Managing medicines in home care: the support you give, the MAR chart, and what to do when something goes wrong
Medicines are where a small slip can hurt someone. This guide sets out what NICE says a home care service should do: decide the support, write it down, record every dose, train and check your staff, and learn when something goes wrong. Each point names the paragraph so you can check it.
In short
- The law says you must provide care safely, and that includes “the proper and safe management of medicines” (regulation 12(2)(g)).
- NICE NG67 does not name fixed levels of support. It says the assessment decides what support a person needs, and the care plan must say what that support is for each medicine (1.2.2, 1.2.5).
- Care workers record the support they give for each medicine, every time. The medicines administration record (MAR) is the tool (1.5.2, 1.5.3).
- Care workers give a medicine only if they are trained and assessed as competent (1.7.5), with a review of their competence each year (1.11.1).
- Errors and near misses are reported, reviewed and learned from, in a culture that encourages people to speak up (1.6.2).
1. What the rule says
Regulation 12 is the “safe care and treatment” rule. Medicines are one of the listed things you must do.
12.—(1) Care and treatment must be provided in a safe way for service users.
(g) the proper and safe management of medicines;
CQC’s guidance says what it expects behind that line. Policies should cover supply and ordering, storage, administration, disposal and recording.
Staff responsible for the management and administration of medication must be suitably trained and competent and this should be kept under review.
Medicines must be administered accurately, in accordance with any prescriber instructions and at suitable times to make sure that people who use the service are not placed at risk.
NICE NG67 is the guideline for adults who receive social care in the community. It is guidance, not law. NICE says “It is not mandatory to apply the recommendations”, and it says its recommendations assume responsibilities for medicines support have been agreed with commissioners. Read it with regulation 12 and CQC’s guidance above.
2. Deciding the support a person needs
Start with the assessment. Medicines support is part of the overall assessment, not a separate decision made at the door.
1.2.1 Assess a person’s medicines support needs as part of the overall assessment of their needs and preferences for care and treatment.
1.2.2 Do not take responsibility for managing a person’s medicines unless the overall assessment indicates the need to do so, and this has been agreed as part of local governance arrangements.
NG67 does not give a ladder of named levels. It does separate two kinds of help: helping a person take their own medicines, and giving them.
Supporting people to take their medicines may involve helping people to take their medicines themselves (self-administration) or giving people their medicines (administration).
The person’s own wishes come first where they can. Recommendation 1.2.4 asks you to “Focus on how the person can be supported to manage their own medicines”. If you take on any part of the job, the care plan must say exactly what.
1.2.5 Record the discussions and decisions about the person’s medicines support needs. If the person needs medicines support include the following information in the provider’s care plan:
- what support is needed for each medicine
- how the medicines support will be given
- who will be responsible for providing it, especially when more than one care provider is involved
- how consent for decisions about medicines will be sought, and who to contact about the medicines
- when the support will be reviewed, for example, after 6 weeks
Care workers then work from that plan and nothing else.
1.7.2 Care workers should only provide the medicines support that has been agreed and documented in the provider’s care plan.
Review the support sooner than planned if things change: a change to the medicines, a concern raised, a hospital admission or a bereavement (1.2.6).
3. The MAR chart
A MAR is the medicines administration record. It is where care workers record what they did for each medicine. It is also what the next worker checks before they act.
1.5.2 Care workers must record the medicines support given to a person for each individual medicine on every occasion
That covers reminders as well as giving, and it covers a refusal. The recommendation lists “reminding a person to take their medicine”, “giving the person their medicine” and “recording whether the person has taken or declined their medicine”.
1.5.3 Care workers should use a medicines administration record to record any medicines support that they give to a person.
| What the record shows | Why it is there | Paragraph |
|---|---|---|
| The person’s name, date of birth and other identifiers, such as the NHS number | So the right record is used for the right person | 1.5.5 |
| The name, formulation and strength of each medicine | So the right medicine is given | 1.5.5 |
| How often, or at what time, it should be taken | So the right dose is given at the right time | 1.5.5 |
| How it is taken or used (route) | So it is given the right way | 1.5.5 |
| The name of the person’s GP practice | So you know who to contact | 1.5.5 |
| Any stop or review date | So a finished or reviewed medicine is not carried on | 1.5.5 |
| Additional information, such as specific instructions and any known drug allergies | So the worker has what they need at the door | 1.5.5 |
| Each reminder, dose given, dose taken or declined | So the next worker knows what has been done | 1.5.2, 1.7.6 |
1.5.5 Ensure that medicines administration records include:
Printed records from the pharmacy are the preferred form (1.5.3). Changes should only be made and checked by people trained and assessed as competent to do so (1.5.4). Before a dose, a care worker should “ask the person if they have already taken the dose and check the written records to ensure that the dose has not already been given” (1.7.6).
4. Training and competency
Training alone is not enough. NG67 asks for a check that the worker can do the task.
1.11.1 When social care providers are responsible for medicines support, they should have robust processes for medicines-related training and competency assessment for care workers, to ensure that they:
- receive appropriate training and support
- have the necessary knowledge and skills
- are assessed as competent to give the medicines support being asked of them, including assessment through direct observation
- have an annual review of their knowledge, skills and competencies
The rule that a worker gives a medicine only once trained and assessed is in 1.7.5, alongside authorisation and the “6 R’s” (right person, medicine, route, dose, time, and the person’s right to decline). The legal footing is regulation 12(2)(c):
(c) ensuring that persons providing care or treatment to service users have the qualifications, competence, skills and experience to do so safely;
For the wider picture of staff training, see care staff training: what is actually required. For checks before a worker starts, see care worker recruitment checks.
5. Covert medicines, controlled drugs, ordering and disposal
Covert medicines
Covert means given in a disguised form, without the person knowing. It is never a care worker’s own call.
1.8.2 Care workers must not give, or make the decision to give, medicines by covert administration, unless there is clear authorisation and instructions to do this in the provider’s care plan, in line with the Mental Capacity Act 2005.
Recommendation 1.8.3 lists who is involved: an assessment of the person’s mental capacity for that decision, advice from the prescriber about other options, a best interests meeting, a record of who decided, and a date to review. CQC’s guidance says the same of the law: “the arrangements for giving medicines covertly must be in accordance with the Mental Capacity Act 2005”.
Controlled drugs
NG67 says little on its own. Where the provider is responsible for storing medicines, it asks for safe access “particularly for controlled drugs”, and sends you to NICE’s separate guideline on controlled drugs (1.10.4). We have not summarised that guideline here.
Ordering
Ordering usually stays with the person or their family. If the provider takes it on, 1.9.2 says you “must ensure that the correct amounts of the medicines are available when required”. Care workers record when medicines are ordered and supplied and check for differences between the two (1.9.5).
Disposal
Where the provider is responsible, 1.10.5 says it must have robust processes, in line with the Controlled Waste (England and Wales) Regulations 2012. Disposal is “usually by returning them to a pharmacy”, with a record of the name and quantity, who returned it, the date and the pharmacy.
6. When something goes wrong
A missed dose, a wrong dose, a refused dose, a medicine that has run out: each is something to raise, not hide. NG67 asks for a culture where that is easy.
1.6.2 When social care providers have responsibilities for medicines support, they should have robust processes for identifying, reporting, reviewing and learning from medicines-related problems.
“Fair blame culture” has a plain meaning in the guideline.
In health and social care, this enables open and honest reporting of mistakes that are treated as an opportunity to learn to improve care.
What should a care worker raise? Recommendation 1.6.4 says to raise any concern about a person’s medicines with the provider, and its list includes the person declining, medicines not taken as the prescriber said, possible adverse effects, stockpiling, possible misuse or diversion, changes in mental capacity or health, and:
medication errors or near misses
The provider then looks across the incidents over time.
1.6.3 Social care commissioners and providers should review their medicines-related problems over a period of time to identify and address any trends that may have led to incidents.
A working sequence, each step from the paragraph shown:
- The care worker raises it with the provider straight away (1.6.4).
- If there are clinical questions, advise the person or family to seek advice from a health professional, such as the prescriber or a pharmacist (1.6.5).
- Record it and review it (1.6.2). Look for trends over time (1.6.3) and share what you learn with your staff, the person and their family, and related services such as GPs and pharmacies (1.6.3).
- Treat a medicines-related safeguarding incident under your safeguarding process. Recommendation 1.6.1 says providers must have processes for these, in line with regulation 13.
- Make sure people know how to report adverse effects of medicines through the MHRA Yellow Card scheme (1.6.7).
Some medicines incidents also bring other duties, such as telling CQC. See CQC notifications: what to report and when. NG67 itself does not set a reporting deadline, and we have not given one.
7. Where care homes differ
NG67 covers people who receive care at home. People living in residential or nursing homes are covered by NICE SC1. The care home guideline is more detailed on some points. Two examples:
1.6.5 Care home providers should record all medicines-related safety incidents, including all ‘near misses’ and incidents that do not cause any harm, as a resident safety incident.
1.17.1 Care home providers must ensure that designated staff administer medicines only when they have had the necessary training and are assessed as competent.
If you run a care home as well as a home care service, use SC1 for the home and NG67 for people in their own homes.
How MyCareGuard handles this
MyCareGuard includes a medicines management policy among its 17 core policy areas (16 for a domiciliary service), which you adopt and sign with a dated audit trail. Medication errors go in the incident and events log, tracked to resolution. Staff take short knowledge checks on the policies you have adopted, and each pass is a dated certificate on a training matrix. These are internal awareness checks. They do not replace the direct observation of competence that NG67 1.11.1 asks for.
Questions people ask
Does NICE set out levels of medicines support?
Not by name. NG67 defines medicines support as “any support that enables a person to manage their medicines” and says it “varies for different people depending on their specific needs”. It describes the support itself: reminding, giving, and recording whether the person took or declined the medicine (1.5.2). If your council or your own policy uses level labels, the labels are theirs, not NICE’s.
Who decides whether a care worker should handle someone’s medicines?
The assessment does. Recommendation 1.2.2 says: “Do not take responsibility for managing a person’s medicines unless the overall assessment indicates the need to do so, and this has been agreed as part of local governance arrangements.” The decision and the support for each medicine then go in the provider’s care plan (1.2.5).
Does a MAR chart have to be printed?
Recommendation 1.5.3 says the record “should ideally be a printed record provided by the supplying pharmacist, dispensing doctor or social care provider”. The word is “ideally”. What it must hold is listed in 1.5.5, and changes should only be made and checked by people trained and assessed as competent (1.5.4).
What counts as a near miss, and do we record it?
NG67 defines a near miss as “a prevented medicines-related patient safety incident which could have led to patient harm”. Recommendation 1.6.4 lists “medication errors or near misses” among the concerns care workers should raise with the provider, and 1.6.2 asks for processes for “identifying, reporting, reviewing and learning from medicines-related problems”.
Can a care worker ever give medicines covertly?
Only with authorisation. Recommendation 1.8.2: care workers “must not give, or make the decision to give, medicines by covert administration, unless there is clear authorisation and instructions to do this in the provider’s care plan, in line with the Mental Capacity Act 2005.” Recommendation 1.8.3 sets out who decides and how.
How often should a care worker’s medicines competence be reviewed?
Recommendation 1.11.1 asks for processes so that care workers “have an annual review of their knowledge, skills and competencies”, and are “assessed as competent to give the medicines support being asked of them, including assessment through direct observation”.
Sources
- NICE guideline NG67: Managing medicines for adults receiving social care in the communityPublished 30 March 2017; capture dated 2025; retrieved 2 October 2026 · GOV.UK
- The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, regulation 12SI 2014/2936; retrieved 2 October 2026 · GOV.UK
- CQC: Guidance for providers on meeting the regulations, regulation 12 (safe care and treatment)Retrieved 2 October 2026 · GOV.UK
- NICE guideline SC1: Managing medicines in care homesCapture dated 2025; retrieved 2 October 2026 · GOV.UK
MyCareGuard is software, not a legal adviser or a CQC inspector; it does not give legal advice. This page describes what the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, the CQC’s published guidance and the other named documents say, with the paragraph for each point, so you can read the source yourself. Versions and dates are those in force on the date shown; the documents change, so check the current version before you rely on any of it.
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