July 2017 Blog. The Importance of Medicines Administration Record (MAR) Sheets
You will be aware that the MAR Sheet service started in 2005 and has remained largely unchanged since. The specification is basic and was originally called “Pharmacy Labels for Attachment to Medicines Administration Sheets for use by Social Services Provided by Community Pharmacy Services.” The service was commissioned by the PCT and contractors could choose whether they wanted to participate. When PCTs became defunct the responsibility transferred to CCGs.
You will also be aware that the need for MAR sheets in order to help avoid medicine-related hospital admissions has never been greater. During the decade this service has been in existence staff turnover of care agencies appears to have increased and the average length of time for visiting service users per visit has come under pressure. Without this important support in place there could be an increase in demand for residential care sooner rather than later as it becomes increasingly difficult to support patients in their homes.
It is currently the case that the Local Authority delivers Adult Care Services and in May 2016 they issued Medication Management Standards which replaced the old Overarching Medication Policy. The guidance sets out the minimum standards for the provision of assistance to customers directly supported by Derby City Council People Services Directorate, (Adults and Health), or Derbyshire County Council Adult Care and agents acting on their behalf. It is expected, by both local authorities, that any provider acting on their behalf will ensure the principles within the document are incorporated into their policy and practice.
In July 2016, Derbyshire County Council Adult Care produced a detailed policy on Home Care Medication and Health Related Activities. The policy aims to promote the independence of clients to manage their own medication wherever possible. It is accepted, however, that in some cases, clients will require support with some parts, or all, of their medication.
The guidance is designed to support employees, managers, and carers involved in the provision of Home Care services.
- The client must agree to any support provided and there will be an initial assessment to determine what these needs are and how they will be addressed.
- Home Care staff will not make judgements on medication (e.g. take as required unless adequate dosage and directions are on the Medication Administration Record (MAR) sheet).
- The prescriber must write clear instructions on the prescription including the reason for the medicine as well as the dose range and the maximum dose.
- Assistance with medication can only be provided where there is a support plan, medication and associated risk assessments and recording documentation accessible in the client’s home.
- Home Care staff must only administer medication from the original container, which the pharmacist has dispensed into, and not from any container filled by any other person.
- All support with medication must be recorded at the time it is provided, by the person who provides it, so having a MAR sheet is an essential part of the support being provided.
- If a client refuses to take medication from either the original container or compliance aid (e.g. blister pack), the Home Carer must record this with the appropriate code on the visit record sheet, the MAR sheet.
- Where blister packs are provided there should be a description of each tablet in the blister pack. If the client then refuses any tablet from the pack, the Home Carer will be able to identify the tablet being refused. Under these circumstances, a record that describes the colour, size, shape of the tablet will need to be included on the visit record sheet and MAR sheet.
NICE Guidelines were published 30th March 2017; “Managing medicines for adults receiving social care in the community.” This guideline covers medicines support for adults (aged 18 and over) who are receiving social care in the community. It aims to ensure that people who receive social care are supported to take and look after their medicines effectively and safely at home. It gives advice on assessing if people need help with managing their medicines, who should provide medicines support and how health and social care staff should work together.
- Section 1.5 of the Guideline covers record keeping. Social care providers are required by law (The Health and Social Care Act 2008 [Regulated Activities] Regulations 2014) to securely maintain accurate and up to-date records about medicines for each person receiving medicines support. Care workers should use a MAR to record any medicines support that they give to a person. This should ideally be a printed record provided by the supplying pharmacist, dispensing doctor or social care provider (if they have the resources to produce them).
- Section 1.9 of the Guideline covers ordering and supplying medicines. Supplying pharmacists and dispensing doctors should supply medicines in their original packaging. A compliance aid should only be considered when an assessment has been carried out by a health professional (e.g. a pharmacist), in line with the Equality Act 2010, and a specific need has been identified to support medicines adherence. Also, supplying pharmacists and dispensing doctors should consider supplying printed MAR sheets for a person receiving medicines support from a social care provider.
Provision of MAR Sheets through community pharmacy should remain a Locally Commissioned Service, whether commissioned by CCGs, Local Authorities, or a combination of these commissioners in partnership. Every pharmacy in Derbyshire should be invited to contract as a provider. As this service is currently commissioned, any proposal to decommission it should be referred to the Improvement and Scrutiny Committee (Health) at Derbyshire County Council, and/or the Protecting Vulnerable Adults Board at Derby City Council for their consideration of the impact that this would have on a very vulnerable group of people.