6 institutional

7/31/2019 6 Institutional

1/17

Institutional PharmacyContinuation of MARS/TARS


2/17

MARS

New orders during the course of themonth are entered manually on theMAR sheet while the nurse is

processing the order.

Medication, strength, directions,admin. times and date of order are

entered.

Prior to beginning of month, newMARS are reviewed for accuracy.


3/17

Process of MARS

New orders-sent to pharmacy, nursetranscribe manually onto MARS

Change in orders-sent to pharmacy,transcribed manually onto MARS.

Approx. 18th to 20th of the month,back copies of MARS/faxed MARS aresent to pharmacy


4/17

Process of MARS

Tech reviews MARS against profilefor accuracy-takes several days(communicate with nurse regardingany discrepancies)

Once complete, prints MARS forfollowing month to go home

***GOAL-ACCURATE MARS FORHOME**


5/17

Process of MARS

MARS reviewed, new MARS sentback to home for following month(few days prior)

Home has their checking proceduresto go through

Nurse reviews new MARS againstcurrent MARS to ensure accuracy(new d/c'd, changes, etc)


6/17

Process of MARS

Nurse must manually enter new Rx'srec'd from the receipt of the newMAR onward.

This check ensures all changes madelate in the month have been addedto the new MAR.

MARS is homes legal document,accuracy is important.


7/17

Process of MARS

Error on MARS is a reflection on pharmacy

Back side of 1st page of MAR can be usedfor TAR.

Nurse enters treatment, location, notes ofimprovement after treatment. May alsochart sites of insulin inj.'s for rotation

sites. Possibly used for areas ofinflammation, sores etc


8/17

Process of MARS

Chart effective/ineffective treatment.

House MD assesses, may change/d/cmed. order until clear, etc., writtenon MARS.

Questions about orders while nurseis reviewing MARS for next month,communicates to pharmacy at thistime.


9/17

Process of MARS

MARS is accurate, everyones job iseasier.

Quick overview: home removes back

carbon copy, send to pharmacy forreview, pharmacy reviews, pharmacyprints new MARS, send to home,

home reviews, MARS is ready fornext month. (new RXs donethroughout month)


10/17

TMR- THREE MONTH REVIEW(QUARTERLY MEDICATION REVIEW)

Q3months, pharmacy send TMR tohome.

MOH requires a TMR be completed

for each resident in a LTC facility. TMR is pharmacys legal

authorization to continue filling

medication for resident for next 3month period.

All orders written by House MD areactive or to be continued until next

TMR unless specified otherwise


11/17

TMR

TMR prepared by pharmacy on 2-ply orsingle laser (duplicates made).

1 copy kept in patient chart at home, 1

copy kept at the pharmacy for legaldocumentation.

If TMR not completed in timely manner,pharmacy does not have authorization torepeat medications, and meds will not besent to resident.


12/17

TMR

Lists all active meds, directions, Dr.,home, last fill date, etc. (other info. Ifreqd for chart), & last fill date.

At specified time for TMR to be completed,the R.Ph does clinical review of eachresidents medications.

Suggestions noted by R.Ph for Dr. to

consider alternative meds that may helpto reduce dosage times for resident. Mayalso suggest to D/C meds based on last filldates.


13/17

TMR

TMR delivered to nursing unit onceR.Ph has completed individualreview.

RN reviews list of meds, ensuresprintout is accurate & updated withany new orders, compared to MARS.

Any additional orders from the timeTMR was prepared by pharmacy theRN must update TMR. Must be

updated until Dr. signs the TMR


14/17

TMR

TMR given to physician. Physicianreviews & makes changed to medsbased on what is printed, or by theRN &/or R.Ph suggestions.

Area on TMR for physician tocontinue or D/C each medication.

Physician must sign the TMR, just asthey would for a new Rx.


15/17

TMR

At this time, the RN processes theTMR. Any orders D/Cd, added,changed, etc. by physician, changesmust be processed by RN in sameprocedure followed for new Rx.

TMR faxed to pharmacy to allow thenew order to be processed by thepharmacy staff.


16/17

TMR

If no changes on TMR, remove backcopy & send to pharmacy with nextdelivery.

TMR is a top priority if there aremedication changes

Very important for TMRs to be kept

up to date & signed by physicianpromptly.

Advisable to use 2-ply carbonless for

the signature required.


17/17

SUMMARYACCURACY AT THE PHARMACY LEVEL IS

VERY IMPORTANT. ERROR AT OUR LEVELHAS THE POTENTIAL TO BE AMEDICATION ERROR. HOME RELIES ONUS FOR ACCURACY & MAY CHANGE ANORDER ACCORDING TO OURINTERPRETATION, WHICH IN TURN ISPASSED ALONG TO RESIDENTS. RNSRELY ON OUR EXPERTISE TO CHECK

PHYSICIANS ORDERS.

6 institutional

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