Medical administration record
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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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What is a 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
First thing to fill out on the MAR


Page number of how many

Shift times - For our Testing purposes: 0700-1459 1500 -2259 2300-0659

Patient Information

Adding medications po
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
Adding Medications IV

Doctor’s Order : Zosyn 3.375mg IVPB Q6H

This is incorrect! the Dosage form should be left blank!

Adding medications prn
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
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
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
A PO medication that has a stop date

Doctor’s order - Alprazolam 0.5mg PO TID X 6 days

Times you need to know
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
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
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
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
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
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
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
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
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
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
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
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