MAR - Frequently Asked Questions

This quick guide answers frequently asked questions about the MAR (Medication Administration Record) in VieCure. It covers recording start and stop times, how Observation Time works, documenting an infusion reaction, missing or duplicate drugs, dose changes, and several users working in the same chart.

 How do I record more than one start and stop time on the MAR?

A medication can have more than one time row, which is used for interrupted administrations (for example, an infusion that is paused and restarted). Times can be entered with the stopwatch (Start/Stop buttons), by entering them manually, or from the drug details window.

1. Rule to mark Administered — A medication needs at least one active (not voided) start time and at least one active (not voided) stop time before you can mark it Administered.
2. Interrupted administrations — When a medication has several time rows, only the last row needs a stop time.
3. Voided entries — Voided time entries do not count toward the requirement; you can have several voided entries.
4. Error messages — If a time is missing, the system blocks the action and shows "Start time is required before marking as Administered." or "Stop time is required before marking as Administered."
5. Bulk action — When multiple medications are selected, Mark Administered is unavailable if any medication lacks a valid start or stop time.

 How does Observation Time work across System Configuration, Treatment Plans and the MAR?

Observation Time is the required monitoring window after an infusion. It is not a separate row; it is a setting linked to one or more medications in a treatment plan.

1. Treatment Plans — On the Treatment Plan Flowsheet, left-click a medication row that has a linked Observation Time and choose Observation Time from the row menu to open Edit Observation Time. Here, you can change the Plan Medications linked to it and the Planned Infusion Time (hours/minutes). The Observation Time type is read-only; to change the type, remove the link and add it again.
2. Which occurrences change — Saving applies to all occurrences that are not yet administered. Administered occurrences are not changed. If some future occurrences were edited individually, you are warned that continuing will overwrite those individual edits.
3. Remove — Use Remove Observation Time in the same window to unlink it.The observation time will no longer appear or be required on the Flowsheet, MAR, or Pharmacy Dispensing for occurrences that have not been administered.
4. MAR — Changes on the Flowsheet appear on the MAR immediately. Observation Time is never locked on the MAR and does not take part in the verify workflow. If drugs with different observation times are combined into one MAR row, the observation window starts after the whole combined group is administered.
5. Row menu is grayed out — Observation Time is disabled with the tooltip "This row is currently disabled because all occurrences are administered" when every occurrence is already administered.

 A patient has a medical emergency / infusion reaction in the clinic - how do I document it on the MAR and notes?

1. If the infusion must be interrupted, record the stop time and any restart as separate time rows (see "How do I record more than one start and stop time on the MAR?").
2. Medications that are Held or Not Delivered must be reset to Ordered before they can be administered later, and charges are not created for medications that were never administered.

 There are no drugs on the MAR, or the same drug appears twice - what do I check and how do I fix it?

1. Order status — A voided order should no longer be available on the MAR. Check the order in Order History.
2. Verification — Drugs on the MAR are tied to provider verification. Verify the treatment medications from the Clinic Schedule (Verify Treatment Medications appear in the Check In dropdown for users with the right permission) so the MAR entries unlock.
3. Combined rows — Medications can be combined or separated on the MAR, so two drugs that look like one row (or one drug split into two) may be a combined or separate action.

 The calculated dose is 11.4 mg, but the final dose is 10 mg - where do I see and change this?

The MAR keeps the ordered / calculated dose and the final dispense dose separate. The original dose stays visible in the Rx Dose column, and the dose you change appears in the Dispense Dose column.

1. On the MAR (or Pharmacy Dispensing), click the Dispense Dose field for the medication. It becomes editable.
2. Enter the new dose. The system checks it against the allowed percentage range; if it is outside the range, an error shows the allowed range and the dose is not saved.
3. After a successful edit, a Modified badge shows on the row.
4. Allowed range — A single enterprise-wide percentage (0 to 25%, applied above and below the ordered dose). If none is set, the default is plus or minus 10%. If it is set to 0%, the field is read-only. An administrator sets this under System Configuration > Dose Calculations & Adjustments > Dose Management (Final Dose Modification section, Clinical Section role permission).
5. Only this administration — The change applies to the current administration only; the treatment plan and future doses are not changed. The edit is recorded in the audit trail.
6. Locked cases — The field cannot be edited once the MAR is verified by the nurse or dispensed by pharmacy (set the status back to Ordered first), while a Recalculation Pending review is unresolved, or when it was already edited on the other screen (MAR or Pharmacy Dispensing). The screen shows where it was edited.

 Can multiple users update a patient's chart during an infusion?

1. Dispense dose can only be actioned from one screen at a time: once it is edited on the MAR it is locked on Pharmacy Dispensing, and the reverse.
2. Vitals entries can only be edited by the user who created them, on the same calendar day. Other users can view them.
3. Actions in the MAR and dose edits are recorded in the audit trail with the user and time.