A Clinician's Guide: What Does "MAR Hold" Mean in Epic?

October 14, 2025 •

4 min read

Medication errors harm at least 1.5 million people in the U.S. each year [1.7.3]. In the Epic electronic health record (EHR), understanding what does "MAR hold" mean in Epic is a critical skill for clinicians to prevent errors by temporarily pausing medication administration.

Quick Summary

A MAR Hold in Epic's Medication Administration Record (MAR) is a temporary stop on a medication order [1.2.3, 1.4.2]. This function allows clinicians to prevent administration for specific reasons without formally discontinuing the order.

Key Points

Definition: A MAR hold is a temporary stop on a medication order in Epic that keeps the order active but prevents administration [1.2.3].
Purpose: It is used for short-term pauses, such as when a patient is NPO for a procedure, refuses a dose, or has a change in clinical status [1.2.1].
Workflow: Clinicians, typically nurses, place and remove holds directly on the MAR, which visually flags the medication to prevent errors [1.3.3, 1.3.5].
Safety Feature: MAR holds are a key patient safety tool that prevents medications from being given when it may be inappropriate or harmful [1.2.5].
Communication is Key: Using a MAR hold requires clear documentation of the reason and effective communication among the care team [1.6.2].
vs. Discontinued: Unlike a discontinued order, a held medication can be resumed without requiring a new order from a provider [1.4.1, 1.4.7].
Automatic Holds: Holds can be automatically applied during events like patient transfers and must be reconciled before resuming medications [1.6.5].

Understanding the Medication Administration Record (MAR)

The Medication Administration Record, or MAR, is a legal document within a patient's electronic health record that serves as a log of all medications a patient is prescribed [1.2.4, 1.2.6]. In Epic, the MAR is a dynamic tool that helps providers track and manage patient medications to ensure accurate dosage and timing [1.2.4]. Every administration, or intentional omission, must be documented on the MAR to reduce dosage errors and prevent harmful drug interactions [1.2.4]. It is a central hub for nurses, pharmacists, and physicians to collaborate on medication management.

What Does "MAR Hold" Mean in Epic? The Core Definition

A "MAR Hold" is a specific function in Epic that indicates a medication should not be administered for a temporary period [1.2.3, 1.6.2]. Placing a medication on MAR hold keeps the original order active in the system but visually flags it on the MAR, signaling to nurses and other clinicians that it should not be given [1.2.2, 1.4.1]. This feature is designed to handle short-term interruptions in medication therapy without requiring a provider to discontinue and then re-enter the order, which improves both workflow efficiency and patient safety [1.4.2]. The hold can be set for a specific duration or until it is manually removed [1.4.1].

Common Reasons for Placing a MAR Hold

A MAR hold is used in various clinical scenarios where temporarily stopping a medication is necessary. The person placing the hold is prompted to select a reason, which is crucial for communication and documentation [1.6.2].

Patient-Centered Reasons:

NPO Status: The most common reason is when a patient is made "Nothing by Mouth" (NPO) for a surgery or procedure. Oral medications are held until the patient is cleared to eat again.
Patient Refusal: If a patient refuses a dose of medication, placing it on hold allows for documentation and follow-up without canceling the entire order.
Acute Change in Condition: If a patient's blood pressure is low, their scheduled antihypertensive medication might be held. Similarly, if a patient is showing signs of sedation, their opioid pain medication may be put on hold.
Pending Lab Results: A medication like Warfarin might be held pending an INR result to determine the correct dose.
Patient Off Unit: If a patient is away for an extended test or physical therapy during the scheduled administration time, the medication can be placed on hold.

Logistical and System Reasons:

Order Clarification: A nurse or pharmacist may place a hold if they have a question for the prescribing provider about the dose, route, or frequency.
Medication Unavailability: If the pharmacy is out of stock or needs to compound a specific drug, a hold can be placed until it is ready.
Patient Transfer: During a patient transfer between units or facilities, medications are often automatically placed on a MAR hold until orders are reconciled by the receiving team [1.2.1, 1.5.4].

MAR Hold vs. Other Statuses: A Comparison

It's important to distinguish a MAR hold from other medication order statuses within Epic. Misunderstanding these can lead to medication errors or delays in care.


Feature	MAR Hold	Discontinued	Pharmacy Hold
Order Status	Active, but temporarily paused [1.4.2]	Inactive / Canceled	Active, but not verified/dispensed
Action to Resume	Hold must be removed ("unheld") [1.5.3]	A completely new order is required [1.4.7]	Pharmacy must verify and release the order
Primary User	Primarily a nursing/provider function on the MAR [1.3.3]	Provider function in order entry [1.4.7]	Pharmacy function within the pharmacy module
Common Use Case	Patient is NPO for a few hours.	Medication is no longer needed or is being changed.	Initial order review or clarification needed by pharmacist before dispensing.
Visibility	Clearly visible as "Held" on the MAR for nursing [1.3.5]	Order moves to discontinued/inactive tabs [1.4.3]	May show as "unverified" on the MAR

The Workflow: Placing and Removing a MAR Hold

The process is designed to be straightforward for frontline clinicians. While specific steps can vary slightly based on an organization's Epic build, the general workflow is consistent.

Placing a Hold

Typically, a nurse or provider can place a hold directly from the MAR activity [1.5.6]. This often involves:

Selecting the medication on the MAR.
Right-clicking or using a menu option to find the "Hold" or "Place Hold" action.
Choosing a reason for the hold from a predefined list (e.g., NPO, Patient Refusal) [1.6.2].
Adding comments for more specific context if needed [1.6.2].
Specifying a duration if known (e.g., for 8 hours, until a specific time) or leaving it as indefinite [1.4.1].

Once placed, the medication's scheduled times on the MAR will visually change, often turning red or displaying a prominent icon to prevent administration [1.3.5].

Removing a Hold

Resuming the medication is equally important. When the reason for the hold is resolved (e.g., the patient returns from their procedure), the hold must be removed [1.5.3]. This is typically done by selecting the held medication and choosing an "Un-hold," "Remove Hold," or "Resume" action [1.6.3]. Once the hold is released, the medication will reappear on the MAR for its next scheduled administration time. A Best Practice Advisory (BPA) may even remind providers when a medication has been held for an extended period, such as two or more administrations [1.4.1].

Conclusion: A Vital Tool for Safety and Communication

The MAR hold function in Epic is more than just a button; it is a critical communication and patient safety tool [1.2.5, 1.4.2]. When used correctly, it provides a clear, documented, and temporary pause in medication administration that ensures the entire care team is aware of the patient's current status. It prevents medication errors by stopping administration during unsafe periods and improves workflow by avoiding the cumbersome process of discontinuing and reordering routine medications. Proper use of the MAR hold, coupled with clear documentation and verbal handoffs, is a cornerstone of safe medication practice in the modern electronic health record.

Institute for Safe Medication Practices (ISMP)

Frequently Asked Questions

A MAR Hold is typically placed by a nurse or provider at the point of care to temporarily stop administration for a clinical reason (e.g., patient is NPO) [1.3.3]. A 'held by pharmacy' status means the pharmacy has not yet verified or dispensed the medication, often pending clarification.

No. A MAR hold keeps the original order active. To resume the medication, you simply remove the hold from the MAR, and it will become due at its next scheduled time [1.4.1]. A discontinued medication, however, requires a completely new order.

When a medication is on MAR hold, it is visually flagged to prevent administration. The scheduled dose times often appear in red font and may have a specific 'on hold' icon next to them [1.3.5].

If a MAR hold is not removed, the patient will continue to miss scheduled doses of the medication. Some Epic systems have a Best Practice Advisory (BPA) that alerts clinicians when a medication has been held for an extended period or for multiple doses [1.4.1].

The clinician who identifies that the reason for the hold is resolved is responsible for removing it. For example, the nurse caring for a patient who is no longer NPO would be responsible for removing the hold on their oral medications.

Yes, providers can place holds on active medications directly from the 'Orders' activity in Epic. This is useful for temporarily pausing a medication and making the hold visible to all team members [1.4.1, 1.5.6].

Medications are often put on an automatic MAR hold during a transfer between units to ensure patient safety [1.2.1]. This forces the receiving care team to perform an order reconciliation, reviewing and either resuming or discontinuing each medication as appropriate for the new level of care [1.5.4].