MAR charts: best practice for UK care providers

What a MAR is and why it matters

A medication administration record (MAR) is the running record of every medicine a person is prescribed and what happened at every scheduled dose: given, refused, omitted or unavailable. It is a legal record, central evidence for CQC's safe key question, and usually the first document an inspector or pharmacist opens.

Regulation 12 (safe care and treatment) requires the proper and safe management of medicines, and NICE's guidance on managing medicines in care homes sets the recognised standard for record keeping. In practice, a complete and accurate MAR is how you demonstrate both.

The six rights

Every administration should satisfy the six rights, and the MAR is where you evidence them:

• Right person, confirmed against the chart's photo and details.
• Right medicine, matched to the label and the MAR entry.
• Right dose, as prescribed, with strength checked.
• Right time, within the acceptable window for that medicine.
• Right route, oral, topical, inhaled or otherwise, as prescribed.
• Right to refuse. The person's consent matters at every dose. A refusal is recorded with the correct code, never worked around.

Completing the MAR correctly

• Sign at the time of administration, after the person has taken the medicine, never before and never in a batch at the end of the round.
• No gaps. An empty box is an unexplained omission. Every space carries either a signature or an omission code.
• Use the omission codes properly. Refused, hospital, asleep, unavailable: each has a code, and repeated refusals or stock problems trigger escalation to the prescriber or pharmacist, recorded in the notes.
• PRN medicines need a protocol. When to offer, the maximum in 24 hours, the minimum interval, and what to try first. Record why it was given and whether it worked.
• Handwritten entries are double signed. Any medicine added to the chart by hand is checked and countersigned by a second competent member of staff.
• Variable doses record the actual amount. "One or two tablets" is evidenced by writing which was given.

Controlled drugs

Controlled drugs carry extra requirements: a bound CD register with a running balance, storage in a compliant CD cupboard, and witnessed administration as strongly recommended practice (and standard in services with nursing). The register balance should match physical stock at every check, and discrepancies are investigated and escalated the day they are found, not at the next audit.

The errors inspectors find most often

• Unexplained gaps on the chart, the single most common medication finding.
• Signing before administering, which becomes a false record the moment a person refuses.
• PRN given with no protocol, or no record of effect.
• Transcription errors on handwritten entries with no second signature.
• Stock that does not reconcile with what the MAR says was given.
• Covert administration without authority. Hiding medicines in food requires a best interests decision under the Mental Capacity Act, involving the prescriber and pharmacist, all documented.

Auditing your MARs

• Weekly spot checks of a sample of charts per house: gaps, codes, PRN records and balances.
• Monthly full audit with counts reconciled against stock and the CD register.
• Trend the results. Errors per hundred administrations, by house and by shift, so patterns show up.
• Close the loop. Every finding gets an owner, a date and a follow up check. Report notifiable medication incidents through your safeguarding and CQC notification routes.

Where digital MAR (eMAR) helps

Electronic MARs remove the failure modes paper invites: doses cannot be signed in advance, gaps are flagged the moment a round closes, PRN entries demand a reason and an outcome, and every entry is timestamped and attributed automatically. Audits stop being an afternoon with a highlighter and become a live dashboard. For a wider look at digitising records, see our guide on moving from paper to digital care records, and our CQC inspection preparation checklist for how medication evidence fits into the whole assessment.