Institutional Pharmacy

Continuation of MARS/TARS

MARS

New orders during the course of the month are entered manually on the MAR sheet while the nurse is processing the order. Medication, strength, directions, admin. times and date of order are entered. Prior to beginning of month, new MARS are reviewed for accuracy.

Process of MARS

New orders-sent to pharmacy, nurse transcribe manually onto MARS Change in orders-sent to pharmacy, transcribed manually onto MARS. Approx. 18th to 20th of the month, back copies of MARS/faxed MARS are sent to pharmacy

Process of MARS

Tech reviews MARS against profile for accuracy-takes several days (communicate with nurse regarding any discrepancies) Once complete, prints MARS for following month to go home ***GOAL-ACCURATE MARS FOR HOME**

Process of MARS

MARS reviewed, new MARS sent back to home for following month (few days prior) Home has their checking procedures to go through Nurse reviews new MARS against current MARS to ensure accuracy (new d/c'd, changes, etc)

Process of MARS

Nurse must manually enter new Rx's rec'd from the receipt of the new MAR onward. This check ensures all changes made late in the month have been added to the new MAR. MARS is homes legal document, accuracy is important.

Process of MARS

Error on MARS is a reflection on pharmacy Back side of 1st page of MAR can be used for TAR. Nurse enters treatment, location, notes of improvement after treatment. May also chart sites of insulin inj.'s for rotation sites. Possibly used for areas of inflammation, sores etc

Process of MARS

Chart effective/ineffective treatment. House MD assesses, may change/d/c med. order until clear, etc., written on MARS. Questions about orders while nurse is reviewing MARS for next month, communicates to pharmacy at this time.

Process of MARS
MARS is accurate, everyones job is easier. Quick overview: home removes back carbon copy, send to pharmacy for review, pharmacy reviews, pharmacy prints new MARS, send to home, home reviews, MARS is ready for next month. (new RXs done throughout month)

TMR- THREE MONTH REVIEW (QUARTERLY MEDICATION REVIEW)

Q3months, pharmacy send TMR to home. MOH requires a TMR be completed for each resident in a LTC facility. TMR is pharmacys legal authorization to continue filling medication for resident for next 3 month period. All orders written by House MD are active or to be continued until next TMR unless specified otherwise

TMR

TMR prepared by pharmacy on 2-ply or single laser (duplicates made). 1 copy kept in patient chart at home, 1 copy kept at the pharmacy for legal documentation. If TMR not completed in timely manner, pharmacy does not have authorization to repeat medications, and meds will not be sent to resident.

TMR

Lists all active meds, directions, Dr., home, last fill date, etc. (other info. If reqd for chart), & last fill date. At specified time for TMR to be completed, the R.Ph does clinical review of each residents medications. Suggestions noted by R.Ph for Dr. to consider alternative meds that may help to reduce dosage times for resident. May also suggest to D/C meds based on last fill dates.

TMR

TMR delivered to nursing unit once R.Ph has completed individual review. RN reviews list of meds, ensures printout is accurate & updated with any new orders, compared to MARS. Any additional orders from the time TMR was prepared by pharmacy the RN must update TMR. Must be updated until Dr. signs the TMR

TMR

TMR given to physician. Physician reviews & makes changed to meds based on what is printed, or by the RN &/or R.Ph suggestions. Area on TMR for physician to continue or D/C each medication. Physician must sign the TMR, just as they would for a new Rx.

TMR

At this time, the RN processes the TMR. Any orders D/Cd, added, changed, etc. by physician, changes must be processed by RN in same procedure followed for new Rx. TMR faxed to pharmacy to allow the new order to be processed by the pharmacy staff.

TMR

If no changes on TMR, remove back copy & send to pharmacy with next delivery. TMR is a top priority if there are medication changes Very important for TMRs to be kept up to date & signed by physician promptly. Advisable to use 2-ply carbonless for the signature required.

SUMMARY
ACCURACY AT THE PHARMACY LEVEL IS VERY IMPORTANT. ERROR AT OUR LEVEL HAS THE POTENTIAL TO BE A MEDICATION ERROR. HOME RELIES ON US FOR ACCURACY & MAY CHANGE AN ORDER ACCORDING TO OUR INTERPRETATION, WHICH IN TURN IS PASSED ALONG TO RESIDENTS. RNS RELY ON OUR EXPERTISE TO CHECK PHYSICIANS ORDERS.