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
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Page number of how many
Shift times - For our Testing purposes: 0700-1459 1500 -2259 2300-0659
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.
Doctor’s Order : Zosyn 3.375mg IVPB Q6H
This is incorrect! the Dosage form should be left blank!
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
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
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
Doctor’s order - Alprazolam 0.5mg PO TID X 6 days
Medication distribution schedule
q day 0900
bid 0900 1700
TID 0900 1300 1700
QID 0900 1300 1700 2100
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
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.
Sites need to be at least one inch apart
needs to be at least two inches from the umbilicus
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
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
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
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