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 Right Patient Right Med Right Dose Right Time Right Route

First thing to fill out on the MAR Date Page number of how many Shift times - For our Testing purposes: 0700-1459 1500 -2259 2300-0659 Patient Information

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 Every 4 hours from the start time Q6 Every 6 hours from the start time Q8 Every 8 hours from the start time Q12 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