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With more than 237 million medication errors happening in England each year, every care worker is required to be at their best game when it comes to medication management.
Get it right, and the people you support are safe, comfortable, and treated with dignity. Get it wrong (even slightly) and the consequences can be severe, not just for the person receiving care, but for your registration, your team, and your career.
The truth is, medication errors in care settings are far more common than most people like to admit. And they do not always happen because staff are careless. They happen because of certain things like gaps in training, unclear processes, poor communication, and the kind of relentless pressure that care workers face every single day.
During a recent Ask the Expert masterclass, Ed Watkinson, Director of Watkinson Consulting and a former CQC inspector with over 35 years of experience across the care sector walked through the medication errors he has seen time and again, both as an inspector and as an adviser to care providers across the UK. This what this blog post aims to reveal in order to help more care workers get it right with medication management.
Here are the five every care worker needs to know.
Incorrect MAR Sheet Documentation
The Medication Administration Record (your MAR sheet) is a legal document. It is the written proof that medication was given safely, to the right person, at the right time. And yet incorrect MAR sheet documentation remains one of the most commonly identified medication errors during CQC inspections.
According to CQC guidance on medicines administration records, staff must keep MAR records up to date at all times, and records must only be completed by a trained member of staff with the skills for managing medicines.
These errors show up in several ways including:
- Signing the MAR sheet before the medication has been administered
- Leaving entries blank with no explanation
- Failing to record when a resident has refused their medication
- Not noting the reason when a dose was omitted or delayed
- Pre-signing sheets in advance to save time during a busy round
Ed shared a real example from his inspecting career that illustrates just how seriously this matters. A resident passed away overnight in a care home, and by morning, the night staff had already pre-signed the MAR sheets for the morning medication round. The medication had not been given. The records said it had. That single medication error exposed by a devastating circumstance became the centre of a formal investigation.
MAR sheet errors are often the result of rushing, of habits that have never been challenged, or of treating the record as a formality rather than a legal document. Even if your service uses paper records or an electronic system, the principle is the same. The MAR sheet must reflect exactly what happened, at the exact time it happened, nothing more, nothing less. CQC will always check MAR sheets during an inspection, and discrepancies will not go unnoticed.
Mishandling PRN Medication
PRN medication also known as medication prescribed to be given “as required” is one of the most widely misunderstood areas of medication management in care, and the medication errors here take several different forms.
The most common is having no written protocol in place at all, leaving staff to make judgement calls they are not trained or authorised to make. Beyond that, giving PRN medication so frequently it has effectively become a regular medication without ever raising it with the GP, and failing to record the outcome after it has been administered, are both medication errors that inspectors look for specifically.
Ed was particularly clear on the escalation point. If a resident is in pain, the protocol should direct staff to try paracetamol first. If that does not work, escalate. Only reach for a stronger option when lower options have been ineffective.
Every PRN medication in your service must have a clear, written protocol attached to it. And every time it is given, the dose, the time, and the observed outcome must be recorded on the MAR sheet.
Poor Stock Control
Running out of a resident’s medication is a medication error. It is also entirely preventable yet it continues to appear in CQC inspection findings. Poor stock control covers a wider range of failures than most people realise, they include:
- Holding medication past its expiry date
- Stock levels that do not match what the MAR sheet shows has been administered
- No clear system for ordering medication before supplies run out
- Disposal and return records that are incomplete or missing entirely
- No documented process for what happens when a resident refuses a dose
Services with an OUTSTANDING CQC rating treat stock control as a safety function but in services where medication errors are found, it is usually treated as an afterthought, which is a wrong approach.
Just so you know, CQC inspectors will physically count your medication stock and compare it against your administration records. If the numbers do not match, you’ll be in a rat race because that discrepancy will become a red flag and questions will be asked.
Covert Medication Without Proper Authorisation
Covert medication means administering medication to a person without their knowledge by either hiding it in food, a drink, or another substance. It is one of the most serious medication errors in care, and when mishandled, the consequences can include criminal prosecution under the Mental Capacity Act 2005.
Covert medication can be lawful but only under a very specific, fully documented set of circumstances. The medication errors occur when:
- It is given without a formal mental capacity assessment for that specific medication decision
- There is no multidisciplinary best interest decision documented
- The GP has not been involved in authorising the covert administration
- There is no dedicated covert medication record detailing when, what, and why
- It is reviewed at the start but never revisited as the person’s condition or capacity changes
The compliance expert, Ed also shared that he witnessed covert medication being used to sedate residents for the convenience of the service, to manage behaviour or make a shift easier to run, rather than in the genuine best interest of the individual. He outrightly called it a safeguarding failure, so if you’ve been practicing this, stop immediately.
NICE Quality Standard QS85 is unambiguous that medicines must not be administered covertly until after a best interests meeting has been held, and that the need for continued covert administration must be regularly reviewed.
Always remember that when it comes to the law, there’s no room for ignorance. CQC expects to see the capacity assessment, the best interest meeting records, GP sign-off, the identities of everyone involved in the decision, and a separate covert medication administration record.
If any of the above mentioned pieces are missing, your service is exposed and this is one of the medication errors inspectors treat with the highest level of scrutiny, so don’t expect an easy going.
Administering Medication Without Competency Sign-Off
With nearly 40% of “Requires Improvement” CQC ratings linked to medication concerns, there’s no room for the slightest medication error if you’re looking to stay compliant with the Care Quality Commission (CQC).
Allowing any member of staff to administer medication without verified, up-to-date training and a formal competency sign-off is a medication error in itself. Attending a training session is not sufficient. Every staff member must be:
- Observed administering medication in practice
- Assessed against the required competency standard
- Formally signed off before administering independently
- Kept up to date with refresher training and reassessment
If your service is short staffed or the available staff are not trained to manage medication, you can get them on our medication management course for just £10 each and they can be qualified to manage medication in 3 days.
Be sure to keep staff training records that we will provide because CQC will ask for it alongside other competency assessments when they come for inspection.
Every medication error we have just covered is preventable. Avoiding them consistently comes down to the same core principles, applied every day not only when an inspection is expected.
Here are the simple steps you can take today to avoid medication errors in your service:
- Keep MAR sheets accurate and up to date in real time. Sign after administering, record every refusal, and never leave a blank unexplained
. - Treat stock control as a safety responsibility, not an admin task. Audit regularly, check expiry dates routinely, and document every disposal and return.
- Have a written PRN protocol for every as-required medication in your service. Make sure all staff understand it, follow it, and record outcomes every time.
- Never administer covert medication without the full legal framework in place. This includes; capacity assessment, best interest decision, GP involvement, and complete documentation.
- Ensure every staff member who handles medication is trained, assessed, and formally signed off, and keep those records accessible at all times.
- Observe practice directly. Do not assume that because training was delivered, it has been understood and applied correctly. Check, verify, and lead by example.
- Keep communication strong between your service, the GP, and the pharmacy.
If you’re a registered manager reading this, the single most powerful thing you need to do to stay ahead of medication errors in your service is to observe practice. By doing this you protect your service users, staff and CQC rating.
If this post has highlighted training gaps you want to address, our Medication Management course is where to start.
It covers safe administration, storage, and record-keeping in both domiciliary and residential settings, designed specifically for care professionals and can be completed online.
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