My name is Grace Robinson, and I am the Clinical Services Manager at Puget Sound Regional Services, where I manage the medication system for the largest supported living provider in Washington State that tailors its services to meet the needs of Deaf, Blind, and Deaf-Blind individuals with developmental and intellectual disabilities.
One of the ways I support our 70+ clients at this agency is by building and auditing our Medication Administration Records (MARs), to ensure error-free documents for our direct support staff to work from. Having an effective and safe medication management system in place is critical to client safety, as medications have the potential to cause great harm. The Therap MAR gives us a lot of flexibility, which has allowed us at PSRS to improve the quality of care we can provide at our agency.
These are some recommendations I’ve developed based on my efforts to provide my clients and their staff with high-quality MARs:
- Avoid using abbreviations on your MAR. Pharmacy labels are small, and pharmacists are forced to rely on abbreviations to effectively communicate physician’s orders to administrators. Therap’s MAR is much less restrictive, so we are able to offer our care team complete instructions that do not assume a level of medical knowledge that our direct support professionals may or may not possess.
- Include both the brand and the generic name for each med on your MAR. You would be surprised how many people do not know that Tylenol and Acetaminophen are the same medication!
- Does your client take multiple strengths of the same med? Alert your care team to the potential for error by including a warning in the instructions on your Therap MAR. Simply include a commonly-used pharmacy warning, such as ***STOP! POTENTIAL ERROR! DOUBLE CHECK!*** or other cautionary language, as per your pharmacist or doctor’s recommendation.
- Always include your medication type on the Therap MAR. Just as we always sort oral, injectable, topical medications, etc, at our sites, we should keep these medications clearly marked for easy sorting on the Therap MAR. This is especially important for drops, such as those meant for the eyes or ears. A clear MAR entry can help your staff prevent a potentially painful or damaging mistake!
- Maintain an agency-wide list of your Look-Alike, Sound-Alike drugs, or LASA medications. These are medication which, due to their appearance or name, could easily be mistaken for another medication. This list should be revisited at least on an annual basis. You can alert your staff to these medications by including an advisory in the instructions section of your MAR. Many pharmacies will recommend that your wording read ***CAUTION! LOOK ALIKE SOUND ALIKE MED!*** You will want to consult with your regular pharmacist for guidance as to the specific language that is best to include on your Therap MAR.
- Include Tall-man lettering on your Therap MAR, as per the recommendation of the FDA and the Institute for Safe Medication Practices. Tall-man lettering helps draw attention to the dissimilarities in look-alike drug names. Entries for LamISIL and LaMICtal on the MAR, for example, are far less likely to confuse a care team member than side-by-side entries for guanfacine and guaifenesin!
- Insist that each order you accept from a physician include clear orders, and an indication for use. Never include the indication within the body of your instructions; instead, take advantage of Therap’s separate “Indication” section, so that this vital information is made quickly accessible on its own line in your MAR.
- Set the expectation that your nursing staff will review medication orders prior to the administration of new meds, to ensure that orders are clearly written and complete. It is our right and duty to question physician orders that are illegible, incomplete, or potentially unsafe.
- Audit! Audit! Audit!
- Make sure that the manufacturer’s instructions for each medication, with a clear picture of the medication and instructions for its safe storage, are made available to your care team. Therap makes this task much easier for us, by drawing on digital databases to automatically connect us with this information for most medications. In the rare occurrence that Therap is unable to generate this information for your med automatically, you can attach a scanned copy of the manufacturer’s instructions, and attach it to the medication under “Medication Details” in Configuration Mode. You can even attach this information to your medication retroactively, so you do not have the discontinue the med on your Therap MAR to create this update!
I hope that these tips will prove helpful to others working to improve their MARs, or transitioning to the Therap MAR for the first time.
Feel free to reach out to me if you have any questions!