We have received a number of queries from pharmacists regarding MAR charts, transcribing and Nursing and Midwifery Council standards for Medicines Management which applies to nurses.
For pharmacists who are also involved in models, the following information may be useful.
The NMC Standards for Medicines Management define transcribing on page 26 as
Any act by which medicinal products are written from one form of direction to administer to another is transcribing.
If A MAR chart is NOT being used as a hospital drug chart, i.e. not being used as a direction to administer then under the NMC definition of transcribing, it has not been transcribed.
Therefore in circumstances (such as within community services, homecare and other settings) where a MAR (Medicines Administration Record) chart is used for the sole purpose of recording medicine administration, and specifically not as an authorised direction to administer, then the act of completing the medicine details on to the MAR chart is not transcribing and standard 3 of the NMC Standards for Medicines Management and associated guidance may not apply.
In this circumstance, it is essential that there exists a valid 'direction to administer' which authorises administration and which is used as the 'direction to administer' - this could be the signed TTO or discharge summary which is almost always available. Alternatively the pharmacy-labeled medicines with dosing instructions should also be available and would be a valid 'direction to administer'.
Where a MAR chart is intended to be used as a 'direction to administer' (i.e. used as a drug chart) then standard 3 of the NMC Standards for Medicines Management applies in full and the chart must be signed by a valid prescriber before use.
MAR charts and signatures
CQC will be looking to see that the person who has written up the MAR chart has signed and dated the chart so there is accountability.
Should the original "direction to administer" be kept with the MAR chart produced?
Yes this would be good practice where possible e.g. if the original direction to administer is a discharge letter from a hospital, it would be best practice for a copy to be kept with the MAR chart as a reference for other practitioners.
As the professional body for pharmacy, we do not issue guidance for day-to-day nursing practice and it would not be appropriate for us to start to do so, however the information above may be useful for pharmacists working with similar models. We would welcome discussion and debate on whether this solves problems, please note - we are in contact with NMC counterparts who intend to consult on NMC medicines management standards next year.