Calculate with ConfidenceCalculate with Confidence55thth edition edition

Gray MorrisGray Morris

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Medication Administration Medication Administration Records and Records and

Drug Distribution SystemsDrug Distribution Systems

Unit Three: Chapter 12Unit Three: Chapter 12

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MARs and Distribution Systems: MARs and Distribution Systems: ObjectivesObjectives

After reviewing this chapter, you should be After reviewing this chapter, you should be

able to:able to:

1.1. Identify the necessary information that must Identify the necessary information that must be transcribed to a Medication Administration be transcribed to a Medication Administration Record (MAR)Record (MAR)

2.2. Read an MAR and identify medications that Read an MAR and identify medications that are given on a routine basis, including the are given on a routine basis, including the name of the medication, the dosage, the name of the medication, the dosage, the route, and the timeroute, and the time

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MARs and Distribution Systems: MARs and Distribution Systems: Objectives (cont’d)Objectives (cont’d)

3.3. Transcribe medication orders to a MARTranscribe medication orders to a MAR

4.4. Identify various drug distribution systemsIdentify various drug distribution systems

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Documentation: 6Documentation: 6thth “Right” “Right”

SPECIAL CONSIDERATIONS to avoid errors:SPECIAL CONSIDERATIONS to avoid errors: TRANSCRIBE CAREFULLYTRANSCRIBE CAREFULLY Document AFTER med administrationDocument AFTER med administration Document accuratelyDocument accurately Document legiblyDocument legibly Document timelyDocument timely MAR is a legal recordMAR is a legal record MAR is verified against orders dailyMAR is verified against orders daily

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Essential Information on a MAREssential Information on a MAR

Client informationClient information Name, DOB, medical record #, ALLERGIESName, DOB, medical record #, ALLERGIES

Dates (when written, start and stop)Dates (when written, start and stop) Medication informationMedication information Time of administrationTime of administration Initials (transcriber, person giving med)Initials (transcriber, person giving med) Special instructionsSpecial instructions

Data such as BP, “Hold if…,” etc.Data such as BP, “Hold if…,” etc. Legends—describe abbreviationsLegends—describe abbreviations

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Documentation of Meds Documentation of Meds AdministeredAdministered

Complete schedule writtenComplete schedule written Initialed in appropriate area by giverInitialed in appropriate area by giver One-time dosesOne-time doses PRN doses (may be a different record)PRN doses (may be a different record) Refused or held meds (special symbols)Refused or held meds (special symbols)

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Figure 12-2 Transcription of medication orders to a medication administration record. (Used with Figure 12-2 Transcription of medication orders to a medication administration record. (Used with permission of St. Barnabas Hospital, Bronx, New York.)permission of St. Barnabas Hospital, Bronx, New York.)

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Figure 12-2 Transcription of medication orders to a medication administration record. (Used with Figure 12-2 Transcription of medication orders to a medication administration record. (Used with permission of St. Barnabas Hospital, Bronx, New York.)permission of St. Barnabas Hospital, Bronx, New York.)

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Figure 12-2 Transcription of medication orders to a medication administration record. (Used with Figure 12-2 Transcription of medication orders to a medication administration record. (Used with permission of St. Barnabas Hospital, Bronx, New York.)permission of St. Barnabas Hospital, Bronx, New York.)

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Use of Computers Use of Computers

Handwritten transcription and documentation Handwritten transcription and documentation are among most common causes of med are among most common causes of med errorserrors

GoalGoal Elimination of errorsElimination of errors Electronic record keepingElectronic record keeping

Systems utilizeSystems utilize CPOE (computer prescriber order entry)CPOE (computer prescriber order entry) Electronic MARElectronic MAR

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Medication Distribution SystemsMedication Distribution Systems

Unit DoseUnit Dose Prepared daily and sent to unitPrepared daily and sent to unit Not available for all productsNot available for all products

Computer-Controlled DispensingComputer-Controlled Dispensing Automated dispensing system (ADS)—60% of Automated dispensing system (ADS)—60% of

hospitalshospitals Detailed transaction recordsDetailed transaction records Linked to pharmacy dispensing systemLinked to pharmacy dispensing system

Bar-Code Medication DeliveryBar-Code Medication Delivery Studies show errors reduced by 65%-86%Studies show errors reduced by 65%-86%

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Figure 12-3Figure 12-3 Unit-dose cabinet. (From ClaytonUnit-dose cabinet. (From ClaytonBD, Stock YN, Harroun RD: BD, Stock YN, Harroun RD: Basic pharmacologyBasic pharmacology

for nurses, for nurses, ed. 14, St. Louis, 2007, Mosby.)ed. 14, St. Louis, 2007, Mosby.)

Figure 12-4Figure 12-4 Pyxis Med Station.Pyxis Med Station.(From Clayton BD, Stock YN, Harroun(From Clayton BD, Stock YN, HarrounRD: RD: Basic pharmacology for nurses,Basic pharmacology for nurses,

ed. 14, St. Louis, 2007, Mosby.)ed. 14, St. Louis, 2007, Mosby.)

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Figure 12-5Figure 12-5 Bar code for unit drug dose. (FromBar code for unit drug dose. (FromKee JL, Marshall SM: Kee JL, Marshall SM: Clinical calculations: withClinical calculations: with

applications to general and specialty areas, applications to general and specialty areas, ed. 6, St.ed. 6, St.Louis, 2009, Saunders.)Louis, 2009, Saunders.)

Figure 12-6Figure 12-6 Bar-code reader. (From KeeBar-code reader. (From KeeJL, Marshall SM: JL, Marshall SM: Clinical calculations:Clinical calculations:

with applications to general and specialtywith applications to general and specialtyareas, areas, ed. 6, St. Louis, 2009, Saunders.)ed. 6, St. Louis, 2009, Saunders.)

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Advantages and Disadvantages Advantages and Disadvantages of Technologyof Technology

AdvantagesAdvantages Improves accuracy and efficiencyImproves accuracy and efficiency Safeguards the 6 rights (especially Bar-Code)Safeguards the 6 rights (especially Bar-Code) Records can be readily accessedRecords can be readily accessed

DisadvantagesDisadvantages Human component in use of systemHuman component in use of system Human component in relying solely on systemHuman component in relying solely on system Requires extensive up-front design and use Requires extensive up-front design and use

planningplanning

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Scheduling Times (Table 12-1)Scheduling Times (Table 12-1)