The short answer
The MAR, or medication administration record, lists every medication a resident is ordered and records each dose: the time, the nurse's initials, and a code if it was refused, held or not available. The TAR, or treatment administration record, does the same for treatments such as wound dressings, skin barrier creams, oxygen and special monitoring. Most nursing homes now keep both electronically (an eMAR and eTAR).
How to read them
- Each row is one order: the drug or treatment, the dose, the route and how often.
- Each box is one scheduled administration. Initials mean the nurse documented giving it.
- Codes or circled entries explain exceptions, such as "refused," "held," "resident out of facility" or "drug not available." The reason should be explained in a note.
- "PRN" means "as needed." For PRN pain or anxiety medications, the nurse should document why it was given and whether it worked.
What to look for
- Blanks. An empty box means the dose or treatment was not documented.
- Repeated "not available" codes, which can mean the pharmacy delivery failed.
- Wound treatments on the TAR that do not match the wound notes, such as a dressing ordered daily but documented only a few times a week.
- Frequent PRN sedatives or antipsychotics, especially in the evening. See antipsychotics and chemical restraints.
- New medications started without notice to the family, particularly psychotropic drugs.
Federal rules require each facility to keep its medication error rate below 5 percent and to ensure residents are free of significant medication errors.
The rules behind this
- 42 C.F.R. § 483.45 (pharmacy services and unnecessary drugs)
- 42 C.F.R. § 483.45(f) (medication error rates)
Related questions
This guide provides general information, not medical or legal advice. Rules change; confirm current requirements with the facility, the New York State Department of Health or a professional. Attorney Advertising.