MAR Description

In licensed settings such as group homes, assisted living facilities, or day activity centers, medication administration records (MAR) are often required. An MAR summarizes all the medications people take and when they take them.  It is used during medication administration as a method of ensuring all medications are given as directed. It also serves as a record of medications that have been given to each person.

In these settings, there are often many people who need medication support. There are also many different people who are assisting with medications. An MAR can be very helpful to direct support staff in preventing mistakes with medications. If a mistake is made, it makes it much easier to know what the next best steps are for the person's overall health.

Information about the Person

If you are providing support to one person in his or her own home you may not need this information to be listed on the medication administration record. However, in the case of a medical emergency, it can be helpful to have some of this information immediately available. For instance, if you had to call for emergency services, would you know the address of the person's home? While much of this information should be available on the health and medication history, the MAR is usually more accessible. When MARs are required for sharing information with others, the name of the person and some other basic identifying information will be required. These may include the home address of the person, the name of the person's primary doctor and pharmacy, health insurance information, and information about allergies, the person's date of birth and gender.

Space to List the Medications

There will be room to list each medication. Most of the crucial information from the prescription label will be here. The five rights of administration will be easy to identify. Information, such as the form, strength, and dose of the medication will be listed. In addition, special directions will appear here.

Information about Timing

A medication administration record needs to have space to list the time of day the person takes each individual medication, and the time it was actually given.  It should be clear which month and year the record is for and have a box for each time and day.

Signature Section

Space is limited on a MAR. Often initials are used to signify who assisted with the medications. It can be difficult to recognize people just from their initials if there is a problem or follow-up is needed. For this reason, a MAR often has a section for initials and signatures. Sometimes this is kept somewhere other than on each individual MAR. That can be helpful since it means each MAR does not have to be signed by each staff for each person every month. On the other hand, in some cases regulations may require the signatures appear on the same form.

Abbreviation Legend

Because of limited space, a set of shorthand is often used to indicate common situations with medications. These will vary a lot from place to place. You will learn more about these in the lesson on documentation. Some examples are seen here.

Reduceing Errors

Reduce errors by doing the following:

• When more than one direct support professional (DSP) is present, designate one DSP to provide ALL the medication support that is needed.
• If you are responsible for medication support, check EACH time you work to see if anything has changed. Do this RIGHT AWAY when you come to work. A new medication may have been started or the timing of an old medication may have been changed. Don't wait until after a medication mistake to find out!
• Plan ahead. Include enough time in the other plans for the day for taking medications.  Don't get caught away from home without medications. Avoid being in the middle of another important task at the time when you need to provide medication support. Avoid being interrupted while giving medications.

Before Giving Medications

Several minutes before giving medications do the following:

• Look at the MAR and review which medications need to be given, to whom, how, and when.
• Let the person know it is almost time to take medications.
• Wash your hands.
• Gather necessary supplies, such as gloves or measuring devices.
• Check the medications for the five rights, make sure all medications are there, and check so nothing seems out of place.

Focus on The Individual

Keep your focus on the individual at all times.

During medication administration these are things to remember.

• Keep the person informed of what you are doing and what will happen next. Do this even when it appears the person cannot understand what you are saying. Many times, even when a person has little capacity for communication or understanding he or she is responsive to voice tone and touch.
• Be gentle. Make sure your hands are warm before touching someone.
• Speak calmly, kindly, and professionally. Stay focused on the person. Don't talk to others or complete procedures as if the person was not there.

Privacy is important to many people. Some people are uncomfortable with everyone knowing what medications they are taking and when.  Direct support professionals are sometimes more focused on their own convenience than ensuring the privacy of individuals during this process.

Observing Privacy

Observe privacy as desired by the person by doing the following:

• Do not announce publicly that it is time for the person to take his or her medications.
• Do not give medications in a public place, even if they are just pills, unless the person has stated that is his or her preference. Remember, preferences can change from day to day.
• Do not announce to others the medications an individual receives.  Don’t say to a person in front of others, “John, it is time for your Dilantin.”
• Do not discuss a person’s medications with others, unless the person has clearly stated this is acceptable. This includes other family members.
• Always complete any procedures that require exposed body parts in privacy.
• If the person cannot communicate clearly, always assume they prefer more privacy not less.

Interruptions

If you are interrupted during the time for medication administration, take steps to ensure that people are safe and comfortable. You must also figure out ways to secure the medications, and ensure that no errors are made. Here are some tips for handling this situation.

If possible, let someone else handle the situation that is interrupting you. Call for help if there is another person in the setting who can help.

Make sure the medications are secured and inaccessible to anyone who may handle them inappropriately. This can include children. It can include some adults with intellectual disabilities, dementia, or other conditions that may impair their judgment with medications. If it would take too long to lock them up, set them out of reach, or carry them with you.

Take a brief moment to remember what you are doing. Did the person take the medications or not? Make sure the person is comfortable if you are in the middle of a procedure. For example, remove blood pressure cuffs and return clothing to its normal position. Cover the person and help them get into a more comfortable position if needed. Tell them what you are doing. Never make things worse by leaving a person in a situation where he or she may be harmed.

Return as quickly as possible to the person.   Get focused and calm down before proceeding. If a delay has been so long it breaks the prescribed timing of the medications, you may need to seek advice before giving the medications.

The Purpose of a “Triple Check”

The triple check is required in many support settings. It means checking to ensure that you are preparing the correct medication, in the correct way, three times, before the medication is administered.

The triple check is important because many pill containers look similar and are easy to mix up.  Labels can be easy to misread. It is easy to think you remember the dosage correctly, when you don't. The triple check is a method for catching these problems and others.  Complete a triple check of prescriptions as well as over-the-counter medications and supplements or remedies.

Mix-ups are more likely in a setting where more than one person receives medication support.  However, they can happen anywhere.

Completing a "Triple Check"

To complete a triple check you need to look for the five rights (Person, Medication, Time, Dose, and Route) of medication administration at three critical points.

When you first pull out the medication container. Look at the label and find all five rights. Do they make sense? For example, if the label says morning and it is the afternoon, STOP, there is a problem. Check for the correct medication container.

1. As you prepare the dose. Compare the label to the MAR if there is one. Confirm that all five rights and any special directions match.  If they don't; STOP and discover why. Maybe the medication has been changed and you have an old container.  If they match prepare the dose.
2. As you return the container to the storage area (after preparing the medication but before it is administered). Check the medication dosage you have prepared. Review the preparation and technique directions. Compare your medication preparation to the label and the MAR. If they don't match, STOP, you need to measure the dose again or change your preparation to match the label and MAR. If they match, store the medication immediately. For eye drops, inhalers, or other medications which cannot be pre-measured, check the label and preparation one more time before administering the medication.

Safe and Effective Hygiene

To keep medications clean and to protect against disease, a direct support professional must do the following:

• Properly wash his or her hands before assisting with medications.
• Avoid touching the medication.  Use medication dispensers such as cups and spoons for liquid medications.  Keep medication dispensers clean.

Use protective barriers such as latex gloves when contact with bodily fluids like blood contact is possible.

Hand-Washing

Hands, more than any other body part, are in constant contact with the environment. They are exposed to many contaminants.  Hand-washing is a very simple, effective, and inexpensive way to prevent the transmission of infection.  However, it must be done properly to get rid of the germs.

Follow these guidelines for hand-washing.

1. Wet hands and exposed areas of the wrist and forearms with running water.
2. Apply soap to the palm of hand; join hands, palm to palm working up a lather on hands, wrists, and forearms.
3. Interlock fingers and work them back and forth and side to side; cover all areas between fingers with soap, thereby creating friction consistently for at least 15 seconds. (STRATEGY: Rather than trying to keep track of the 15 seconds of time, sing or hum a verse of a favorite children’s song. For example, “Twinkle Twinkle Little Star”.)
4. Cleanse the finger tips and finger nails by cupping the finger tips in the palm of the other hand and rubbing vigorously.
5. Rinse with running water, beginning at the finger tips to the hands, wrists, and finally forearms.
6. Dry the hands and the arms with a clean paper towel.
7. Turnoff water using the paper towel.
8. Discard the paper towel without touching the waste container.

Other things to know about hand washing: bar soap and cloth towels just provide a place for germs to wait. Use liquid soap and disposable towels.  Chapped skin provides an opening for blood borne pathogens. Use cool water to wash.  Keep skin healthy with lotion, but not until after providing medications support.  Wash your hands even if you will be using disposable gloves. Always wash hands between each person to whom you provide medication support.

Preventing Medication Contamination

Make sure that medications do not get contaminated.  Follow the guidelines provided with your medications. In general, let the person handle as much of the medication as possible, however, supervise as needed to ensure medications stays clean.

Pills and Capsules in Bottles

Do not touch the pills with your hands. Get the correct amount by gently pouring the right number of pills into the container lid. Place the pills into a disposable or washable medication cup, or directly into the person's hands. If you must do a medication count, use a clean paper plate or paper towel and a clean pair of disposable gloves.

Pills in Bubble Packs

Place the medication cup behind the bubble and pop them through into the cup. If the medication is delicate use a clean sharp knife to gently tear the backing, before popping the pills out.

Liquid Medications that Require Dispensers

With liquids that are swallowed, do not touch the part of the dispenser that goes into the person's mouth. Clean dispensers in a dishwasher or by using a bleach rinse (1 tablespoon of bleach per sinkful of water) if you must wash them by hand. For medications that are dropped into the eye or ear or mouth, do not let the tip of the dispenser touch any surface. This includes the person's body.  Let the drops fall. Otherwise the medication can cause an infection.

Ointments or Creams

If the ointment goes into the eye, make sure the tip of the dispenser does not touch the eye. Use a clean tissue or paper towel to wipe the tip off before recapping. If the ointment or cream is to be placed on the skin, the person must have clean hands when applying it. If a direct support professional is assisting, he or she must use clean disposable gloves. Do not let the medication tip touch the skin. Use a clean tissue or paper towel to wipe the dispenser before recapping.

Protective Barriers

Whenever there is a possibility of transfer of bloodborne pathogens, use protective barriers.

Situations that require protective equipment include:

• When your hands may or will touch or enter a person's body. For example, applying skin cream, administering a suppository, or placing a pill under the tongue.
• When the skin is broken or blood is present. For example, applying ointment to a cut, testing blood sugar, or helping someone with an injection.

Protective barriers include gloves, aprons, and eye wear. Remember protective barriers are meant to protect the person being supported as well as you.  Make sure the gloves or other protective equipment are in good repair with no holes. Use a clean set for each procedure. (For example, you may put on clean gloves to assist with a suppository; you will want to put on a clean set of gloves before assisting with skin cream, even if the medications go to the same person.)

Role of DSP in Administering

In some settings, direct support professionals (DSPs) are not allowed to directly administer medications to others. In these cases, usually DSPs are allowed to assist people with their medications. DSPs provide reminders of how to correctly take the medication. They can prepare appropriate doses and help with preparation. They can supervise to ensure the medication is taken correctly. They may provide physical prompts such as helping a person steady or lift a cup. They will often document the completion of the person's self-administration.

In some settings, DSPs are allowed to administer medications directly. They usually are required to have some specific training and are supervised by a licensed health care professional. In some cases there are limits to the role, including certain routes that they cannot administer.

Review the Five Rights

Right Person: Before assisting a person with medications, make sure you have the right person. In some cases direct support professionals are asked to provide medication administration support to people they do not know well.  Use caution in these instances. Be aware that some people may appear to be agreeing with the question "Are you James Billings?" when in fact they do not understand the question. Direct support professionals must take the time to ensure they have correctly identified the person. In addition, DSPs must be careful to ensure they have the correct container for that person.

Right Medication: It goes without saying that you must give the right medication. These types of errors happen when medications look or sound very similar to each other. It may happen that there is an error where a person does not receive medication at all. It could happen due to errors on the medication administration record (MAR).

Right Time/Date: Some medications must be given at specific times.  Serious and negative consequences can be experienced if these medications are late or too early. Medications that help people regulate seizure activity, blood sugar, high blood pressure, symptoms of mental illness or antibiotics and birth control pills, are among the medications that need to be carefully timed. Other medications have a wider time period in which they will remain effective. In some cases it can be dangerous to "double up" a missed medication. If the time for giving a medication is missed, the direct support professional should speak to qualified medical professionals or a pharmacist regarding the timing of the medication and what can be done.

Right Dose: Dosage information is very important. The direct support professional must know how to correctly measure medications when needed. Sometimes the same medication is given in different doses at different times. Dosage errors are hard to track and can have serious and even life-threatening effects. It is very important that the correct dose of the medication is given.

Right Route/Preparation/Technique: Medications can be given in many different ways. A common way is by mouth which is known as orally. Some other methods include nasal (through the nose), topical (on the skin or through the skin), intramuscular (through an injection into the muscle) or intravenous (through an injection into the vein), vaginally (placing the medication in the vagina) or rectally (placing the medication into the rectum).  In addition, drops into ears or eyes are common.  In all cases, the correct route must be observed. In addition, medications must be given with the correct preparation and technique. For example, some medications must be taken on an empty stomach. Others must be taken on a full stomach. Some medications can be crushed, some cannot. Some medications need to be mixed, shaken, or otherwise prepared before administering. If the medications are given thorough the wrong route or are incorrectly prepared, they are not likely to be effective.

Managing the MAR

It is a good idea to come up with a method that helps track when the medication has been prepared. For example, in some places they use the "dot" method. In this method the direct support professional (DSP) places a tiny dot on the MAR in the correct date and time box of the MAR for each medication that has been correctly prepared. After medications are given they sign their initials in the same box.