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In UK homecare, a missed medication or an incorrectly logged dose can trigger a safeguarding investigation, damage your CQC rating, or harm a client. MAR (Medication Administration Record) sheet codes exist to prevent that.
These standardised codes document who took which medication, when, and why it might have been missed. They're the universal language of medication administration — and if your care professionals don't understand them, you're exposed to risk.
This guide explains what MAR sheet codes are, why they matter, how to use them accurately, and what legal requirements apply to maintaining these records in homecare settings.
What are MAR sheets?
A MAR sheet is a record that tracks every medication administered to a client. It includes:
- The name and dosage of each medication
- When it should be given
- Who administered it
- Whether it was taken fully, partially, or not at all
- A reason code if it wasn't taken
MAR sheets are legal documents. They're inspected by the CQC, reviewed by GPs and pharmacists, and used as evidence in safeguarding investigations. Here's an example of a standard MAR sheet from the NHS.
In many homecare agencies, MAR sheets are still paper-based, which creates problems. Handwriting can be illegible, signatures can be missed, and errors can go unnoticed for days or weeks. Digital eMAR (electronic Medication Administration Record) systems solve these issues by standardising how medication is recorded and flagging problems in real time.
Why MAR sheet codes matter
MAR codes aren't optional. They exist to:
Reduce medication errors
Clear codes mean care professionals can identify the medication, dosage, and route at a glance — reducing the chance of giving the wrong drug or dose.
On average, homecare agencies using Birdie's eMAR system catch 61 medication errors per week that would have been missed on paper. Nationally, over 237 million medication errors occur in England each year, with more than half happening at the point of administration.
Improve accountability
When a medication is recorded using standardised codes, it's clear who administered it, when, and whether there were any issues. This creates an auditable trail that protects both clients and staff.
Support CQC compliance
Inspectors expect to see accurate, legible, and complete MAR sheets. Missing signatures, unclear codes, or unexplained gaps can contribute to a downgrade in your rating. Digital systems that use standardised codes make it easier to stay inspection-ready — one Birdie partner, CHD Care at Home, achieved a Good rating across all CQC key lines of enquiry after moving to eMAR.
Save time
Standardised codes streamline documentation. Care professionals spend less time decoding handwritten notes and more time delivering care. Caring Forever, a UK homecare provider, reduced time spent on medication audits by 75% after switching to a digital system with built-in MAR codes.
What information must be included in medication records?
Under UK regulations, medication administration records must be comprehensive. Here's what should be documented:
For the individual:
- Full name and date of birth
- Weight (especially for frail or elderly clients where dosage calculations may be affected)
- Known allergies to medications or ingredients
- Previous adverse reactions, including the type of reaction experienced
- GP name and practice details
For each medication:
- Medication name, formulation (tablet, liquid, patch, etc.), and strength
- Dosage and frequency (how often it should be given)
- Route of administration (oral, topical, subcutaneous, etc.)
- Specific instructions (e.g. with food, on an empty stomach, at bedtime)
- Date when the medication should be reviewed or stopped
- Any monitoring requirements (e.g. blood tests, blood pressure checks)
For PRN (as-needed) medications:
- Clear protocols explaining when the medication should be given
- Maximum dosage and minimum time between doses
- Conditions under which it should be administered
- How to assess whether it has been effective
For adherence support:
- Any assistance the client needs to take their medication (e.g. help opening packaging, reminders, prompting)
This level of detail isn't bureaucracy for its own sake. It ensures that anyone administering medication has the information they need to do so safely, and it provides evidence that you're meeting the 6 Rs of medication administration: right person, right medicine, right dose, right time, right route, right record.
NICE guidelines NG67 (Managing Medicines in Care Homes) and SC1 (Medicines Optimisation in Care Homes) set out these requirements in detail.
Common MAR sheet codes explained
Here are the most frequently used MAR sheet codes in UK homecare:
Medication name
Medications are often abbreviated using their generic name or BNF (British National Formulary) code. For example:
- Aspirin → ASA
- Paracetamol → PARA
Always use the name from the prescription to avoid confusion.
Dosage
Dosages are recorded in milligrams (mg) or micrograms (mcg). For example:
- 25 mg → "25"
- 500 mcg → "500 mcg"
If a medication comes in a blister pack, note the pack details rather than individual doses.
Administration route
The route describes how the medication is given:
- PO (per os) = Oral
- IM = Intramuscular injection
- SC = Subcutaneous injection
- TOP = Topical (applied to skin)
Getting the route wrong can cause harm. If you're unsure, check the prescription or care plan.
Frequency
Frequency codes show how often a medication should be given:
- QD (quaque die) = Once daily
- BID (bis in die) = Twice daily
- TID = Three times daily
- QDS = Four times daily
- PRN (pro re nata) = As needed
PRN medications require extra care. They should only be given when specific conditions are met, and the reason for giving them must be documented.
Time of administration
Time codes indicate when medication should be given:
- AM = Morning
- PM = Evening
- AC (ante cibum) = Before meals
- PC (post cibum) = After meals
- HS (hora somni) = At bedtime
Reason codes (for missed or refused medications)
If a medication isn't given, a reason code must be recorded:
- R = Refused by client
- A = Client asleep or unavailable
- H = Client in hospital
- O = Out of stock
- S = Withheld on medical advice
Every missed or partially taken medication must have a reason code and, ideally, a brief note explaining the context.
How to record medication changes in homecare
Medication changes happen regularly — a GP adjusts a dose, a medication is stopped, or a new prescription is issued. How you record these changes matters.
Immediate documentation
Any change to a client's medication must be recorded as soon as you're informed. This includes:
- Changes in dosage
- New medications added
- Medications discontinued
- Changes in frequency or timing
The record should show what changed, when it changed, and who authorised the change (usually the GP or prescriber).
Who can make changes
Only staff who are competent to manage medication records should update MAR sheets. If you're using paper records, handwritten amendments must be:
- Legible
- Dated
- Signed by the person making the change
- Made in a way that doesn't obscure the original entry (e.g. a single line through outdated information, not scribbled over)
If you're using an eMAR system, changes are timestamped automatically and create an audit trail showing who made the change and when.
Why this matters
Medication records need to reflect the current treatment plan at all times. If a client's medication was changed three months ago but your records don't show it, you can't be sure your care professionals are administering the right treatment. Digital systems solve this by ensuring that updates made in the office are instantly visible in the app used by care staff during visits.
What to do when a visiting health professional administers medication
If a district nurse, GP, or other health professional visits a client and administers medication during a homecare visit, you still need to record it on your MAR sheet. This should include:
- What medication was given
- The dose and route
- Who administered it (name and role)
- The date and time
Even though you didn't administer the medication yourself, maintaining a complete record ensures there are no gaps in the client's medication history. It also prevents duplication — if a care professional arrives later and doesn't know a dose has already been given, they could administer it again.
This is particularly important for PRN medications (like pain relief), where multiple doses within a short timeframe could be dangerous.
How long should medication records be kept?
Medication records are subject to legal retention requirements. In the UK, medicines administration records must be retained for a minimum of eight years after a person's care ends.
This applies whether records are kept on paper or digitally. After the eight-year period, you should review the records to determine whether they're still needed for any legal or operational purpose. If they're no longer required, they should be disposed of securely in line with your local information governance policies.
If you've digitised paper records:
- Perform quality checks on the digital versions before destroying the originals
- Ensure the digital records are complete, legible, and accessible
- Retain metadata (timestamps, who made entries, etc.) as part of the audit trail
Digital eMAR systems simplify this by storing records securely and ensuring they remain accessible for the required period without the risk of physical deterioration or loss.
Legal requirements for medication support in adult social care
If you provide medication support to clients, you're legally required to maintain accurate, up-to-date records. This is mandated by The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Medication support includes:
- Reminding clients to take medication
- Helping clients remove medication from packaging
- Administering medication (partially or fully)
Even if you're only providing prompts or reminders, you must record what support was given and whether the medication was taken.
The 6 Rs of medication administration
All medication administration must follow the 6 Rs framework:
- Right person — you're giving medication to the correct client
- Right medicine — you're administering the correct medication
- Right dose — the dosage matches the prescription
- Right time — it's given at the prescribed time
- Right route — it's administered via the correct method
- Right record — everything is documented accurately
Failure to follow these principles increases the risk of errors and non-compliance. Digital eMAR systems support the 6 Rs by prompting care professionals with the correct information at the point of administration and ensuring records are completed in real time.
How MAR codes prevent errors
In practice, MAR codes act as a safety net. Here's an example:
A client is prescribed 10 mg of Amlodipine (a blood pressure medication) once daily in the morning. The MAR sheet shows:
- Medication: Amlodipine
- Dosage: 10 mg
- Route: PO
- Frequency: QD
- Time: AM
If a care professional sees this recorded clearly, they know exactly what to give and when. But if the MAR sheet is incomplete, illegible, or uses non-standard codes, the risk of error increases.
Now imagine the client refuses the medication. The care professional records:
- Code: R (refused)
- Note: "Client stated they didn't feel well and wanted to skip today's dose. GP informed."
This creates a clear record of what happened and why. If the client's condition worsens, the GP can review the MAR sheet and understand the full context.
The shift to digital MAR sheets
Paper MAR sheets are being replaced by eMAR systems for good reason. Digital systems:
- Use standardised codes automatically, reducing ambiguity
- Flag missed or late medications in real time
- Provide instant alerts to office staff if something goes wrong
- Integrate with NHS databases to reduce transcription errors
- Create an auditable trail that's always inspection-ready
- Ensure records are retained securely for the required eight-year period
If you're still using paper, learn more about how eMAR systems work and the risks they help you avoid. Agencies that make the switch report 61% less time spent on medication audits and significantly fewer medication errors.
What this means in practice
Understanding MAR sheet codes isn't just about compliance — it's about keeping clients safe and reducing risk for your agency. If your team isn't confident using these codes, invest in training. If your MAR sheets are still paper-based and prone to errors, consider whether a digital system would reduce your exposure.
The agencies that get this right see fewer medication errors, faster issue resolution, and better inspection outcomes. The ones that don't often find out the hard way.
For more detail on how to manage medications safely in homecare, read our guide to medication management or explore how medication management software supports compliance and safety.
Want to see how Birdie's eMAR system works in practice? Watch our on-demand webinar on managing medications safely in real time, or explore an interactive demo of safe medication delivery.
Published date:
August 25, 2023
Author:
Frances Knight
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