{"report_id":218,"form_id":"23","user_id":81,"organization_id":10,"question_id":"100","question_type":"Free_Text","text_answer":"The Program Manager (PM) listing the daily medication as a PRN medication in the Medication Administration Record (MAR) was influenced by it being the PM's first time creating a MAR for a new admission of a person that was coming from a hospital discharge. The PM was working in an unfamiliar environment coordinating a discharge from the hospital and had never completed the forms related to both a hospital discharge and new admission to the provider. Further complicating this process was that PM felt pressure from the hospital to complete the discharge quickly. In turn, the PM felt rushed to complete the discharge process which includes creating a MARS due to hospital beds are in high demand due to a very low availability of psychiatric beds. This is influenced by the state regulating the number of hospital beds that need to be available as psychiatric beds.   \r\n\r\nOn the hospital discharge summary report the medications were in a list. The daily medication was listed right below the PRN category which influenced the PM's decision to list it as a PRN. The confusing layout of the discharge summary was influenced by the hospital's lack of understanding of licensed crisis homes.\r\n\r\nAdditionally, the PM listing the daily medication as a PRN medication was influenced by it being their first time creating a MAR without the house supervisor. The PM didn't typically work with PRNs and when they did, the house supervisor was leading the process in creating the MAR. \r\n\r\nAfter the MAR was completed, the home\u2019s House Supervisor double checked the MAR for accuracy. Further contributing to the daily medication being incorrectly listed in the MAR is that the House Supervisor that completed the double check didn't catch the error on the MAR. The House Supervisor not identifying the error was influenced by her being new to the position and it was the first time they completed a double check of a MAR after a hospital discharge.   The double checker  may have been hesitant to correct her direct supervisor.\r\n\r\nAn additional factor influencing the PM listing the daily med as a PRN was that the MAR is created by the provider. Staff felt like the provider staff are not as knowledgeable about medications as a hospital or pharmacy would be. It was the provider's responsibility to create the MAR when the person was discharged from the hospital. The provider had a practice of signing and preparing medication orders 24-48 hours before admission to the provider\u2019s residence. Confirming medication regimen prior to admission was a practice developed to decrease medication errors and ensure continuity between settings. However, sometimes there are medication changes at the hospital during that 24-48 hour window and that information may not be shared or updated within the MAR. While this practice of preparing the medication order in advance wasn\u2019t required, it was influenced by licensing and liability laws for providers and the medication administration policies the provider created.  The provider\u2019s medication administration policies were influenced by the county assigning the responsibility to providers and 245D licensing requirements.","created_by":81,"updated_by":81,"updated_at":"5\/25\/2021 10:26:52 am","created_at":"5\/25\/2021 10:26:52 am","id":16011}