Customizing the MAR
You can choose to print either a MAR (i.e., standard) or MAR Pain Effectiveness from the AIP Reports menu.
The MAR can be customized by setting the option defaults found on the MAR tab of the Utilities/Options menu (see screen print below).
Note: some options are specific to the "MAR Pain Effectiveness" only. The options are explained in detail below.
MAR - Standard Options
Columns Start/Stop times
The times set in the screen print (above) are configured to run a daily MAR, where each column represents one shift. A 3 day MAR can also be configured, where each column represents one day.
MAR Sections
You can define the headers for the various sections of your MAR and the order in which the sections are printed (e.g., section 1 = "Scheduled", 2 = "PRN", etc.).
Print Times
You can set whether you want administration times to print in these sections. Most MAR sections for scheduled orders should have this box checked. The section which will be used for "PRN" orders may be checked or unchecked since most PRN orders do not have scheduled times in any case. Some users choose to NOT display the scheduled times for large volume IV solutions, while others treat them like any other scheduled order.
Assign Each Order Type to a MAR Section
All of the order types currently defined in the database should appear on the list. You must assign each order type to a section of the MAR. For example, in the screen print above, "TPN IV" order types will print in section 3, the "IV SOLUTIONS & IRRIG" section of the MAR.
"No Dose Today" Reminder Text
This option lets you display a reminder (e.g., "No dose") in the administration times column when no doses are scheduled for this period. This applies to scheduled orders only; PRN orders will continue to show a "blank" in the administration times column.
Place PRN orders in section
Indicate which section of the MAR has been designated for PRN orders by entering a section number.
Show both drug names
With this option checked, all drugs that have more than one name in the formulary (e.g., brand and generic name) will have both names printed on the MAR. This is a system-wide override setting that affects all drugs in the formulary.
If you want both drug names to appear on MARs and labels but only for selected drugs, leave the box unchecked here. Instead, go to the formulary drug record for each of the target drugs. Then check the "Show both names" box (under Defaults) for these drugs only.
Show dosage fields
Most facilities that have completed dosage fields in their drug formulary records will want to check this option. Dosage fields include "Dose" (i.e, strength), or "Per" (i.e., volume), and "Qty/Dose" (i.e., the quantity of tablets, vials, etc that make up each dose). If you are in the process of adding dosage fields, you may want to temporarily leave this unchecked until you are done editing. Contact HOS for more advice on editing drug descriptions and dosage fields.
Show administration times on MAR
You can opt to either show administration times or have the time columns appear blank. Most MARs are formatted with room to display the administration times. Some custom MARs (e.g., 30 day) do not have room to do so.
Show AHFS code
Some states require reference information be printed on the MAR for use by nurses. If this option is checked, the American Hospital Formulary Service code from the formulary records of the drugs will appear on the MAR to meet this requirement
Show Active Orders After Stop Date
Check this box if you want active orders to continue to appear on the MAR, even if their scheduled stop date/time will have been passed. In such cases, the orders will be displayed on the MAR, but no administration times will be included. Discontinued orders do not appear on MARs, therefore this option only affects orders that will have reached their effective stop date/time but are still active at the time the MAR is printed. Facilities that actively maintain and control a strict stop order policy usually do not use this option whereas others that continue to allow "soft stops" may use this option. The user accepts all medication safety responsibilities by choosing to display, or to not display, orders on the MAR that may require renewal by the doctor.
Include Order Number
This is a unique number assigned to each order that is entered into AIP (appears in "OrderRef" field of the order entry screen). If this option is checked, the number will print below the route on the MAR. Some users charge off the MAR and use the order number as a reference. Most users will not use this option.
Include SIG/Comment/Label
Check which of these fields from the order you would like to appear on the MAR. HOS recommends checking the "Sig" and "Comments" boxes, but leaving the "Label" box unchecked.
Include Entered/Verified boxes for new orders
When Ascend finishes printing an MAR page, there is often room for nurses to manually "write-in" new orders. If this box is checked, Ascend will include two boxes for nurses to document the initials as to "who entered" and "who verified" these manual order entries.
Administrations Codes/Sites
On the lower left portion of the screen, you can specify the nursing administration/site codes and descriptions that are used at your facility. If the codes/descriptions are entered into the user-defined fields, and the checkbox above the list is checked, the administration/site codes and descriptions will appear on the MAR when i is printed. This enables each facility to customize their MAR to meet their special needs. See the examples in the screen shot above.
MAR Pain Effectiveness - Options
The "MAR Pain Effectiveness" MAR is one of several standard Ascend MAR formats, but the only one that includes areas for nurses to document pain effectiveness (i.e., the patient's perceived pain level before and after a pain medication has been administered). As of 8-10-2003, the options described below apply only to the "MAR Pain Effectiveness" format and do not function for other MAR formats.
Pain Assessment
Within the "Pain Assessment" frame that appears at the bottom left of the screen, enter pain assessment codes (pre-dose) on the left, and effectiveness codes (post dose) on the right. Include a definition or description to the right of each code. See the examples in the screen shot above. You can opt to have your user-defined Pain Codes/Descriptions and Effectiveness Codes/Descriptions display on this MAR by checking the boxes above the lists.
You can choose to display areas to document pain assessment (i.e., before/after each dose) under each column for selected pain medications (e.g. "__/__"). For example (using the pain codes shown in the screen shot above), upon completion by nurse "Tess Smith" (initials = "TS"), the column next to "MEPERIDINE 50MG INJ" might include:
"12:00 TS 2 / E"
indicating "moderate pain" prior to the "12:00" MEPERIDINE dose, and "no pain" 30 minutes after the dose.
To identify which drugs in your formulary should display these pain assessment documentation areas, perform the following one-time steps: