Medication Administration 101: Safe Nursing in Philippines | ORBITECH

What is a Medication Administration Record (MAR)?

MAR is a legal record of all drugs administered to a patient—every signature is a legal document in Philippine courts.
Sign as you give—never before, never after. Your signature = proof of administration.
In the Philippines, MAR is called a 'kardex'—same document, just different name nationwide.
When doctors say 'check the kardex', they mean check the MAR. No confusion needed.
Every medication given must be documented immediately with your full name, PRC license number, and exact time.
PRC number goes next to your signature—hospitals check this during audits.
Allergies, patient details, and prescription info must be clearly visible on the kardex—red wristband? Check kardex first.
Allergy alerts are your first priority. No shortcuts here.

Right patient: Use two identifiers—full name + hospital number—never just 'Are you Maria?'
Ask for name and birthdate. No exceptions in Philippine hospitals.
Right drug: Verify generic name matches prescription exactly—Paracetamol vs. Biogesic? Generic only.
Brand names change, generic names don't. Stick to generic for safety.
Right dose: Calculate carefully—double-check with another nurse for high-risk drugs like insulin or heparin.
Insulin and heparin require buddy checks. No solo calculations allowed.
Right route: Oral, IV, IM? Confirm prescription specifies correct route—crushed tablet ≠ NG tube unless ordered.
If the route isn't clear, ask the doctor. Better safe than sorry.
Right time: Give within 30-minute window before or after scheduled time in most Philippine hospitals.
8am dose means 7:30-8:30am window. Late doses must be documented with reason.

Write legibly—kardex entries must be clear for doctors, nurses, pharmacists, and future audits.
If you can't read it at 6am, rewrite it now. Illegible = unsafe.
Sign with full name and PRC license number after administering each medication—no initials.
PRC number is your professional identity. Include it every time.
Document refused doses with reason—'Patient vomited' or 'Refused oral med'—never leave blank.
Blank space = unanswered question. Always document refusal reasons.
For PRN meds, document assessment findings—'Pain 8/10 before paracetamol 1g PO' shows clinical reasoning.
Show why you gave it. 'Given' alone isn't enough documentation.

Use the formula: Desired dose ÷ Have × Quantity = Amount to give. D=doctor's order, H=what you have, Q=quantity available. $D / H \times Q$
D=500mg ordered, H=250mg per tablet, Q=1 tablet → 500/250×1 = 2 tablets. Simple!
Convert units first: 1g = 1000mg, 1mg = 1000mcg—metric system is your best friend in Philippine hospitals.
When in doubt, convert to milligrams. No guessing with grams.
For IV drips: (Volume × Drop factor) ÷ Time in minutes = drops per minute. DF is microdrip 60gtt/ml or macrodrip 10-15gtt/ml. $\frac{V \times D F}{T}$
Microdrip for pediatrics, macrodrip for adults. Know your tubing before calculating.
Pediatric doses are weight-based: Dose = mg/kg/day × weight. A 10kg child is NOT a small adult—doses are weight-based. $D o s e = \frac{m g}{k g / d a y} \times w e i g h t$
Always check weight in kg. Never use pounds in Philippine hospitals.

D / H \times Q

Common errors in PH hospitals: wrong time, wrong patient, wrong dose calculations—most happen during night shifts.
Night shifts = fatigue = higher error risk. Stay extra alert from 10pm-6am.
Use the '3 checks' rule: check when you take it, when you prepare it, when you give it—three opportunities to catch mistakes.
Three checks = three layers of safety. Skip one = skip safety.
If you make an error, report it immediately per hospital policy—never cover it up. Honesty builds trust.
Mistakes happen. What matters is how you handle them. Report = professionalism.
Use tall man lettering for look-alike drugs—predniSONE vs. prednisoLONE written as 'predniSONE' to highlight differences.
Capital letters save lives. Write 'predniSONE' to prevent confusion.

Controlled drugs (morphine, pethidine) require double documentation: MAR + controlled substance log with witness signature.
Witness signature needed for wasting controlled substances. No exceptions.
Waste must be witnessed by another nurse and documented with reason—'expired vial' or 'patient refused'—never throw in regular trash.
Controlled waste goes in locked bins with witness signatures. No shortcuts.
Keep controlled substances in locked cabinets with limited access per DOH guidelines—only authorized personnel can access.
Key/card access only. No sharing passwords or keys.
Report lost or stolen controlled substances immediately to hospital administrator—this is a legal and ethical requirement in the Philippines.
Lost controlled substances = immediate report. No waiting, no excuses.

In Philippine hospitals, MAR is commonly called a 'kardex' nationwide.: Both government and private hospitals use this term interchangeably with MAR.
Controlled substances require witness signature when wasting.: Per Department of Health regulations in the Philippines, this is mandatory for all controlled drugs.
Medication errors are the 3rd leading cause of patient harm in PH hospitals.: Based on reports from Philippine Health Research and Development Council on patient safety incidents.
Most Philippine hospitals use metric system for medication dosing.: Always convert to milligrams unless the prescription specifically states otherwise.