The six rights, the MAR and the errors that actually happen

Amara Medicines. This is the one that keeps registered managers awake.

Nadia And it should, because medication errors are among the most common causes of avoidable harm in adult social care. But I want to correct something at the start. Most of them are not carelessness.

Amara What are they then?

Nadia Systems failures. Interruptions. Unclear records. Look alike packaging. Two residents with similar names. Covert administration done without a lawful process. If you design a round badly enough, a conscientious person will still make an error.

Amara Let me ask something basic. Is social care different from hospital?

Nadia Fundamentally, and nurses moving into social care are caught by this. In social care the medicines belong to the person. You are supporting somebody to take their own medicine, not dispensing from a ward stock.

Amara Does that change anything practical?

Nadia It changes consent, storage, and above all what happens when they say no. In hospital a refusal is unusual. In somebody's own home it is their medicine, in their house, and refusing is entirely their right.

Amara The six rights. Run through them.

Nadia Right person. Right medicine. Right dose. Right route. Right time. And right to refuse, which is the one that gets left off the poster. Some services add right documentation and right to know, and both are worth having.

Amara Which error is most common?

Nadia Wrong person. And it happens almost exclusively when somebody is interrupted mid round.

Amara Which happens constantly.

Nadia Constantly. Which is why the single most effective intervention is not more training, it is treating the medication round as an interruption free task. Some services use a red tabard or a do not disturb sign. It looks theatrical, staff feel silly wearing it for about a week, and it measurably reduces errors.

Amara The MAR chart. What are the rules?

Nadia Sign after administering, never before. Never sign for a colleague. And code every omission and refusal rather than leaving a gap.

Amara Why does a gap matter so much?

Nadia Because afterwards nobody can tell the difference between a dose that was given and not signed for, and a dose that was never given. A gap is not a small administrative untidiness. It is an unanswerable question in an investigation.

Amara Talk to me about as required medicines. PRN.

Nadia Every one needs a written protocol. What it is for. The dose. The minimum interval. The maximum in twenty four hours. And what to do if it does not work.

Amara And without a protocol?

Nadia Then you are making a clinical decision that you are not authorised to make, however experienced you are. And record why you gave it and whether it worked, because that is the only information a prescriber has to work with when they review it.

Amara Homely remedies?

Nadia Over the counter medicines a service may hold under a written policy agreed with a GP or pharmacist, with a maximum duration before you escalate. It is not a licence to give paracetamol for three weeks because somebody keeps saying their hip aches. At some point that hip needs a doctor.

Amara Controlled drugs.

Nadia Register with a running balance. Correct cabinet. Second signature where policy requires. Witnessed disposal. And one absolute rule that I want said very plainly.

Amara Go on.

Nadia Never adjust a record to make a count balance. Ever. If the numbers do not agree, you report it immediately, that day, even if you are sure it is your own arithmetic. Adjusting the book turns a discrepancy into a falsified record, and that is a dismissal and a referral in every service in the country.

Amara Which brings me to the last thing. I have made an error. What do I do?

Nadia Check the person first. Always the person before the paperwork. Get clinical advice immediately, whether that is the pharmacist, 111 or 999. Tell your manager. Complete an incident report. Record factually on the MAR.

Amara And how frightened should I be?

Nadia Less frightened than you are, and I mean that. Here is the thing about medication errors. Most single errors are survivable. A concealed error that delays treatment very often is not.

Amara So the concealment is the danger, not the error.

Nadia The concealment is the danger. And that puts an obligation on managers as much as on staff. A service that punishes people for errors is a service where errors get hidden. And a service where errors get hidden is a service where somebody eventually dies of something that was entirely fixable in the first twenty minutes.