Standards for the provision and use of Medicines Administration Record (MAR) charts Background The MAR chart is the formal record of administration of medicines and may be required to be used as evidence in clinical investigations or court cases. It is therefore important that they are clear, accurate and up-to-date. MAR charts are required for people who have been assessed as needing support with their medicines from formal carers in either their own home or in a care home setting. The different levels of support include: Assisting Reminding Applying Preparing Objective To provide information on the expected standards required to ensure the safe and appropriate supply and use of MAR charts. To also provide information on the appropriate supply of multi-compartment aids (MCAs) Purpose Sets out the roles and responsibilities of different staff groups to support safe and appropriate supply and use of MAR charts Scope The safe and appropriate supply and use of MAR charts is a multi-agency issue. These standards therefore apply to all involved in the provision and use of MAR charts. Key Principles It should be assumed that every person can self-medicate. A simple medication assessment should be undertaken by healthcare professional or the social care team to establish what level of medicines support is required If the assessment highlights any concerns about the person s ability to take medicines this should be discussed with a member of the pharmacy team A local authority approved MAR chart should be used wherever possible The following information should be included on the MAR chart when produced by the pharmacy: o Patients name, DOB, address o Pharmacy details Page 1 of 5
o GP details o Known allergies o Start date of cycle o Medication name, strength, form, dose, frequency to be taken and dose times, stop dates where appropriate Original packs of medicines with MAR charts should be supplied wherever possible. If a medicine is dispensed in an original pack with a MAR chart, and support with medicines is being provided, the care provider should not re-order the medicines in order to obtain them packaged into an MDS for ease of administration by the carer MDS may be considered reasonable where patients are being encouraged to self-administer through a rehabilitation programme e.g. intermediate care The provision of MDSs will be at the discretion of the pharmacy team; and will not be issued for ease of administration for carers. MDSs should be reserved for those who self-administer which would therefore negate the need for a MAR chart Once the medication has left the pharmacy MAR charts will not routinely be provided retrospectively; pharmacists should use their professional judgment to decide if it is safe to issue retrospective MAR charts. If these are requested from the original supplier, where the system allows MAR charts can be provided with the words no medicines supplied this cycle included on the MAR chart. On discharge from hospital MAR charts will only be provided retrospectively at the discretion of the pharmacy team. It is the carers responsibility to ensure the MAR chart is correct against the medication before administration occurs. This is particularly important when retrospective MAR charts have been supplied without medication. ROLES AND RESPONSIBILITIES Care providers (social care, intermediate care, district nursing) Care providers have responsibility for: Appropriately assessing the person to ensure the reason for support with medicines (and therefor the need for a MAR chart) is appropriate. Communicating the need for a MAR chart to the hospital pharmacy/nursing teams informing them of the level of support being provided and the number of calls being made each day. Any changes in circumstances should also be communicated. Communicating with the persons GP to inform them which provider is giving care to the patient and how many calls are being made. On receiving the medication and MAR chart care provider should ensure that the MAR chart includes: Full name and date of birth Details of medicines being taken Known allergies Any special instructions about how the medicine should be taken. Ensure the MAR chart records are legible, clear, accurate and easily understood. As well as keeping a record of when a prescribed medicine has been given, it is also important to keep Page 2 of 5
Nursing teams (in Acute Trusts) Pharmacy (community & hospital) GPs a record of when it has not been given. Contacting the pharmacy team and/or the GP if information on the MAR chart is incomplete. Written authorisation should be used to confirm missing information. Writing MAR charts where a pharmacy printed MAR chart is unavailable. Handwritten MAR charts should be legible, clear, accurate and easily understood. There should be a robust system in place to check the MAR chart is correct before administration takes place as per local medication policy. Nursing teams have a responsibility for: Communicating the need for a MAR chart to the hospital pharmacy team informing them of the level of support being provided and the number of care visits being made each day in the community. Pharmacy teams have responsibility for: Providing a MAR chart when requested by care providers if the medicines have been supplied by that pharmacy. Ensuring the MAR chart is legible, clear, accurate and easily understood by the carer see appendix 1. Ensuring directions are explicit and unambiguous. Discussing medicines support options where concerns have been raised about a person s ability to take their medicines. Pharmacy teams should assess patients and make reasonable adjustment as outlined in the Equality Act 2010. The Act requires that medication should, wherever possible, be supplied in container which supports the patient to overcome their specific disability. However all patients should be assessed and supported based on their individual function, ability and cognition, regardless of any disability criteria. In the Act, a person has a disability if: o They have a physical or mental impairment o The impairment has a substantial and long-term adverse effect on their ability to perform normal day-to-day activities. Community pharmacy Weekly prescriptions should only be supplied where the pharmacist issues seven days supply of medicines at weekly intervals. The GP / prescriber should immediately be notified (by the community pharmacist), should this situation change. Requests to GPs for weekly prescriptions, by pharmacists, should only be made if there is a risk with giving the patient a full month s supply of medication see Derbyshire Medicines Management position statement for the Supply of Multi-Compartment Aids. GPs have a responsibility for: Ensuring directions are explicit and unambiguous Returning written authorisation forms for dose/directions by secure e-mail, fax back or as per local policy within 48 hours. Where possible keeping a record of the following in the persons clinical record: level of medicines support being provided the number of calls being made each day details of the care provider Read codes are available within the GP clinical systems: Page 3 of 5
SystmOne: XaN5J needs domiciliary care work to administer Emis Web: 8BML needs domiciliary care worker to administer For provision of prescriptions to patients on MDS see Derbyshire Medicines Management position statement for the Supply of Multi-Compartment Aids. Useful contacts Mary Aldred, Medicines Management Technician, North Derbyshire & Hardwick CCGs (For queries about housebound patients with medicines compliance issues) Tel: 01246 514944 Jon Vinson, Lead Medicines Management Pharmacist, North Derbyshire & Hardwick CCGs Tel: 02146 514967 Sian Burleigh, Care Homes Medicines Management Technician, North Derbyshire & Hardwick CCGs Tel: 01246 514941 Emma Benton, Service Manager (Direct Care), Quality and Compliance, Derbyshire County Council Tel: 01629 532090 Shabnum Aslam, Specialist Pharmacist Care Homes & Social Care, Southern Derbyshire CCG and Derby City Council Tel: 01332 868712 Darren Allsobrook, Health & Safety Advisor, Derby City Council Tel: 01332 642380 For queries relating to discharges from the Royal Derby Hospital or the London Road Community Hospital contact the discharging ward Written by: Shabnum Aslam, Specialist Pharmacist, Care Homes & Social Care, Medicines Management Team, SDCCG Pardeep Dhillon, Medicines Management Interface Technician, DTHFT & SDCCG In consultation with: Chesterfield Royal Hospital Foundation Trust Derby Teaching Hospitals Foundation Trust Derbyshire Community Health Services Derby City Council Derbyshire County Council Derbyshire Local Pharmaceutical Committee Appendix 1 Good practice principles (Adapted from Principles of safe and appropriate production of MAR charts, Royal Pharmaceutical Society, February 2009) Principle 1 Page 4 of 5
The MAR chart is constructed on the basis of the current prescription together with information about repeat prescriptions for PRN medicines. Changes to MAR charts should only be made after communication from or with the prescriber. Principle 2 The MAR chart should include all prescribed externally applied medicines Principle 3 When a medicine is prescribed for as required (PRN) administration or as directed (UD) clarity is sought from the prescriber for clear directions and these directions are added to the chart Principle 4 The pharmacy and care service should have robust systems in place to ensure timely removal from the MAR chart of items no longer prescribed or administered Principle 5 When a medicine is included in a MAR chart as two or more differing strengths for administration at differing times of day, these should be placed next to each other on the same MAR chart Principle 6 When medicine formulations are changed, for example from a tablet to a liquid version, the pharmacist should ensure the original item is removed from all future MAR charts for that person Principle 7 Care should be taken to ensure that MAR charts contain clear instructions for medicines that when taken in combination can cause patient harm Principle 8 When a new prescription is issued mid-cycle for a long-term medicine, ideally a new MAR chart will be produced and the product included in subsequent MAR charts when the next cycle commences Principle 9 When a new prescription is issued mid-cycle for an acute medicine a new MAR chart is produced that will cover the entire treatment period Principle 10 Where a pharmacy produces a MAR chart which contains codes to explain why a medicine is not administered, they should ensure that care workers are informed of the purpose and meaning of each code Principle 11 MAR charts should provide the facility for care workers to record additional notes and exceptions Principle 12 The pharmacist should use their professional judgement and liaise with the care service to include appropriate times of administration for each medicine on the MAR chart Page 5 of 5