Using the Medication Administration Record (MAR)
effectively
Guidance Sheet 22
A MAR chart is the record that shows drugs have been administered to a patient. The carer signs
each time a drug or device is administered to a patient.
Carers administrating medication in the care home setting should be suitably trained and competent
to do so. This should be documented and recorded by a senior carer or manager.
General guidance on MAR charts
1. Care workers who give medication must have a MAR chart which details:
a. Which medication(s) are prescribed for the patient
b. When they must be given
c. What the dose is
d. Any special information, i.e. should the medication be given with food.
2. The MAR chart should be signed when the patient is administered an individual dose or a full
pack if the patient self-administers.
3. The codes shown on the bottom of the MAR chart should be used when a medication is not given
and possibly explained on the reverse of the chart.
4. The information on the MAR chart should be supplemented by the person’s care plan. The care
plan should include personal preferences. For example the care worker giving the medication
should be the same sex as the patient.
5. The MAR chart should be used to record medication which is carried over from a previous month.
The printed MAR chart from the pharmacy may indicate that none of this medication has been
supplied this month but the care worker is able to use the boxes below the medication box to
indicate any medication carried over. Liaise with pharmacy to ensure all current medications are
listed including those not ordered this cycle
6. The MAR chart should be used to record when any non-prescribed medication is given to a
patient. For example a homely remedy.
7. Administrations of controlled drugs (CDs) should be recorded on the MAR chart as well as in the
CD register with the same 2 witness signatures .
How to keep a MAR chart up to date
1. Responsibility for providing and using MAR charts is with the care provider, not the dispensing
GP or pharmacy.
2. Under the general medical services contract (GMS) the GP does not have to sign any documents
produced by the care provider in relation to medicines administration.
3. There may be some incidences when it is appropriate to ask the GP to sign the MAR chart for
example when they visit and change a dose of prescribed medication.
4. Poor records are a potential cause of preventable drug errors. Printed MAR charts are not
essential but are better than handwritten MAR charts. This is due to less risk of error to:
a. Incorrectly transcribing the details from another document
b. Handwriting may be difficult to read or may be misunderstood.
Where handwriting (this is necessary when new items are prescribed at times and on discharge
from hospital) is the only option ensure that there is a robust system in place to check that the
MAR is correct before it is used. Signing and countersigning are appropriate
5. Printed MAR charts are usually supplied by the pharmacy or dispensing GP when the medication
is packaged though this is a complimentary service which the supplier is paying for and therefore
care providers cannot insist on having a printed chart.
Potential problem with MAR chart
MAR charts are only correct at the time of
printing
New prescriptions can be issued at any
time during a monthly cycle. This can result
in a resident having a number of MAR
charts, and some may have different start
dates
If the GP issues a new written prescription
there should be a new MAR chart, but a new
prescription is not always necessary
Medicines prescribed ‘when required’ may
not be required every month. The MAR
chart may only be a list of medication
prescribed and dispensed that month and
therefore ‘when required’ medication may
not be listed
The MAR chart should be supplemented by
information that clearly describes the
circumstances when ‘when required’
medication can be safely given
The MAR chart may include medication
which has not be supplied.
Solution
Anyone can change a MAR chart. But the care provider
should have a system in place to check the source and
accuracy of the changes. A cross reference to the
patients notes is recommended.
When a residents medication is changed carers have
responsibility to amend the MAR chart:
a. Cancel the original directions
b. Write the new directions legibly and in ink on a new
line of the MAR chart
c. Write the name of the doctor or other prescriber who
gave the new directions
d. Date and sign the entry (including a witness when
possible)
Ensure that ‘when required’ medication is added onto the
MAR chart or medication carried over
Ensure that any supplementary information is on the
MAR chart or in the patients care plan
The care provider must check whether the prescriber has
stopped the medication and if so cross it off, clearly
document the reason i.e. stopped and date and sign it. If
treatment is to continue, the care provider should check
why there is no supply.
What does good look like?
1. MAR charts form an essential element in determining whether people who use social care have
been given medication as the prescriber instructed. Consider:
a. Is the person’s name clearly identified?
b. Is the print or handwriting legible and in ink?
c. Are hand written entries cross linked to daily notes?
d. Does the chart show the date including the year?
e. Does the chart look ‘used’ an indication that it was completed at each medication
administration?
f. Are there gaps in the records? If so, do these need to be investigated further?
g. Can the reader clearly identify exactly what has been given on specified dates, for example if
the dose is one or two tablets?
h. Is there sufficient information to enable care workers to give ‘when required’ medication
safely?
i. Is there a guide to the codes used to explain why a medicine has not been given?
j. Can you confirm that the records are valid, for example by checking whether the number of
signatures recorded for the administration of an antibiotic are consistent with the quantity
supplied.
k. In care homes can you cross reference records for controlled drugs on both the MAR chart
and in the CD register?
l. The route of administration should be recorded on the MAR sheet.
2. MAR charts may include details of medication received and disposed of, if this is not the case
ensure these records are kept in another format.
3. Any allergies the patient has should be clearly identified on the MAR chart for the resident. If you
receive printed MAR charts for your residents ensure the pharmacy or dispensing GP has a
record of these so that they can be printed onto the MAR chart.
Example MAR chart.
Record Keeping
Once the current monthly cycle has been finished it is a legal requirement for these records to be
kept in the home even when the service user has left. It is recommended they be retained for a
minimum of 3 years and should be retrievable, if needed. In the case of children’s homes
medication records should be kept for at least 15 years.
To contact us please email: D-CCG.CaringForCareHomes@nhs.net
Version 1_2014 _Review Date: December 2016