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Top Ten Tips to Building Beautiful MARs in Therap

grace_robinson_medication_administrationMy 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:

  1. 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.
  2. 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!
  3. 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.
  4. 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!
  5. 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.
  6. 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!
  7. 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.
  8. 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.
  9.  Audit! Audit! Audit!
  10. 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!

Going to MARs

Progress Industries staff and local Therap expert Josh Stafford recently returned from an African safari but was still eager to answer questions about his adventures with MARs…Medication Administration Records, that is:

BT: Josh, how long have been using Therap MARs?

JS: I believe around 3 years.

BT: How does the Therap MARs module save you time and/or help you complete your job more efficiently?

JS: It allows me to review the MAR from anywhere that I have an internet connection. This also allows the nursing staff that are entering new medication orders or making changes to existing orders the ability to make changes without having to go to each program location.  The Due Medications feature allows for a quick and simple review of medication administration of the day.

BT: There have been a number of improvements made to the MARs module in the past year. Which of these are your favorites and why?

JS: My two favorite MARs improvements have been the Due Medications and the Medication Scheduler. The Due Medication feature allows both the medication passer and any one that would be reviewing the MAR a quick and very simple way to see if all of the medications that are scheduled to be administered have been signed for. If you are the person administering those medications and you have a missing signature, you are able to follow the links to sign for the medication. The Medication Scheduler allows the person that is entering the medication history and updating the MARs a method of scheduling medications for only certain days/times during the month. This will then highlight the medication on the days that it is to be administered. This is just another visual queue for the person that is administering the medication.   

BT: What additional changes would you like to see made in Therap MARs?

JS: I would like to see the Due Medication feature have a date range greater the one day. If you are off for several days and want to complete a review for more than one day, you have to select each day one at a time.  

BT: What advice would you give to another provider thinking about starting to use Therap MARs?

JS: Start with small groups and spend testing the medication history form to make sure you understand in completely. All the information for the MAR will be pulled from this form and you want to make sure tis information comes a crossed clearly to those that are administering the medications. (BT: Progress Industries has employed Pilot Groups in rolling out every Therap module. It helps test the waters and work out any unanticipated problems and also allows for an excellent mentor to trainee ratio for great support.)  THANKS JOSH for your help with Therap training and implementation!

By |2016-11-03T10:15:35+00:00July 23rd, 2012|Categories: Bryan Thayer's Posts|Tags: , , |1 Comment

MAR

Happy Valentine’s Day!

I have been working with our provider agency nurse to get medications entered, so that ALL MARs will be entered in Therap (for that agency) by March 1st.  Yes, I truly wish it was less tedious, but just to see how well staff are responding and recording makes it all worth it  ;-/.  As I work through the 1000+ drugs we are entering (currently at 822), I keep looking for shortcuts and ways to speed it along.  I am liking the copy form feature!  However, it is critical to assure you check each field to assure it is updated if needed.  One suggestion we would like to share – although many have probably discovered it already – is that it helps to leave a blank line between dosage times for meds given more than once a day.  When they are one after the other on the MAR, it is easy for staff to accidentally complete two blanks instead of just the one.  Just thought I’d share!

Update on our agency fundraising house raffle:  We had our first early bird drawing yesterday, giving away $2500 to a local woman who had purchased two tickets.  We called her via speakerphone to give her the good news.  Man, was she excited!  Not only did she win the first early bird drawing, but she is still in the running to win the remaining early bird drawings, the multi-ticket drawing, and the grand prize!  I hope that different people win each prize, but wouldn’t it be amazing to win more than once?!?!  If you are that person, of course…  It is not too late to get your tickets, to help support a great cause.  Purchase by 2/28, and you will be entered into two more early bird drawings, with the multiple ticket and grand prize drawing on 5/31.  www.envisionhomeraffle.org.

‘Til next month – or until I get a wild hair to share –

Linda

By |2016-11-03T10:15:45+00:00February 14th, 2012|Categories: Linda Medina's Posts|Tags: , , , |Comments Off on MAR

MAR, Going Live!!!

Wow, what a few weeks. Rainbow of Challenges Residential Program is going live with the MAR module. It has been a task, so thank you to all the wonderful folks at ROC that have helped me get ready. I have to say that the finished product is well worth the effort. The forms are already making documenting easier, and , okay, I will say what I really like, Therap forms are prettier. Emoticon showing smiley face

ROC is making lots of changes and using Therap for more and more tasks and we are getting to the ultimate goal (mine anyway), no paper on my desk. It is exciting to see everyone at ROC getting excited about the new things we are doing. Instead of paperless being an idea to “think about”, we are moving quickly to accomplish it and so many of our wonderful staff are on board. It is a wonderful feeling!!!

By |2016-11-03T10:15:54+00:00May 4th, 2011|Categories: Misty Maroon's Posts|Tags: , , , |2 Comments