tid/qid: two/three/four times per day
    • prn: as needed
    • q4h: every 4 hours
    • stat: immediately
  • Route abbreviations:
    • PO: by mouth
    • GT/NGT: gastrostomy/nasogastric tube
    • IM: intramuscular
    • IV: intravenous
    • SUBQ: subcutaneously
    • PR: rectally
  • Form abbreviations:
    • EC: enteric-coated
    • LA/XL: long-acting
    • gtt: drops
    • CR/SR/XR: controlled/sustained/extended release
  • General abbreviations:
    • ā/

      : before/after

    • /

      : with/without
    • NPO: nothing by mouth

4-2 Identify error-prone medical abbreviations.

See Tables 4-5, 4-6, 4-7, and 4-8.

Per ISMP and TJC do not use these abbreviations:

  • QD/qod: use daily/every other day
  • hs/qhs: use HS or bedtime/nightly
  • OD/OS/OU: use right eye/left eye/both eyes
  • AD/AS/AU: use right ear/left ear/both ears
  • U/IU: use unit/international unit
  • μg: use mcg
  • cc: use mL
  • Symbols such as <, >, @, &, +, °: write the intended meaning instead

4-3 Identify required elements of a medication order.

Name of patient and date of birth (DOB), name of medication, dose, route, time/frequency of administration, date/time order is written, prescriber signature

4-4 Apply the procedural guidelines for receiving verbal orders.

  • Personnel, such as registered nurse or pharmacist, must be authorized to accept verbal orders or telephone orders.
  • An order should be labeled with T.O. or V.O., signed by the nurse upon verification, and cosigned by the prescriber as soon as possible.
  • Guidelines:
    • Document the order.
    • Recite the order.
    • Verify the order.

4-5 Recognize the components of a medication order on the MAR.

  • The MAR/eMAR is a legal document.
  • The medication order is transcribed, and specified times for medication administration are added.
  • The MAR/eMAR provides a place for documentation of medications given.

Homework ⬆

Homework

For exercises 1–10, differentiate the pairs of abbreviations. (LO 4-1)

1. q8h, tid

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2. prn, ad lib

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3. NG, GT

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4. PO, NPO

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5. SL, XL

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6. bid, q12h

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7. IM, IV

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8. q6h, qid

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9. SUBQ, ID

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10.

,

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For exercises 11–15, circle the correct documentation for each error-prone abbreviation/symbol. (LO 4-2)

11. QD

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a. right eye

b. daily

c. every other day

12.<

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a. less than

b. more than

c. mL

13. IU

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a. intravenous

b. insulin unit

c. international unit

14. hs

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a. bedtime

b. hourly

c. half-strength

15. cc

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a. units

b. mL

c. cubic centimeter

For exercises 16–20, fill in the blanks.

16. The Institute for Safe Medication Practices is an organization whose mission is to prevent ____________ .

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17. Illegible ____________ is a contributing factor to medication errors related to error-prone abbreviations.

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18. ____________ (TJC) is an organization whose mission is to evaluate healthcare organizations for their compliance with federal regulations.

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19. TJC published a list of error-prone abbreviations called the ____________ List.

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20. One of the most common error-prone abbreviations is ____________, which was used to mean daily.

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For exercises 21–30, interpret (write out the abbreviations in) the medication orders and label these order components: medication name, dose, route, and frequency. Also identify the medication form and special instructions when provided. (LO 4-3)

21. Docusate sodium elix 100 mg per GT bid

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22. Furosemide 40 mg IV stat

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23. Propantheline 15 mg ac PO tid at bedtime

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24. Simethicone 80 mg PO pc

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25. Acetaminophen supp 650 mg PR qid prn fever greater than 101.5

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26. EC aspirin 325 mg PO daily

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27. Nitroglycerin tab 0.4 mg SL stat; may repeat q5min × 2

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28. Amoxicillin susp, 200 mg/5 mL,

1 over 2.

tsp q6h

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29. Timoptic ophthalmic solution 0.25% 2 gtt both eyes bid; hold/contact MD for systolic BP less than 90

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30. Topricin oint, apply topically to hands ad lib

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For exercises 31–35, indicate whether the statement is true or false. Correct the false statements. (LO 4-4)

31. The nursing assistant must follow TJC's procedural guidelines for accepting verbal orders.

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32. When accepting a telephone order, the patient should be verified by full name and DOB.

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33. After the prescriber states the order, the nurse documents the verbal order.

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34. Once the nurse has written a complete order, the order should be recited back to the prescriber as a final step in the verbal order process.

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35. A verbal order should be signed immediately by the nurse and as soon as possible by the prescribing practitioner.

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For exercises 36–45, answer the questions regarding the MAR. (LO 4-5)

A medication administration record of Cityville Hospital.

The form depicts the address of Cityville Hospital at the top center, name, date of birth, M R number, diagnosis, allergies, and week ending date below them. Below it, a table depicts order date, scheduled medications, times, 2 slash 10 slash 2023, 2 slash 11 slash 2023, 2 slash 12 slash 2023, 2 slash 13 slash 23, 2 slash 14 slash 2023.Row 1. Order date: 2 slash 10, scheduled medications: Lanoxin 0.25 milligrams P O every other day, Odd dates at 1000, hold for apical rate less than 60, times: 1000. Row 5 depicts order date: 2 slash 10, scheduled medications: Furosemide 10 milligrams intravenous every 12 hours, 0800 to 2000, times: 0800. Row 6 depicts times: 2000. Row 8 depicts order date: 2 slash 10, scheduled medications: Ferrous sulfate 325 milligrams P O bid before breakfast and dinner, 0800 to 1700, times: 0800. Row 9 depicts times: 1700. Below it, a table for P R N medications depicts Order Date, Medication, Date, Time, Route, Reason, Result, Initials. Row 1 depicts order date: 2 slash 10, medication: Morphine sulfate 4 milligrams intravenous every 4 hours p r n severe pain. Row 2 depicts order date: 2 slash 10, medication: Ibuprofen 600 milligrams intravenous every 8 hours p r n mild to moderate pain. Below it, a blank table depicts Initials, Signature or Title, Initials, Signature or Title, Initials, Signature or Title.

36. Which component(s) of the medication order is not visible on this MAR/eMAR?

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37. By what route and how often is furosemide to be administered?

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38. Prior to administration of Lanoxin, what action should the nurse perform?

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39. After administration of Lanoxin on 2/11, when is the next dose due to be administered?

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40. What medications are scheduled to be given on the day shift, 0700–1500?

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41. What medications are scheduled to be given on the evening shift, 1500–2300?

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42. What medications are scheduled to be given on the night shift, 2300–0700?

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43. If morphine sulfate is administered at 2045 on 2/10, when can the next dose be administered?

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44. Differentiate Mr. Jones' scheduled and prn medications.

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45. What medications does Mr. Jones take orally?

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For exercises 46–50, indicate whether the statement is true or false. Correct the false statements.

46. If Simon Jones' heart rate is 66 at 0800 on 2/11, the nurse should not give the scheduled Lanoxin and contact the authorized prescriber.

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47. Mr. Jones reports pain on 2/12 upon arising at 0730. He rates his pain as a 3 on a scale of 1 (mild) to 10 (severe). The nurse should administer morphine sulfate 4 mg IV.

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48. Mr. Jones experiences chronic pain for which he prefers to take ibuprofen twice daily with meals, so he can take his ferrous sulfate and ibuprofen at the same time.

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49. Furosemide is ordered to be given two times per day.

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50. At bedtime, Mr. Jones complains of pain and rates it as an 8 on a scale of 1–10. The nurse should administer morphine sulfate 2 mg IV.

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Illuminations: Clinical Judgment Queries

For questions 1–4, select the best response.

  1. Select the properly written medication order. (LO 4-1, 4-2)
    1. Acetaminophen with codeine 4cc PO q4h prn pain
    2. Furosemide 40 mg PO QD
    3. Heparin 5,000 U SC q12h
    4. Levothyroxine 150 mcg PO daily ā breakfast
  2. A medication is ordered to be given q8h. If the first dose is administered at 1630, when should the next dose be given? (LO 2-4, 4-1)
    1. 0130
    2. 2430
    3. 0030
    4. 0430
  3. When taking a verbal order, the nurse should: (LO 4-4)
    1. document the order as it is dictated by the prescriber.
    2. recite the order to the pharmacist.
    3. verify the order with another nurse.
    4. get the order cosigned by the pharmacist.
  4. When should Lasix 40 mg IV stat be given? (LO 4-1)
    1. By injection
    2. As needed
    3. Immediately
    4. As soon as possible

For questions 5 and 6, select all that apply.

    5.
  • Identify the components of a medication order. (LO 4-3)
    1. Route of administration
    2. Name of pharmacy
    3. Signature of authorized prescriber
    4. Type of medication
    5. Patient's date of birth
    6. Dose of medication
    • 6.
  • Select the common medical abbreviations that indicate frequency of medication administration. (LO 4-1)
    1. bid
    2. GT
    3. NKA
    4. ac
    5. q4h
    6. NPO
    7. SUBQ
    • 7.
  • Match the medication order component with the corresponding abbreviation and abbreviation type. (LO 4-1)

    Medication Order Component

    Abbreviation

    Medication Order Component/Abbreviation Type

    a. By mouth

    b. Every 2 hours

    c. After meals

    d. With, without

    e. Sublingual

    f. Three times a day

    g. Suspension

    h. Before, after

    __ BIW

    __ SL

    __

    ,

    __ SUBQ

    __ ac

    __ supp

    __ TIW

    __ pc

    __ q2h

    __ tid

    __ PO

    __ susp

    __ ā,

    _______________ Frequency

    _______________ Route

    _______________ Form

    _______________ General

    • 8.
  • From the word bank below, highlight and correctly notate all error-prone documentation: (LO 4-2)

    A table is 1st column IM qid 1000U oslash intake 2nd column 0.5 mg 10.0 mcg 2hr prn 3rd QD cc NKA 100 mL

    • 9.
  • On the medication administration record, highlight the medication frequencies, circle the medication names and doses, underline the routes, and place a check mark next to the patient identifiers. (LO 4-5)

    A medication administration record of Cityville Hospital.

    The form depicts the address of Cityville Hospital at the top center, name, date of birth, M R number, diagnosis, allergies, and week ending date below them. Below it, a table depicts order date, scheduled medications, times, 9 forward slash 24, 9 forward slash 25, 9 forward slash 26, 9 forward slash 27, 9 forward slash 28, 9 forward slash 29, 9 forward slash 30. Row 1 depicts order date: 9 forward slash 22, scheduled medications: Levofloxacin 750 milligrams I V q 24 h, times: 1200, 9 forward slash 24: J P. Row 5 depicts order date: 9 forward slash 22, scheduled medications: Famotidine 20 milligrams P O B I D, times: 0800. 9 forward slash 24: J P, times: 1800, 9 forward slash 24: J P. Row 9 depicts order date: 9 forward slash 22, scheduled medications: Enoxaparin 40 milligrams SUB Q daily, times: 0800, 9 forward slash 24: J P. Row 9 depicts times: 1700. Below it, a table for P R N medications depicts Order Date, Medication, Date, Time, Route, Reason, Result, Initials. Row 1 depicts order date: 9 forward slash 22, medication: Lorazepam 0.5 milligrams P O q 6 h p r n anxiety. Below it, a blank table depicts Initials, Signature or Title, Initials, Signature or Title, Initials, Signature or Title. Row 1. J P, Jennifer Palmunnen, R N.

    • 10.
  • Identify the steps for accepting a verbal order and place actions a–f in order next to the corresponding step. (LO 4-4)
    1. The physician clarifies the frequency as "q6h prn anxiety greater than 6/10."
    2. The nurse updates the documented order and repeats it back to the prescriber.
    3. Physician calls to provide an order for a patient experiencing anxiety.
    4. The nurse rechecks or verifies the updated order with the physician.
    5. The nurse documents the following order: lorazepam 1 mg PO q6h
    6. The nurse asks the physician to clarify the frequency.