When an inspector looks at how a service manages medicines, the medicines administration record (MAR) is one of the obvious places to start. It is a written account of what happened, dose by dose, and it does not depend on who happens to be on shift that day. Read across a few weeks, it says a great deal about how the whole medicines system works.

The small gaps that add up

The things that show up on MAR charts are rarely dramatic. A blank box where a signature should be. A dose recorded without the time, when the timing matters. A “when required” medicine given with no reason written down and nothing to say whether it worked. A handwritten entry nobody else has checked.

On their own, each looks like an admin slip. Together they raise a harder question: if the record cannot show a dose was given, how does anyone know it was? Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 requires “the proper and safe management of medicines”. An inspector judging that will usually start with what the records show.

What CQC expects to see

CQC’s guidance for adult social care is specific. Records should be legible, clear and accurate, without jargon or abbreviations, and signed by the staff who gave the medicine. New handwritten MARs should only be produced in exceptional circumstances, and a second trained member of staff should check and sign them before use.

For “when required” (PRN) medicines, CQC expects the care plan to set out what the medicine is for, the signs to look for, the maximum dose and minimum gap between doses, and other things to try first. When a PRN dose is given, the record should show why, how much, the time where that matters, and whether it worked.

None of this is new. What matters is whether your records meet it on an ordinary Tuesday, not just in the week before an audit.

A records problem is usually a system problem

When MAR gaps keep appearing, the instinct is to remind staff to sign. That rarely holds for long, because the gap is a symptom. It usually points to a process that relies on individuals remembering rather than one that catches errors as they happen.

A few questions help locate where the system is leaning on memory:

  • Checking: Who checks the MAR, and how soon after each round? A gap found the same day can be followed up. One found at the monthly audit usually cannot.
  • PRN protocols: Is there one for every PRN medicine, written so a new or agency worker could follow it?
  • Follow-up: When a gap is found, is it recorded and reviewed, or simply signed off?
  • Electronic MAR: Are missed-dose alerts acted on, or have staff learned to dismiss them?

Electronic systems can remove blank boxes, but they do not remove the need for someone to own the follow-up.

Read your own records first

Pull the MAR charts for one person from the last four weeks and read them as an outsider would. Could you tell, from the record alone, that every dose was given, why each PRN dose was needed and whether it helped? If not, what would have to change in your process, rather than your reminders, for the answer to be yes?