What to do when the MAR says “given” but the medicine stock does not match

Treat the mismatch as an unanswered safety question

The medicines administration record says a dose was given. A stock check suggests an extra tablet remains, or a count seems short. The immediate temptation is to correct the number, assume the resident took the medicine or ask a worker to change the MAR. None of those actions establishes what happened. A discrepancy can mean an administration error, a recording error, a delivery or disposal error, or a counting mistake. The resident's current safety depends on which explanation is true.

Start with the resident. Check their condition and any change from usual within the care team's competence. Identify the medicine, the prescribed schedule and the time of the last administration that can actually be confirmed. If the mismatch raises a realistic possibility of an omitted dose, an extra dose or another significant medicine exposure, seek medicine-specific advice through the agreed prescriber, pharmacy or urgent clinical route. Do not give a replacement dose, withhold a scheduled dose or alter the next round based only on the stock calculation. Tell the clinician precisely what is known and what remains uncertain.

Preserve the source records as they stand. Keep the MAR, prescription, dispensing label, delivery record, stock record and any separate administration chart available for review. Note when the difference was found and who checked it. A second competent person can independently recount the stock under the home's policy. That check may resolve a simple arithmetic error, but it should not erase the original observation. Record both the first count and the verified count, with their times and authors.

This page concerns an apparent conflict between evidence of administration and physical stock. The missed-dose response owns a known or suspected missed scheduled dose discovered later. Here the MAR already says “given,” so the task is to verify whether that entry, the stock expectation or both are wrong. A signed box is useful evidence, but it is not proof that a tablet was swallowed. A surplus tablet is a clue, but it is not proof that this resident missed this specific dose.

Work out what the stock should have been

A meaningful reconciliation starts with a clear opening balance. Find the last count that was verified, the date and quantity of each supply, any returns or disposal, and each dose documented between the opening balance and the new count. Separate formulations and strengths. Two boxes with similar names may have different strengths or pack sizes. Do not combine a liquid, tablet and dispersible form into one count. Keep medicines prescribed for different residents separate.

Check delivery and ordering records. Was a new pack received but not entered? Was a partial pack carried forward? Did a pharmacy substitute a quantity? Was a medicine returned after a prescription change? Did staff record a disposal or wastage in another log? For a liquid, the apparent remaining volume may be imprecise because of measuring and bottle design. For a patch, creams or inhaler, a simple tablet-style subtraction may not make sense. The reconciliation method must suit the formulation.

Review the MAR timeline. Which doses were signed as administered? Were any entries marked refused, withheld, hospitalised or away from the home? Were any doses given by a visiting professional? Does a medicine have a separate chart that the MAR should cross-reference? CQC's guidance on medicines administration records says records should be accurate and up to date, and that a visiting professional's administration should be recorded on the MAR. NICE SC1 similarly calls for accurate administration records and cross-references where a separate record exists.

Check prescription changes during the period. A dose reduction, temporary hold or new schedule changes the expected stock use. Compare the current prescription, written change confirmation, label, care plan and MAR version. If they differ, stop treating any one document as a complete answer. Escalate the conflicting instruction before the next dose. A MAR is a record of administration, not authority to invent a prescription. The care home needs a current, authorised instruction and a record that clearly shows when the change took effect.

Test alternative explanations without rewriting history

Ask the worker who signed the entry for a factual account. What did they prepare, hand over, observe and record? Did the resident swallow or use the medicine? Was the worker interrupted? Was the signature entered at the bedside or later? An honest statement may reveal that a dose was prepared but not given, or that the administration happened but stock was counted incorrectly. Ask open questions. A leading question such as “you definitely gave this, didn't you?” can make the evidence less reliable.

Speak with the resident where possible. They may remember taking, declining or setting aside the medicine. Their account deserves respect, but memory can be limited by time, illness or the routine nature of the dose. If a family member was involved during a visit or the resident was away from the home, check the agreed medicines handover record. Do not assume that a family member administered a dose simply because the resident was with them. The care plan should specify who supports medicines during absence and how that is communicated.

Review the storage and administration route. Was the medicine in the correct resident's compartment? Was a pack moved to another trolley or room? Was a spare pack opened? Could another resident's medicine have been affected? If a mix-up is plausible, the safety check may need to include another person, with appropriate confidentiality. Secure the medicine and restrict access as local policy requires while the mismatch is investigated. A stock difference may point beyond a single record.

Consider whether the medicines system itself caused the mismatch. A supply delivered after the count but dated earlier, a hand-copied MAR, a late eMAR entry or an unrecorded return can all produce a false expectation. A paper calculation should show each addition and subtraction so someone else can reproduce it. If the electronic system holds the audit history, retain it. Do not replace a record with a clean version that hides the original sequence.

Decide what the resident needs before the next dose

The clinical contact should hear the uncertainty clearly. Explain the medicine and schedule, the apparent stock difference, the signed MAR entry, the last confirmed dose, any symptoms and when the next dose is due. Ask whether the resident needs assessment or monitoring and what to do with the next scheduled dose while the discrepancy remains unresolved. A clinician may need more information before advising. Name the person responsible for gathering it and arrange a time for a decision.

Keep clinical judgement with an appropriate professional. Staff should not apply a universal rule such as “give the spare tablet” or “skip tonight because the MAR was signed.” The effect of a possible missed or extra dose varies with the medicine, dose, interval, indication and resident condition. A high-risk medicine can make time particularly important. This article deliberately provides no medicine-specific dosing table. The safest editorial instruction is to bring the complete evidence and uncertainty to someone qualified to decide.

Write the advice in the resident's care or clinical record and hand it over directly. Record who was contacted, when, what information was shared, what advice was given, whether the dose plan changes and who will review the resident. The next worker should be able to distinguish a verified administration from an unresolved entry. If the clinician gives a new prescription instruction, obtain and incorporate the required written confirmation under the home's policy and NICE guidance. Do not leave an ambiguous verbal message in the incident log.

If the resident deteriorates or new information suggests an additional dose was given, escalate again. A decision based on one hypothesis may no longer fit. The incident should stay open until the immediate dose plan and resident follow-up are clear. Administrative closure must not be used to imply clinical resolution.

Correct the records without concealing the original entry

The MAR needs to be factually accurate. NICE SC1 recommendation 1.14.11 says staff should make an administration record only when the resident has taken the medicine and should record when and why a medicine was not given. For paper mistakes, it advises a single line through the error, then the correction, signature, date and time. Correction fluid should not be used. Follow the electronic system's audit-preserving correction process for an eMAR.

Do not change a signed “given” entry to “not given” solely because the stock count is high. First establish the strongest supported account. If uncertainty remains, record the uncertainty and the actions taken according to local policy. A clear addendum may be more honest than a forced binary outcome. The entry should show the time of the later clarification and its author, so readers do not mistake it for a contemporaneous administration note.

Correct the stock ledger separately, with a reason and traceable author. A revised balance may follow a verified delivery, disposal or counting correction. Do not invent a balancing transaction. Where two people perform a recount, record each check as required by the home's procedure. The goal is to restore a reliable balance and explain the difference. A balance that simply matches after an unexplained adjustment leaves the safety question unresolved.

Keep the incident record linked to, but distinct from, the medicine record. The MAR shows medicine support. The incident record shows investigation, resident response, reporting decisions and learning. An audit should be able to follow the path from discrepancy to clinical advice, corrected record and improvement. It should not require an inspector to infer why an old signature was overwritten.

Apply a separate controlled-drug pathway when relevant

Controlled drugs carry additional stock and record requirements. CQC's controlled drugs guidance for care homes addresses running balances and detailed administration records. If the discrepancy concerns a controlled drug, use the home's controlled-drug procedure immediately as well as the resident-safety response. Involve the registered manager and appropriate accountable officer route where indicated. Preserve registers, stock, packaging and access information. Do not treat a controlled-drug balance difference as an ordinary arithmetic adjustment.

A controlled-drug discrepancy can have several explanations, including recording, supply, disposal, administration or possible diversion. Do not accuse a worker or conclude theft from a single count. Equally, do not postpone escalation while trying to make the numbers fit. CQC's medicines incident guidance says relevant controlled-drug incidents, including loss or theft, should be reported to the local NHS Controlled Drugs Accountable Officer and to police if necessary. CQC notification depends on whether a statutory notification criterion is met.

Keep the broader page boundary clear. A detailed controlled-drug incident article, if one is approved, needs specialist review of the exact drug, register, accountable officer and police routes. This page shows the branch point so a reader recognises when the ordinary MAR-stock reconciliation is insufficient. It does not replace controlled-drug policy or professional advice.

Communicate and report based on what the investigation finds

Tell the resident what happened and what is being checked in a way they can understand. If a medicine may not have been given, or an extra dose may have been taken, explain the uncertainty honestly and what clinical advice has been sought. Follow the resident's preferences, capacity and lawful sharing arrangements when involving family or representatives. Avoid saying “it was only a paperwork error” before that is verified.

Record the communication and follow-up. If the event meets the definition of a notifiable safety incident under CQC Regulation 20, follow the statutory duty of candour process. The broader duty to be open applies in all cases. The manager should make a case-specific decision on the formal threshold and document it. An apology can be given while the investigation is still underway without pretending all facts are settled.

CQC's medicines incident guidance says a medicines error alone is not a separate CQC notification category. A resulting death, injury, abuse or allegation of abuse, or an incident involving police, may trigger a statutory notification. Assess the actual event against current CQC guidance. If the cause is uncertain, state that honestly in the notification. Safeguarding may require a separate local authority referral if there is abuse, neglect or a pattern of concerning failures. An internal incident review does not replace required external reporting.

Report the problem internally even if there is no confirmed harm. NICE expects providers to record medicines-related safety incidents, including near misses, and learn from them. A discrepancy with no proven omission may still reveal a record or stock-control weakness that could harm a resident later. Record the decision maker and reason if external reporting is not required. “No CQC notification” is a conclusion to support, not a default assumption.

Learn from the reconciliation rather than only closing the count

Once the immediate safety issue is controlled, ask which process failed. Was the stock opening balance reliable? Did the pharmacy delivery reach the record? Were returns recorded? Did the MAR reflect the current prescription? Did staff sign before observing administration? Were visiting professionals' doses incorporated? Did the resident self-administer under a current plan? Was a medicine moved between storage locations without traceability?

Test one explanation at a time. If delivery entries are often delayed, compare recent deliveries with stock ledgers. If duplicate administration is possible, review the handover between staff and visiting clinicians. If eMAR corrections are opaque to workers, observe the actual correction process. A policy may be correct on paper yet unusable on a busy shift. A short observed test can reveal more than another reminder email.

Use proportionate action. A single miscount corrected by an independent check may need a clearer counting method. A repeated pattern of signed entries without credible evidence of administration needs wider review, competence assessment and resident safety checks. A mismatch after prescription changes needs better information flow with the prescriber and pharmacy. Set an owner and a date to verify that the change worked. Review whether similar discrepancies appear elsewhere in the home or group before calling the action complete.

Keep staff reporting open. CQC encourages a fair approach to medicines errors and learning. Staff are more likely to disclose uncertainty when they are not pressed to produce a tidy explanation immediately. Fairness does not remove accountability for deliberate concealment or unsafe practice. It allows the investigation to distinguish a weak system, a skills gap and misconduct on evidence.

Example: one extra tablet in a regular pack

During a weekly stock check, the count for a resident's regular medicine is one tablet higher than expected. The MAR shows every scheduled dose as given. The senior worker recounts independently with a colleague and verifies the number. They note the time and do not amend the MAR. They check the last verified balance, delivery quantity, any returns and prescription changes. A delivery record appears complete. The resident has no obvious new symptom, but the team cannot confirm whether one dose was omitted or whether the opening balance was wrong.

The senior worker contacts the pharmacist or prescriber with the medicine, schedule, count and uncertainty before the next dose decision. They record the advice and hand it over. The worker who signed the relevant entries gives a factual account. The resident is told that the team is checking a difference and will update them. The manager opens an incident, reviews whether safeguarding or external reporting criteria are met and checks whether other residents or medicines are affected. The MAR is clarified only when the evidence supports a correction. If the origin remains unknown, the record says so.

The review finds that a part pack was carried over but its opening quantity was not independently verified. The manager updates the receiving and opening-balance check, then audits the next few medicine cycles to see whether the new process prevents unexplained differences. This example illustrates an evidence path, not a claim that every spare tablet is an omitted dose. A different medicine or resident condition could require a more urgent clinical response.

Where Complys may fit

The live Complys care home guide says Complys does not replace the clinical care system used for day-to-day medicine records. Public material supports an administrative compliance context around policies, staff competence, audits and incident reviews. It does not verify that Complys keeps a MAR, counts stock, reconciles medicine balances, calculates a dose or reports incidents to CQC. Product review is required before making any such feature claim.

If the product supports it, a governance record could hold an incident reference, investigation owner, reporting decision, corrective action and follow-up audit. Keep the resident's detailed medicine chart and clinical advice in the authorised care system. A reference to those records may be enough to show the manager that the case is being handled. Copying clinical detail into a general compliance tool should be justified by the provider's information governance arrangements.

CTA: Review Complys for Care and ask how current incident, audit and action workflows can support medicines governance alongside the home's clinical MAR system. Related tool opportunity: A stock-reconciliation worksheet with opening balance, supplies, returns, documented doses, physical count, uncertainty, independent check and clinical escalation. It must not infer that a dose was given or missed automatically. Suggested internal links out: Missed-dose response, care home CQC guide, Complys care page. Suggested links in: Care home medicines governance section, future care medicines cluster page and missed-dose response when a signed record conflicts with stock. Cannibalisation boundary: This page owns a signed MAR entry conflicting with physical medicine stock. Draft 70 owns a missing or uncertain scheduled dose discovered later. Neither owns a controlled-drug discrepancy in full. Do not create separate pages for a surplus or shortage of one tablet unless source and search evidence show a different decision journey.