ADDRESSING THE MAR ( MEDICATION ADMINISTRATION RECORD}

 

What is the MAR?

The MAR is the medication administration record.
It is a complete record which is kept on every patient.

It includes the patient's name, age, diagnosis, height,
weight and allergies. All medications ordered by the
doctor and a place to sign when medications are given.

Five rights:

There are 5 basic rights for medication administration.
Over time, more rights have been recognized. This may 
vary from 7 or more. Always follow your Institution's
policies and procedures, in order to avoid errors.

The standards of care are an essential part of  the
Nursing profession. It provides guidelines within a
framework of practices.

Learn more about : The standards of care

Learn more about : Nursing communication

PCA ( Patient Controlled Analgesia)

Patient Controlled Analgesia may be ordered by
the doctor for the patient who is awake, alert and
able to self medicate. This method of administering
pain medication , is done via a pump, through the
intravenous route. Dosages are decided by the doctor.

However, patient and family teaching should be
included in the care plan. It is not uncommon for
family members to press the pain button for the
patient. Sessions 12 gives an overview of pain
assessment.

Indications for the use of the PCA pump include:

- patients who have surgical intervention

- patients with cancer or chronic pain issues

- conditions such as pancreatitis, sickle cell 

  anemia and more.

The Numerical Pain Scale is a useful tool when
assessing pain. It is based on a scale of 0-10.

A ladder starts from the ground and escalates to|
the highest point, so does pain start from 0-10.

It is important to do a pain assessment after pain
medication has been given. See image for more
information.

NEUMERICAL PAIN SCALE ASSESSMENT

 

Scenario: Paul had surgery on his back two days prior.
He is having pain and requests medication. The nurse
does an assessment.

Neumerical pain scale assessment

This a very useful tool when assessing pain. It is 
based on a scale of 0-10 ( 10 being the worst).
A ladder starts from the ground which is the
lowest point. It escalates to the highest point,
so does the pain. Pain scale:

0 = no pain
1-3 = mild pain
4-6 = pain is considered moderate
7-10 = pain is extreme or severe

Helpful hints:

Medication that is given by mouth, takes
longer to be absorbed than when it is given 
IM or IV.

It is important to do a pain assessment after
medication has been given. Documentation 
of the effect it has and any side effects, is 
also helpful. Learn more:
Safe medication administration

Learn more : The Nursing Process

WAS AN ASSESSMENT DONE?

Scenario 1: Lynn is a new RN. Her preceptor did 

not do a good job explaining the correct way to do 
an assessment. Lynn is not aware of the mistake 
she is about to make.

She goes to the bedside of a patient who does not
respond. Her mistake is obvious, no assessment 
was done.To compound the problem, Lynn leaves
the pills at the patient's bedside. She then advises
the patient , to take the medication when awake.

Scenario 2 : Lynn returns twenty minutes later. The 
medication she left at the bedside, has been removed. 
She has no idea who took it . She has still not taken
steps to do an assessment or document findings and
notify MD.
This is by no means good clinical judgement.

 

COMMON CAUSES OF MEDICATION ERRORS

   

 When a patient is admitted to a healthcare facility, 
 information such as allergies, past medical history,
 height, weight and medications taken, are all recorded.

This type of information is very important, as it will help
 the doctor when prescribing medications. It will also be
of use to the pharmacist with providing correct drug dosages.

Regardless of where a nurse works, medication administration 
 is done.The nurse who gives drugs of any kind, should take time, 
to ensure that everything is done correctly.

 Learn more: Nursing fundamentals

Helpful information for the clinical nurse

 Here are some of the ways in which errors may occur:

- Misreading MD orders. If the nurse is uncertain about
an order , it is best to communicate with the doctor or
pharmacist.                                     
 - Poor communication of information, for example
when a patient is  transferred from one unit to another
 - Improper dilution of medication ( always check
the manufacturer's instructions for proper dilution).
 - Drug incompatibility : an example - Dilantin is mixed with
Normal Saline.                          
- Confusing one drug with another, as some drugs have similar
  names.
- Distraction, like having a conversation while administering
 medications .             
 - Forgetting to document medications when given.                                              

      

Clinical judgement

            

                                                                         

IDENTIFYING THE ENDOCRINE SYSTEM / DEHYDRATION IN THE ELDERLY

The Endocrine System is made up of glands 
that secrete hormones. Hormones are necessary
 for regulating normal body functions.      

 

The information provided on hormones and the
endocrine system is intended to help the nurse
 understand this complex system.

There are Parts 1, 2, 3 and 4 , including quiz
questions in each part. To learn more, please
click on the link below:
  Hormones and the Endocrine System         

             

Elderly people are more prone to dehydration. This may
range from mild to severe, depending on the situation.
Some elderly people live alone and may tend to neglect
taking adequate fluids. Fluid and electrolyte replacement
are beneficial when combating dehydration.

Learn more by clicking on the link:

Sessions 57:Hydration vs.Dehydration