When something goes wrong with a patient or a med

You pulled the medication but never gave it

A canceled dose still leaves documentation work. Keep the MAR accurate and account for everything you removed.

6 min read built on 1 full opinion updated 2026-09-14

Written by a med-surg RN, ten years, day shift. Why there is no name on it · How this guide is made

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You pull a controlled medication from the cabinet. Before you give it, the order is canceled. The MAR needs to show that the patient did not receive the dose. The return or waste record needs to show where the medication went.

Key points

  • Don't chart the dose as administered. Use your EHR’s appropriate nonadministration status and give the actual reason, such as the order being discontinued before administration.
  • Account for the medication separately. Complete the approved return or waste transaction linked to the patient and the cabinet removal.
  • Account for everything you removed. If nothing reached the patient, the administered amount is zero. The return or waste record must account for all unused medication, not just the intended dose.
  • Follow your facility’s return, disposal, and verification process. Not sure whether you can return it? Secure it through the approved process and contact pharmacy or the charge nurse. Don't improvise disposal or ask someone to verify waste they didn't observe.

What to write

Your documentation needs to answer two questions:

MAR: What did the patient receive?

Chart the medication and intended dose as not administered, using the appropriate status and the actual reason. Include relevant timing, assessment, communication, and follow-up when needed to explain what happened. Don't chart a medication response for a drug the patient never received.

Return or waste record: Where did the medication go?

Use the designated transaction fields to record:

  • The patient/encounter and original removal transaction.
  • Medication name, strength or concentration, and quantity.
  • The amount returned or wasted, with clear units.
  • The actual date/time and approved return destination or waste method.
  • Your authentication and any required verification from a witness or the person receiving the medication.

Some fields may fill in automatically. You still need the required return transaction or authenticated waste verification. A free-text note doesn't replace either.

The examples below are illustrative charting language, not excerpts from actual patient records. They assume the stated events happened. Use your facility’s actual status labels, and chart only what you can verify.

as written

Canceled order; unopened tablet returned

0912: Oxycodone 5 mg PO administered.

as it holds up

MAR: 0912: Oxycodone 5 mg PO not administered. Order discontinued by J. Lee, MD, at 0910, before administration.

Return record: 0918: Oxycodone 5 mg, 1 unopened unit-dose tablet returned to the ADC designated return bin using the return transaction linked to the 0905 removal.

as written

Canceled order; entire opened vial wasted

1022: Morphine held. Wasted 1 mg.

as it holds up

MAR: 1022: Morphine 1 mg IV not administered. Order discontinued at 1022 before administration.

Waste record: 1026: Morphine 2 mg/mL, 1 mL vial removed at 1020. Administered: 0 mg. Wasted: entire 2 mg, 1 mL, in the approved controlled-substance waste system. Waste observed and electronically verified by A. Patel, RN.

as written

Patient refusal; opened tablet wasted under facility policy

1110: Patient refused. Med discarded.

as it holds up

MAR: 1110: Oxycodone 5 mg PO not administered. Patient declined dose when offered.

Waste record: 1114: Oxycodone 5 mg, 1 opened unit-dose tablet wasted in the approved controlled-substance waste system; linked to the 1105 removal. Waste observed and electronically verified by M. Jones, RN.

Check the morphine total: 2 mg removed, 0 mg administered, 2 mg wasted. The intended dose was 1 mg, but you still have to account for everything you removed.

Refusal isn't cancellation. Document what happened, not whichever reason is easiest to select.

If the order has disappeared from the active MAR: use your facility’s discontinued-order or nonadministration workflow. Ask pharmacy or EHR support for help if needed. Don't create an administration entry just to reconcile the cabinet removal.

If you already signed the dose as given: use the approved MAR correction process. Preserve the audit trail and explain that the dose wasn't administered. Then complete or reconcile the separate return or waste record.

If you are documenting later: follow the late-entry process and make clear which time is the entry time and which is the event time. Don't guess. If you can't verify what happened to the medication, report the discrepancy through the approved process rather than entering an assumed return or waste.

Words to avoid

Wording Why it causes confusion Replace with
GivenSays the patient received the medication.Not administered, followed by the actual reason.
HeldMay suggest a temporary withholding rather than a canceled order.Order discontinued before administration, if accurate.
Returned/wastedLeaves two different dispositions unresolved.The single disposition that occurred, with amount, time, and destination or method.
Med discardedDoes not identify the medication, quantity, or disposal process.Medication name, strength, quantity, and completed approved waste transaction.
Wasted with JaneA name in a comment does not replace required witness authentication.Complete the designated witness verification for the waste actually observed.

Treating the cabinet record as the MAR

The common mistake is treating the cabinet record and the MAR as if they document the same thing.

A cabinet removal shows that medication left inventory. It doesn't show that you gave it. A nonadministration entry in the MAR explains what happened clinically, but it doesn't account for the medication you still have. Even if the systems are linked, these are separate events.

That leaves two common gaps:

  • The MAR says the dose wasn't given, but there's no completed return or waste record.
  • The medication was returned or wasted, but the MAR still says it was administered, or the dose entry is left unresolved.

Canceling the order doesn't close either gap. You still need to document that the dose wasn't given and what happened to the medication. And choosing held or patient refused just to close the entry can give the wrong reason.

Bottom line

The MAR shows what the patient did not receive. The return or waste record shows where the medication went.

In court, 2009

What happened in 1 court case

Davis v. Louisiana State Board of Practical Nurse Examiners, Louisiana Court of Appeal, 2009.

The opinion describes complaints that included hydrocodone entries in the controlled-substance record with no corresponding MAR entries. The court upheld the Board’s license revocation based on a broader record involving multiple facilities and other practice concerns.

This was not a canceled-dose case. You can't attribute the outcome to one documentation mismatch. The connection here is narrower: unless you complete both accurately, the controlled-substance record and the MAR can tell different stories.

Court decisions

Published decisions, linked to CourtListener.

All decisions behind this guide

From nurses online

Quoted as written. Opinion, not a source.

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