Bar Code Medication Administration and MAR Resource Manual
Basic Information
Glossary of Terms ......................................................................................................................2
MAR Summary ...........................................................................................................................5
MAR Summary – Frequently Asked Questions ..........................................................................8
Changing MAR Summary Defaults .............................................................................................9
MAR Tab ..................................................................................................................................10
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Glossary of Terms
Care Mobile: Cerner software package that interfaces with PowerChart to allow scanning and
charting with a mobile device; the Cerner application used to communicate with the PDA.
Chart not done: used to chart on the MAR, meds that have been omitted based on clinical
guidelines, orders (low pulse or BP), duplicate administration (already taken at home), or pt.
refusal.
Create an administrative note: used on eMAR (not on PAL) to note patient preferences;
displays in Care Mobile.
Cross encounter: patient data from one admission will appear on the next admission’s chart,
depending on the tab and search criteria set in PowerChart; medication tasks can carry over to
the PAL but not to the MAR or CareMobile.
Diluent: the base solution in which IVPB medications are mixed, such as D5W or NS; when
scanned, the meds and diluent are recorded on the MAR and I&O.
Drop down menu selection: the button with a drop down arrow on the PDA used to select
patient list or medication list
Drop-down menu list
 Due tasks: currently due meds. Display meds 1 hour prior to
due time to approx 30 minutes to 1 hour after med is due
 Overdue tasks: meds that are past due 30 minutes
 Continuous IV’s: IV ‘s ordered to run continuously
 Sched Meds: due meds and overdue meds.
 Sched Pt Care: scheduled patient related tasks,
such as vitals signs
 PRN Meds: med orders available for administration
as needed
 PRN Pt Care: optional patient related tasks
 Unscheduled Meds: one time meds for which
administration time is not known, such as pre-op
 Resp Therapy: Respiratory Therapists’ med list
 To be Signed: completes charting process; signing occurs
after scanning meds and completing PPID
 Discontinued: a list of discontinued tasks for 24 hours
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EMAR: electronic Medication Administration Record.
Enter Orders through Ad Hoc: used to enter Stat and Now orders of floor stock meds; the
nurse enters the order so the med and patient can be scanned; the med is given without
Pharmacy review, presenting a potential safety issue.
Icon: pictorial short cuts that open specific applications or programs.
Image reader: the scanner part of the PDA (see Scanner)
Indicator: a pictorial symbol that alerts the user to certain information. For example, the
eyeglasses indicate that the medication order has not been Nurse Reviewed; the symbol does
not open when tapped.
Label: the manufacturer’s packaging or sticker applied in Pharmacy containing drug dose,
description and UPC code; also the patient ID band.
Locked MAR: the charting function on the eMAR will be locked (unavailable); all medication
charting will be done through CareMobile. The information charted using the PDA will be
viewable on the eMAR. The eMAR will be unlocked following periods of PowerChart downtime
so that meds may be back charted. Some departments, such as IV Therapy, ED and Dialysis
will chart on the eMAR
MAR: Medication Administration Record tab in PowerChart where medication information
displays. Synonymous with eMAR
Near code: an emergent patient condition that requires rapid med administration; the nurse
administers meds without scanning drug or patient (see Retrospective Charting.)
Not Given: used to chart meds that have been omitted based on clinical guidelines, orders
(low pulse or BP), duplicate administration (already taken at home, etc.), or patient refusal.
PDA: Personal Digital Assistant. A hand-held wireless computer that allows the clinician to
scan patients for Positive Patient Identification (PPID) and to scan and chart medications in
PowerChart.
Tap: selects an option or places the cursor in a field; equivalent to left-click mouse
function
Tap and Hold: opens a short cut menu; equivalent to right-click mouse function
1st time login: the first time a user logs into a PDA, the device needs to load settings;
occasionally this requires the user to enter his or her password a second time
Load settings: the period of time following login when the PDA readies itself for use
PMAR: paper medication administration record; used during periods of PowerChart downtime.
PPID or Positive Patient Identification: at Munson, PPID includes scanning the patient ID
band and asking able patients to state his or her name and birth date.
Range Dose Administration: for orders with a dose range, for example: for Morphine 110mg PRN, IVP, the nurse must enter the dose and unit of measure dose.
Reader: the scanner part of the PDA (see Scanner).
Remove: an option to take a patient off a custom list or to remove a medication from the ‘To
be Signed’ list (before signing.)
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Retrospective charting: back charting a period of time after the medication has been
administered; the med packaging is no longer available for scanning; retrospective charting will
be done following PowerChart downtime and near-code situations.
Save: the step prior to signing when in a charting window. When saved, the information goes
to the “To be Signed” list.
Scanner: the Scan button on the PDA emits the laser light needed for barcode reading; a
beep will sound when scanning is complete.
Sign: the final step of the bar coding medication administration process, done after PPID and
drug administration; charts the medication in the patient record.
Symbology: refers to the different UPC codes that display on labels; “linear” and “two
dimensional” are two of the UPC codes that exist on product packaging.
Task Bar: the bottom bar on the PDA screen
Workflow: tap on Workflow for Exit option
Tasks: tap on Tasks for List Maintenance option
Tasks: a general term used in PowerChart and CareMobile that refers to work or interventions
to be done for the patient; there are many different tasks found in PowerChart and CareMobile.
Medication tasks are on the PAL and listed in CareMobile (see picture of drop down menu
selection above for task examples.)
Time Charted: time the medication task is signed
Time Out: when the CareMobile application is left inactive beyond set parameters, the user is
returned to the login screen and presented with the message: “The application has timed out
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MAR Summary
MAR Summary is a separate tab within PowerChart that will enable clinicians to see med
administration information in a condensed view. It provides:
 A high-level view with easy access to more detail.
 Concise med information, including pending, given, not given, and overdue medications.
Features:
 Reverse Chronological order
 Hovering to display more detail
 Legend of indicators that appear for any order or result
 Links to order or result details
 Use of color to indicate pending/overdue/given/not given
 Ability to change settings (time frame, time columns, sections, IV events) and store
preferred defaults
 Ability to filter by section (scheduled/unscheduled/PRN/continuous infusions) and/or by
active/inactive orders
MAR Summary:
4 Sections:
 Scheduled
 Unscheduled
 PRN
 Continuous
Infusions
Reverse
Chronological order
24 hour intervals
Search criteria:
 48 hours back
 8 hours forward
(see next page for
customizing)
 Selected
encounter only
Midnight start-of-day
Color-coding:
 Blue: pending
 Red: overdue
 White: given
 Yellow: given
 Orange border:
not given/not done
Given
Not given
Overdue
Pending
Current time column is highlighted in yellow
Hover for more
detail:
 Order detail
 Status
 Icon legend
 Administration
detail
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Customizing:
Click on Navigator
button, then select
Change Properties
Date Range tab:
 Date
 Column time
intervals
Filters tab:
 Sections
 Display inactive
orders
Options tab:
 Pending doses
 Continuous
infusions
 Save As Default
Note: selecting Infuse
(Volume Documented)
will display infused
volumes charted on
I&O on the MAR
Summary
Change Interval
 Select number of
hours to display in
time column
Navigate to sections
 Quickly move to
specific section
Changing defaults:
 Right-click on blue
search criteria bar
 Select Change
Defaults
Hours back
Hours forward
Column Time
Interval
Day begin time
Font size
 Click OK
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Scheduled meds
 Displays
administered dose
and time
 Pending dose time
displays
Overdue
Given
Pending
PRN medications
 Multiple doses
may list in one
cell, depending on
column intervals
 Hover on cell to
display details
Multiple
doses
Charting patient’s response to PRN med is
pending; when charted it will not display on MAR
Summary. Data will display on MAR, Patient
Result Comment: to view, click
Assess flowsheet and Forms tab.
on Details, then Comments tab
Continuous and
Titratable IVs
 Hover on cell to
display details for
each ingredient
 Allows access to
View Details
screen
 Infused volume
charted on I&O
tab displays
Inactive Orders
 Display with gray
background
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MAR Summary – Frequently Asked Questions
I don’t see a dose
that I know was
given.
What do different
colors/indicators
mean?
I have to scroll too
much.
* Change search criteria dates/times
* Click the Refresh button
* Hover to view details including indicator description and medication
status
* Change column intervals to a larger interval
* Change date range
* Click on Navigator button and use ‘Navigate to’ option to go quickly to a
section
How do I know
who gave a med or * Hover over cell
IV?
* MAR is a high level overview
Why use MAR
* MAR Summary provides a more condensed view and more detail than
Summary instead
MAR
of the MAR?
* Can filter off sections, change defaults on MAR Summary
How do I know site
* Hover over cell; if charted will display
of injection?
Why don’t I see all
* Change your Properties to include sections you want displayed
of my sections?
Why can’t I see a
* Only PRN responses yet to be charted display; once charted, data may
pain response?
be viewed on
the Assess flowsheet or the Forms tab
What do I need to
do to see IV
* Click on the Navigator button and select Change Properties. Go to the
infused volumes in Options tab and select Infuse (Volume Documented). Also select Save
the continuous IV
as Default if you always want to view infused volumes.
section?
Can I change my
* Yes. Right-click on the search criteria bar and select Change Defaults.
view to match my
Click the dropdown arrow next to Column Time Intervals and select the
unit’s usual shifts? desired number of hours. Then change the Each Day Begins At time.
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Changing MAR Summary Defaults
1. Go to MAR Summary tab
2. Click Options on the Menu bar
3. Click Change Defaults
4. Make changes
5. Click OK to apply defaults
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MAR Tab
The MAR (Medication Administration Record) tab displays a patient’s medication orders and
documented administrations for the selected time frame and selected order status’.
Medications will display when a Provider has entered the order into PowerChart or Pharmacy
has entered them into the PharmNet application. The MAR tab includes scheduled,
unscheduled and PRN medications, continuous infusions and a discontinued section.
Time Frame Selection
The MAR tab time frame default is the current 24 hrs and the previous 24 hrs. To change your
time frame, right- click on the Search Criteria bar, select Change Search Criteria and enter the
desired time frame. You may also select Set to Today.
Search Criteria bar
Right-click
Click
Select time frame
Order Status Filters
To change the types medication orders displayed on the MAR tab, click Options on the Menu
bar. Click Filters. Select or deselect the order status’ to include by clicking in the box.
Click Options
Click box to select
or deselect
Click Filters
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Navigator and Medication Sections of the MAR
The Navigator on the MAR tab allows you to move within the Medication Section by clicking
the various medication categories (the ‘Future’ category is not used). The Medication Section
displays the patient’s medications and associated order details. The time frame and filters
selected determine which medications will be listed. Administration dates and times are
displayed to the right on the same row. The current date and time column is highlighted in
yellow.
Navigator
Med Order Section
Administration columns
Medication Section icons
Nurse Review – the order has not been nurse reviewed.
Admin Note – click to view previously entered notes for this medication.
Pharmacy Comment – Click or hover to view comments entered by Pharmacy for this
medication.
Linked medication – Hover to view details; info is also listed with the medication details.
Request Pharmacy Verification - The medication order has not been verified by Pharmacy.
The med is approaching its stop date/time. Right-click to view order details.
The med is approaching its stop date/time. Right-click to view order details.
The med is approaching its stop date/time Right-click to view order details.
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Right-click options in the Medication Order section
The following options are available by right-clicking the medication order:
Click to view general
details of the order
Click to view/print
Drug Reference
material
Click to send Med Request to
Pharmacy. Reason field must
be completed for the request to print
in Pharmacy. Enter short message
in the comment field if needed.
This option is for IVs only. Click to
view bag #, date/time, site, rate, and
who it was performed by.
Click to chart a communication note to
another nurse or view previously
entered notes for this medication.
Make sure to include your initials
when entering an Admin Note.
Administration column indicators - Viewing
Medication task – displays in the d/t column when it is due.
Administered medication (gray background with blue √). After clicking As Of, the
medication dosage is listed in the appropriate d/t column.
Administered medication (blue background).
Displays in the current d/t of the PRN administration column (green background). ‘Not
previously given’ will display if appropriate.
MAR note – reminder to chart data.
Comment indicator (blue background). Right-click to view comment.
Medication was not given (blue background). Hover to view reason.
Medication was not given (blue background). Hover to view reason.
Medication was uncharted (blue background). Right-click to view comment.
Right-click options in the Administration section
The following options are available by right-clicking the medication task cell:
Use for meds administered on noneMAR units (OR, PACU), if med not
given or for Not Given on IVPBs.
Click to view general details of
the order +/or task
Use for meds given prior
to their scheduled time
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Right-click options for a charted medication
Do not use





View Details – Click to view medication and administration details.
View Comments – Click to view comments.
View Order Info - Click to view general details of the order.
Add Comment – Click to add comments.
Modify – Click to modify charted details.
NOTE: If you modify the date +/or time of a medication that generates a Pain Response task,
and the Pain response task has not been completed, the Proposed Modifications window
displays:
If the proposed date/time are appropriate, click to highlight and click OK.
The task will then display in the new date/time column. If you click Cancel, the Pain Response
task remains at the original date and time.
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When the Pain Response task has been completed prior to the modification, the New
Response Task window opens.
Click OK. Pain Reassessment form opens. Click the Cancel Charting button.
On the MAR, right – click on the task and select Chart Not Done.
Enter a reason of inappropriate at this time.
NOTE: The charted pain reassessment may need the time changed.
Unchart – Click to unchart a medication. Uncharting will return the medication to its previous
status of due, overdue, etc. and mark it as ‘In Error’.
NOTE: If you unchart a medication that has a documented pain response, a warning
displays indicating that the pain assessment may also need to be uncharted.
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Charting on a unlocked MAR following Downtime
During periods of scheduled or unscheduled PowerChart downtime, medication charting will be
done on the pMAR. When PowerChart becomes available the MAR tab will be ‘unlocked’ to
allow downtime charting. All medication documentation done on the PMAR will be back
charted in PowerChart through the MAR tab or PAL.
Unlocked MAR
Navigator
Med Order Section
Administration Columns
Administration Column Indicators
Medication is due (blue background). Displays in the date/time column that the med is due.
Administered medication (gray background with blue √). After clicking the Refresh button,
the medication dosage is listed in the appropriate d/t column.
Administered medication (blue background).
Displays in the current date/time of the PRN administration column (green
background). ‘Not previously given’ will display if appropriate.
Pain response task – displays in PRN category 5 min after a PRN medication is
charted (blue background). Click to chart response.
Overdue medication (red background).
MAR note – reminder to chart data (blue background). Only displays when Pharmacy enters a
PCA note order.
Comment indicator (blue background). Right-click to view comment.
Medication was not given (blue background). Hover to view reason.
Medication was not given (blue background). Hover to view reason.
Medication was uncharted (blue background). Right-click to view comment.
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To chart on the MAR tab, click the medication in the Administration column:
Click medication task
The medication charting window displays. Verify information, make changes, complete any
required fields and sign.
NOTE: When back charting, verify that the Performed date/time and the Performed by fields
are accurate.
Right-click options in the Administration section
When the MAR is unlocked to allow charting, 2 additional options are available on the drop
down list: Chart Details and Quick Chart.
Chart Details opens the charting window for changing the time or other chart details. Chart as
you would in Care Mobile.
Quick Chart signs the med task without opening the charting window. The medication will
have the due time and all other details associated with the task.
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1. Enter your user name in User Name field. The next time the PDA is used tap the dropdown arrow. The last 7 user names will display. Tap your user name if listed.
2. If keyboard does not open, tap Keyboard icon.
3. Tap Password field and enter password.
4. Tap OK.
Keyboard Icon
5. Occasionally an Alert opens informing user that he/she
has never logged into this device.
6. Tap OK.
7. The log in window opens again requiring you to enter
your password again.
8. Tap OK after entering your password.
Your patient lists will not display in CareMobile the first time
you log into CareMobile. See the following page to create
lists.
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