The importance of using the MAR/eMAR when administering medications

As seen in the Consultant Connection March 2016 Issue
Long-Term Care Advise ERR November 2015 
Safety-Wire-Icon-small-(1).jpg  The medication administration record (MAR) or electronic medication administration record (eMAR) is a vital tool to use when administering medications. Yet, ISMP repeatedly receive reports of errors during medication administration in which the failure to verify the drug using the MAR, eMAR, or medication order was a root cause of the error. For example, in one case, the nurse administered milk of magnesia (MOM) to a resident with chronic kidney disease stage IV (CKD IV) despite the lack of an order for this drug and a comment in the eMAR that stated, “No MOM due to CKD IV.” Since most residents in the long-term care (LTC) facility had been prescribed MOM as needed, the nurse assumed the resident had an order for the drug, as well. Even though the eMAR note, “No MOM due to CKD IV,” could be misunderstood, the nurse said she did not look at the eMAR prior to administering the medication. Fortunately, no harm resulted. 
In another example, a resident received propranolol 40 mg instead of the ordered pantoprazole 40 mg for 6 days. The order was entered correctly into the MAR by the LTC facility staff, but the pharmacy had dispensed the wrong medication with a similar name. Again, the medication was not checked against the MAR or order when it was received or when the doses were administered, resulting in the administration of the wrong drug for 6 days. The error was not discovered until the resident complained of lethargy and stomach pain. 
To prevent these types of errors from occurring, make it a routine practice to always check the MAR/eMAR and medication order when checking in medications received from the pharmacy, and to take the MAR/eMAR to the resident’s bedside when administering each dose to verify the resident and drug with the MAR/eMAR.

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