MAR: An overview
The Scarborough Hospital
January 2016
Contents • What is a Medication Administration Record (MAR)
• MAR layout
– Hand-written MAR layout
– Computerized MAR layout
• How to print a patients MAR
– From NUR
– From EDM
• Nursing Responsibilities
– Verification
– Transcription
– Documentation
Medication Administration Record…
a.k.a. the MAR • “Official record of all medications prescribed and
administered to a patient” (Medication Documentation and Administration Record Policy)
Different types: • Computer Generated MAR (cMAR)
– Printed from Meditech once daily in evening
– Covers 24 hour period 2330h-2329h
– ONLY medications that have been entered by Pharmacy will be reflected on the MAR
– MAR must be verified
– New orders must be hand-transcribed, until the next print
• Hand Written MAR – In ICU and ED – with some exceptions
• Varying Medication Records – Used in ED, PACU, OR, FMC, and during CPR
MAR Layout – Hand Written
MAR
Hand-written MAR layout – First Page
Place patient
information label
here - Ex: Purple, Test
G0001567
STAT and
One time doses - Found on first sheet of MAR
Signature boxes - All providers who administer
medication must print their
name, sign their signature and
their initials
Date, Allergies - Always ensure to write the
correct date range
Hand-written MAR layout – Medications
Each order is verified
by 2 nurses - Both nurses initial the
MAR upon transcription of
the original order
- MAR is not
to be used
unless verified
by two nurses
**Covers up to 7 days of
medications** Scheduled Meds - 2nd and 3rd page
PRN Meds - 4th page
MAR Layout – cMAR
Patient Identifiers,
Date/Time, Allergies - Always ensure the right
date/time was printed
Verified by - Nurse must sign off the
MAR after verification of
orders
- MAR is not to be used
unless verified
STAT and
One time doses - Found on first sheet of MAR
Scheduled Meds - Administration time
indicated
cMAR layout - First page
cMAR layout – PRN medications
PRN medications - Show up after
scheduled meds
No scheduled times - Must document time of
administration
cMAR layout – Final Page
Final page - Signature boxes
- All providers who
administer medication
must print their name,
sign their signature
and their initials
How to Print the cMAR
Printing the MAR:
From Meditech NUR… method 1
1) Select “OE Registered Nurse Menu”
2) Select “Print MAR”
Printing the MAR: From Meditech NUR… method 2
1) On “Status Board”, highlight the patients name.
2) From the
menu on the
right click “Print
Report”.
3) Select “OE Registered Nurse Menu”
“Rpts Scheduled to Print Automatically” “Print MAR”
Printing the MAR:
From Meditech EDM (in emergency department) 1) From the main ED tracker select option: “OE”
2) Select “Rpts Scheduled to Print
Automatically” “Print MAR”
Printing the MAR: For the entire ward
“INP” - to indicate inpatient Use F9
look-up to
select unit - ex: 3D
medicine,
printer will
already pre-
populate
Select appropriate date -Recall: MARs start at 2330 and end at 2329 the
following day…
- Enter “T” for next (tomorrows) MAR
- Enter “T-1” for current (todays) MAR
Leave these blank… - You can F9 for other
options if you need a
blank MAR or to change
printer
Printing the MAR: For an individual patient
“INP” - to indicate inpatient
Type
patient
name into
field, hit
enter - Select
appropriate
patient
Leave these blank… - You can F9 for other
options if you need a
blank MAR or to change
printer
Select appropriate date -Recall: MARs start at 2330 and end at 2329 the
following day…
- Enter “T” for next (tomorrows) MAR
- Enter “T-1” for current (todays) MAR
Nursing
Responsibilities…
** For more detailed information on the nursing responsibilities
review the “Medication Administration and Documentation” Policy**
Verifying the MAR What do I need for proper
verification?
• Today’s MAR
– ending at 2329 tonight
• Tomorrow’s MAR
– starting at 2330 tonight
• Patient’s Chart
– to check for new orders or changes
** In order to ensure a MAR truly
reflects all current orders you MUST
use these three items during your
check**
How to Verify the MAR 1. Compare each MAR entry on the new MAR to the previous MAR
– Indicate an entry is correct with a checkmark next to the entry
– Highlight any important comments/details on the MAR
2. Cross-reference to the patient’s chart to ensure all new and existing orders were
– Entered correctly by Pharmacy
– Transcribed and signed off correctly by nursing staff
– Sign the chart to indicate orders were reviewed
How to Verify the MAR (continued)
3. If there is a medication missing from the new MAR:
– Transcribe it and have it checked according to policy
– Ensure the yellow backing has been sent to Pharmacy
– Send an OE message to Pharmacy indicating the
discrepancy
4. When verification is complete:
– Sign the “Verified by” line on the first page of the cMAR
Transcribing Orders to the MAR
• Accurate transcription is important for safe
medication administration practices
*Transcription errors cause medication errors*
• Process: – Transcribe order to MAR
• This may be done by a Unit Clerk or a Nurse
• Transcriber must sign-off order sheet and initial the
MAR
– A nurse must review the order and transcription
• This must be done by a Nurse
• Nurse must sign-off order sheet and initial the MAR
Documentation • Always document the actual time of administration
– If the dose is late or missed
• Indicate the reason on the MAR, contact MD if necessary
• Adjust the timings of future dose’s to prevent over-medicating and maintain
appropriate dosing intervals
• Always document immediately after giving the medication, to
keep the chart up to date
• Always remember to sign the signature section at the end of the
MAR
• Ensure your writing is legible
Important Variations in Documentation • Use the “Anticoagulant Record” to document anticoagulants with
varying dosing (i.e. Warfarin, Heparin infusion)
– Do NOT signature on the MAR
– Computerized MAR will prompt you to look at the record
– See TSH’s “High Alert Medications” policy
• Narcotics are documented on both the MAR and on the Narcotic Sheet
– See TSH’s “High Alert Medications” policy
• Some medications require an “Independent Double Check”
– 2 signatures required during administration
– See TSH’s “Independent Double Check Medication
Administration” policy
For a comprehensive review, see “Medication
Documentation and Administration Record” policy
• Review the following policies on iConnect: – “Medication Documentation and Administration Record”
– “High Alert Medications”
– “Independent Double Check Medication Administration”
• Speak with your CRL and/or Pharmacist
• See iConnect’s “Medication Safety Practices” page
Questions?