Medication Basics: The 6 Rs, MAR Charts and Common Errors

Practice guides · Published 16 August 2026 · Last updated 16 August 2026

Medication is one of the highest-risk routine activities in adult social care. Errors are common across the sector, most are preventable, and the defences against them are neither complicated nor expensive: trained staff, the 6 Rs, accurate MAR charts, clear PRN protocols and a culture that reports mistakes fast. The legal footing is Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which requires the safe management of medicines, and the detailed good practice reference is NICE guideline SC1, Managing medicines in care homes. Only staff trained and assessed as competent should administer medication, with competency reviewed regularly.

The 6 Rs of administration

Before any medicine passes your hand, check the 6 Rs, every time, without shortcuts:

1. Right person. Confirm identity positively, by face, photograph on the MAR and, where used, asking the person their name. Never rely on a room number or habit, especially with new residents or agency shifts.
2. Right medicine. Check the label against the MAR chart: name, strength and form. Be alert to look-alike and sound-alike medicines and to changes after hospital discharge.
3. Right dose. Check the dose on the MAR against the label, including units. If a dose seems unusual, stop and query it with a senior, the pharmacist or the prescriber before giving anything.
4. Right time. Check the scheduled time, the minimum interval since the last dose, and timing rules such as before or with food, or time-critical medicines like those for Parkinson's disease, where lateness causes real harm.
5. Right route. Oral, topical, inhaled, patch, eye drops, PEG: give by the route prescribed, and only if you are trained for that route.
6. Right to refuse. An adult with capacity may decline medication, and their refusal must be respected, recorded with the correct MAR code and reported so the prescriber can review. Refusal is information, not defiance. If the person lacks capacity for this decision, a best-interests process under the Mental Capacity Act 2005 applies, and any covert administration needs a documented multidisciplinary plan involving the prescriber and pharmacist.

Some services add further Rs, such as right documentation and right to a review; the habit of checking systematically matters more than the exact count.

MAR charts: the golden rules

The medication administration record (MAR) is the legal record of what was given, and often the first document an assessor, coroner or safeguarding enquiry reads. The rules are simple and unforgiving:

• Sign at the time, not before, not later. Sign immediately after the person has taken the medicine. Signing in advance records something that has not happened; batch-signing at the end of a round invites omissions.
• Never leave gaps. An empty box is an unexplained mystery that reads as a missed dose. If a medicine was not given, enter the correct code for the reason, such as refused, nausea or vomiting, hospitalised, or medicine unavailable, using your service's code list, and record details in the notes.
• One task, one person, start to finish. Do not administer medicines someone else has prepared, and do not sign for anything you did not personally give. Never leave medicines out for later or for someone else to hand over.
• Handwritten entries need care. New or changed prescriptions transcribed by hand onto a MAR should be checked and countersigned by a second trained member of staff, with the prescriber's instruction as the source.
• Record variable doses and patches precisely. For a dose range, record the actual amount given. For patches, record the application site and rotate it.
• Controlled drugs have extra requirements under the Misuse of Drugs Act 1971 framework: storage in an approved cupboard, a controlled drugs register, and, in care homes with nursing and as good practice widely, witnessed administration and running balance checks.

PRN medicines: when required means a protocol, not a habit

PRN (as required) medicines, such as pain relief, laxatives or anxiety medication, cause a disproportionate share of poor practice because they rely on judgement. Every PRN medicine should have an individual protocol stating: what it is for and the symptoms that indicate it; the dose, the minimum interval between doses and the maximum in 24 hours; how the person communicates the need, which matters especially where someone cannot verbally ask, so the protocol should describe the signs of pain or distress to look for; what to try first, such as repositioning or reassurance; and when to escalate to the GP. Record on the MAR the time given, the dose, the reason and, crucially, the outcome, whether it worked, checked after a suitable interval. Watch for drift: PRN given daily for weeks is a prescription review waiting to happen, and PRN sedation used for staff convenience rather than the person's distress is a restrictive practice and a safeguarding issue.

Common errors and their causes

The recurring errors in adult social care are: omitted doses, often masked by MAR gaps; wrong person, usually from interruptions or reliance on habit; wrong time, particularly time-critical medicines; double dosing after unclear handover or unsigned charts; transcription errors on handwritten MARs; missed changes after hospital discharge; and out-of-stock medicines not reordered in time. Behind most of them sit the same conditions: interruptions during the round, rushing, poor handover, and charts not completed in real time. Protect the round: many services use do-not-disturb tabards or quiet protocols, and every service can insist that the person administering is not pulled away mid-task.

When an error happens

Errors happen in good services; what distinguishes good services is what happens next. If you make or discover an error: first, check the person and make them safe; contact the GP, NHS 111, the pharmacist or 999 as the situation requires, and follow any advice given. Tell the senior on duty and the manager immediately. Record the facts on the MAR and in an incident report: what was given or missed, when, what advice was sought and what monitoring follows. Never falsify, backdate or quietly correct a chart; concealment turns a mistake into misconduct. The manager will consider onward duties: notification to CQC where the error caused or risked significant harm, safeguarding referral where neglect is in question, and the duty of candour under Regulation 20, which requires openness with the person and their family when notifiable harm occurs. A good employer treats honest error reporting as learning, reviews the systems behind the mistake, and reserves blame for concealment and recklessness; that is exactly the safety culture CQC's safe key question looks for.

Dos and don'ts

Dos

• Check all 6 Rs for every person, every medicine, every round, however routine it feels.
• Sign the MAR immediately after administration, and use the correct code whenever a dose is not given.
• Follow individual PRN protocols, record the reason and the outcome, and flag frequent PRN use for prescriber review.
• Query anything unclear, unusual or illegible with a senior, the pharmacist or the prescriber before giving it.
• Get handwritten MAR entries second-checked and countersigned.
• Protect the medication round from interruptions and complete one person's medicines at a time.
• Report every error and near miss immediately, and record it honestly.

Don'ts

• Don't administer medicines you did not prepare, or sign for anything you did not personally give.
• Don't pre-sign charts, leave gaps, or leave medicines out for later.
• Don't override a capacitated refusal, or give medicines covertly without a documented best-interests plan.
• Don't use PRN sedation for convenience or let regular PRN use continue without review.
• Don't guess on doses, times or identities; stop and check.
• Don't conceal, backdate or amend records after an error; report it and make the person safe first.