ASC — Medication Administration Record (MAR)

1. On the Main Menu, click Settings > Clinicals.

2. In the left menu, under Practice Links - Order Configuration, click MAR Order Configuration.
   Tip: Alternatively, enter text in the search box.
   The MAR Order Configuration page appears, with the Procedure MAR Orders tab displaying.

3. Click the MAR Order Configuration tab at the top.
   The MAR Order Configuration tab appears.

4. Click the add icon in the top right corner.
   The Medications window appears.

5. Enter the name of the medication you want to add and select the appropriate option from the dropdown menu.
   The option you selected appears in the list of medications.

6. Click the expand icon next to the medication you added.

7. Click Add Sig.
   
   The sig details appear.

8. Complete the sig details as appropriate:

   1. Procedure Stage

   2. Sig

      1. Dose Amount

      2. Dose Unit

      3. Frequency

      4. PRN

      5. PRN Note

      6. Duration Type

      7. Duration Amount

      8. Duration Unit

   3. Note
      

9. Click Save.
   The details you entered appear below the medication on the MAR Order Configuration tab.
   

 

Medications or sigs you delete are removed from the associated order sets. Similarly, medications or sigs you edit are reflected in the associated order sets.

1. On the Main Menu, click Settings > Clinicals.

2. In the left menu, under Practice Links - Order Configuration, click MAR Order Configuration.
   Tip: Alternatively, enter text in the search box.
   The Procedure MAR Orders page appears.

   Note
   There must be at least one medication and sig added in the MAR Order Configuration page before you can create an order set in the Procedure MAR Orders page.

3. Click Add new card in the top right corner.
   A new order set card appears under the listed order sets.

4. Click the expand icon next to the new order set card.

5. Click the pencil icon to rename the order set card.
   The order set card name becomes editable.

6. Enter an appropriate name for the order set card.
   

7. Click Add Meds.
   The MAR Order Formulary window appears.

8. Check the box next to the medications you want to add to the order set.
   

9. Click Add Selected Meds.
   The selected medications appear underneath the order set card.

1. In the Physician stage of the surgical case, click the add icon next to Diagnosis & Orders.
   The Diagnosis & Orders cart opens.

2. Under MAR Orders, click the order you want to add.
   
   

   Note

   • You can click the expand arrow next to MAR Orders to view more options.

   • Alternatively, you can search for the order via the search bar under Diagnoses & Orders.

   • Medications listed under Orders are for prescribing while orders listed under MAR Orders are for surgical use.

    

   The order appears in the Medication Orders section under Drafts. A temporary message also appears in the bottom left corner to confirm you successfully added the medication.

3. Under Drafts, click the medication to expand its sig details.

4. Complete the sig details as appropriate:

   1. Order provider – Required

      • Provider name – Required

      • Ordering method - Required

   2. Priority - Required

   3. Priority time – Required

      • Phase of care
        

        Note
        Medications assigned to a phase of care can be added at any time during that stage.

      • Date

   4. Priority time – Required

      • Phase of care

      • Date

   5. Sig – Required

      • Dose amount – Required

      • Dose unit – Required

      • Frequency - Required

   6. PRN

   7. Duration – Required

      • Duration type – Required

      • Duration amount – Required

      • Duration unit - Required

   8. Note
      

5. Click Sign if you are a prescriber or Enter if you’re a delegate to mark the order as active for administration on the MAR.

   Important
   Be sure to confirm all draft orders are accurate before signing or entering them.

1. In the Physician stage of the surgical case, in the Medication Orders section, click the order you want to edit under Drafts.
   

   The order expands.

2. Complete the sig details as appropriate:

   1. Order provider – Required

      • Provider name – Required

      • Ordering method - Required

   2. Priority - Required

   3. Priority time – Required

      • Phase of care
        

        Note
        Medications assigned to a phase of care can be added at any time during that stage.

      • Date

   4. Priority time – Required

      • Phase of care

      • Date

   5. Sig – Required

      • Dose amount – Required

      • Dose unit – Required

      • Frequency - Required

   6. PRN

   7. Duration – Required

      • Duration type – Required

      • Duration amount – Required

      • Duration unit - Required

   8. Note
      

3. Click Sign if you are a prescriber or Enter if you’re a delegate.

   Important
   Be sure to confirm all draft orders are accurate before signing or entering them.

   The order appears under the Active section and is available on the MAR for administration.

Note
You can only edit medications in Drafts. If you want to edit an active medication, you need to discontinue it and reorder it as appropriate.

In the Physician stage of the surgical case, in the Medication Orders section, under Drafts, hover your cursor to the right of the order and click Delete.

athenaOne removes the order from the Drafts section. You cannot delete active or discontinued orders.

1. In the Physician stage of the surgical case, in the Medication Orders section, under Active, hover your cursor to the right of the order you want to discontinue and click Discontinue.

2. Complete the following fields:

   1. Discontinuing provider – Required

      • Provider name – Required (for nurses only)

      • Discontinue method - Required (for nurses only)

   2. Reason to discontinue – Required

   3. Discontinue priority – Required
      

3. Click Discontinue.

   The order moves under the Discontinued section. Click the discontinued order to expand and view its details.
   

MAR orders entered by nurses require sign-off by a prescriber with order sign-off privileges.

1. In the Physician stage of the surgical case, in the Medication Orders section, review the medications listed under Active and Discontinued for orders that need a prescriber sign-off, as indicated by a yellow NEEDS SIGN alert .
   

2. Click the order to expand its details.

3. Review the order details and click Sign.

4. Repeat steps 2-3 for any other orders that need sign-off.

Alternatively, prescribers can bulk sign orders entered by delegates.

1. In the Physician stage of the surgical case, in the Medication Orders section, click the dropdown menu at the top and select your username.
   
   Selected checkboxes appear to the left of the medications assigned to you.

2. Uncheck the boxes next to medications you don't yet want to sign if needed.

3. Click Sign in the top right corner.

Prescribers can also sign off on medications that aren't assigned to them. To do so, click the dropdown menu under Medication Orders and select All unsigned orders or select the prescriber for whom you want to sign. Repeat steps 2-3 from above.

1. In the Pre, Intra, or Post stage of the surgical case, click the arrow next to the stage name and select MAR from the dropdown menu.
   
   athenaOne automatically scrolls down to the MAR section.
   

   Note
   Medication orders are sorted in order by priority, such as STAT, Now, Scheduled by Time, Stage (Pre, Intra, Recovery, Post), and PRN.

2. Depending on the order schedule, click the:

   • Medication scheduled to a phase of care — Hover your cursor over the time cell you want to administer the medication for and click the add icon .
     The medication administration window appears with the current date and time auto-populated.

   • Medication scheduled for a specific time — Click the time stamp for the medication you want to administer.

     The medication administration window appears with the current date and time auto-populated.

3. Start time/date - Required — If you want to change the time and date, click the clock icon to select the appropriate time and the calendar icon to select the appropriate date.
   

4. Complete all other fields as needed (optional).

5. Click Sign.

For IV drip medications — Once signed, click Started or Continuous in the MAR flowsheet, followed by clicking Add New Bag to add a new bag or discontinue the infusion by clicking Stop Bag Only.

For overnight stays — You can view the date in the medication administration window title and dropdown menu.

1. In the MAR flowsheet, click the dose for the medication that you want to edit or delete.
   The medication administration window appears.

2. Click Edit.
   The fields become editable and the Delete Administration or Delete Bag link appears, depending on if it's an IV fluid/medication or non-IV medication.

3. Edit as needed or click Delete Administration or Delete Bag.

1. In the Clinical Inbox, click the down arrow in the corner and select Delegated Orders from the dropdown menu.
   The Delegated Orders/Authorizations page appears.

2. Select the check box next to the orders you want to sign off on.
   

   Note
   You can click the Select All check box at the top of the page to select all listed orders across both tables.
   

3. Click Acknowledge at the bottom of the page.
   The orders you signed off on disappear from the Delegated Orders/Authorizations page.

A drug interaction warning appears in the surgical case for MAR orders and the MAR flowsheet if any of the following occurs:

• The new medication conflicts with existing MAR orders

• The new medication conflicts with the patient's current Medications, Allergies, or Problems lists

• The patient is geriatric and the medication requires caution

Important
These warnings appear only in MAR workflows for the surgical case. They do not display on the chart medications list or during new active medication prescribing outside of the surgical case.

 

The warning is based on drug-drug, drug-allergy, drug-problem, or drug-geriatric interactions and ranges from moderate to serious to severe.

Warning icon	Description
	Moderate interaction
	Serious interaction
	Severe interaction

These warnings remain visible as you place and administer medication orders and cannot be hidden.

 

Note
Diluent checking is not supported at this time.

 

ASC medication warnings use the same user preference controls as ambulatory and hospital medication warnings. Users with access to the User Preferences admin page (Settings > User Preferences) can configure them in the Drug interaction warnings field.

 

You can view these medication alerts in the following places:

Order entry

To view what triggered an alert for a medication during order entry, click the medication to expand it and see more details.

MAR flowsheet

To view what triggered an alert for a medication on the MAR flowsheet, click the medication to expand it and see more details.

Medication administration window

Dose warnings

You can view two types of dose warnings for MAR orders once you have entered dose amount, dose unit, and frequency:

• Max daily dose: The highest or maximum total amount of medication that could be administered in a 24-hour period

• Max single dose: The highest or maximum amount of medication that could be given at one time in a single administration

 

If there is inadequate information to perform dose range checking, athenaOne displays either one or both of the following warnings:

• Single dosage range checking cannot be performed.

• Max daily dosage range checking cannot be performed.

When medication interactions cannot be checked

When medication interactions cannot be checked, an alert displays in MAR orders and the MAR flowsheet due to either of the following:

• The medication is obsolete and no longer orderable

• The medication is no longer manufactured, but may temporarily have non-expired supply available

The alert states, “[Drug] could not be checked for drug interactions. Perform a manual review before proceeding.”

 

You can view this alert in the following places:

• Order entry

• MAR flowsheet

• Medication administration window

Note
As medication status changes over time, you may need to update medication preference cards with new medications and sigs as needed. Review each impacted preference card and update as needed.

You can view MAR orders and MAR administration activity such as who ordered, entered, and signed the order in patient encounter summaries.

Note
Dates in the MAR section of the Full Case Summary, Full Procedure Summary, and Summary in the Visits tab, Close stage, and Find tab now display as MM-DD-YYYY.

Practice administrators and providers can now assign delegates for MAR orders through the new MAR order type group on the Order Delegation admin page (Settings > Clinicals > Order Delegation). Assigned delegates may include nurses. Only designated delegates can enter MAR orders and activate them for administration on the MAR flowsheet.

 

The following MAR orders are now included as order types:

• MAR – Medications (IV)

• MAR – Medications (Other Routes)

When adding an individual delegation, you can access the new MAR order types.

You can also access the new MAR order types when adding a group-based delegation.

 

Once you’ve assigned the MAR order type(s) to the appropriate delegate(s), they appear on the Order Delegation admin page.

 

When there are delegated orders pending review and sign-off (including MAR and other order types), a task is created in the provider’s Clinical Inbox with the Acknowledgment Required description.

 

Providers can then review MAR orders placed by delegates and acknowledge them in the Delegated Orders/Authorizations page.

 

In addition, providers can now acknowledge delegate-entered MAR orders in bulk from the Delegated Orders/Authorizations page without having to manually go through individual patient charts to sign or acknowledge delegate-entered MAR orders.

New MAR order type table in Delegated Orders/Authorizations admin page

You can view the new MAR order type table at the bottom of the Delegated Orders/Authorizations page. The table at the top of the page is for all other order types (such as prescription, lab orders, etc.).

Once you acknowledge orders, they disappear from the Delegated Orders/Authorizations page.

Acknowledge MAR orders in bulk

1. In the Clinical Inbox, click the down arrow in the corner and select Delegated Orders from the dropdown menu.
   The Delegated Orders/Authorizations page appears.

2. Select the check box next to the orders you want to sign off on.
   

   Note
   You can click the Select All check box at the top of the page to select all listed orders across both tables.

3. Click Acknowledge at the bottom of the page.
   The orders you signed off on disappear from the Delegated Orders/Authorizations page.

Note
Clicking a patient name or order brings you to the patient briefing.

Signing an order on behalf of another provider

If any of your MAR orders on the Delegated Orders/Authorizations page have unsigned components, an info icon appears next to the unsigned order and at the top of the page. Hover your cursor over the info icon next to the order to view who has not signed the order.

If you acknowledge an unsigned order, you would be signing the order on behalf of yourself and the other collaborating provider.