Electronic medication management systems: how to choose an eMAR system for your care home

An electronic medication management system, usually called an eMAR, replaces paper MAR charts with a prompted round on a device, records each dose at the moment it is given, and produces the reports a manager otherwise builds by hand. Choosing one comes down to what it does on the round, how prescriptions and changes get into it, which reports you will actually use, how it handles controlled drugs, PRN and stock, what it costs, and how well the supplier supports the switch from paper.

The short answer

An eMAR system is worth having if it removes the error routes that paper cannot: transcription, illegible charts, missed signatures found weeks later, PRN given too soon, wrong-resident errors, and stock that never reconciles. To judge one, watch a real round on it, ask how a new prescription and a mid-month dose change get in, look at the missed-dose, PRN and stock reports, check how controlled drugs and a witness are handled, ask what happens when the wifi drops, and get the total monthly cost in writing with the contract term and the data exit terms. Then plan the switch properly: a pharmacy-reconciled chart on day one, every administering member of staff trained and observed, a paper fallback, and a manager who runs the audit from the new reports in the first month. The benefits of electronic medication management are real, but only if the system is set up and used properly.

Why homes move from paper MAR charts

Most homes move to an electronic medication system for one of three reasons. An inspection has found gaps on the MAR, a transcription error or a stock discrepancy, and the manager wants an end to it. The monthly audit takes a full day and still misses things. Or the home is adopting a digital care record and wants medicines in the same place. All three are good reasons, and the last one is increasingly common as NHS England's Digitising Social Care programme has pushed most homes towards a digital social care record.

Paper MAR charts fail in predictable ways. Handwritten entries for interim prescriptions are misread. Signatures are missed and found at the end of the month. A PRN is given at 2pm because nobody saw the 11am entry on the previous page. Two residents with the same surname share a trolley. Stock is counted once a month and the discrepancy is unexplainable by then. See eMAR versus paper MAR for the full comparison.

An eMAR does not make staff competent, and it will not fix a home where rounds are chronically understaffed. But it makes each of the failures above much harder to commit and immediately visible when it happens.

At a glance: what to look for in an eMAR system

What the system needs to do on the round

The round is where an eMAR earns its keep or fails. Watch one before you sign anything, on the device your staff will use, with a real or realistic set of residents. The carer should see the residents due in the round in a sensible order, each with a photograph, and for each resident the medicines due now with the dose, form and any special instructions. Allergies should be visible without a tap. For any PRN, the time of the last dose and the number given in 24 hours should be visible before the carer can give another.

Signing should happen at the moment the medicine is taken, on the device, with the carer's identity and a time stamp. Codes for not given should be a short list with a reason prompt, and a refused dose should be one tap plus a note, not a form. Late doses should be flagged as they become late, not at the end of the round, and anything unsigned at the end of the round should be impossible to miss.

The screen should be readable on a trolley in a corridor, with gloves on, by someone who has been at work for ten hours. If the demo needs a mouse and a large monitor, it is not designed for the round.

Getting prescriptions in and changes made

This is the part suppliers demonstrate least and the part that causes most errors. Ask how the monthly MAR gets into the system. Some suppliers have an electronic link with pharmacies so the chart is populated from the dispensing record; others require the home to enter each medicine from the label or the prescription. Either way the home checks every item against the prescription on receipt, and the system should support that check with a confirmation step by a second person for any manual entry.

Then ask how a mid-month change is handled: a new antibiotic from the out-of-hours GP on Saturday night, a dose increase phoned through, a medicine stopped after a hospital discharge, a resident admitted with a bag of medicines and a discharge summary. Each needs to be entered, checked, and made visible on the next round. Ask who can make these changes, whether a second confirmation is required, and how the audit trail records who did what.

A large, maintained medicine dictionary matters here. Staff should pick a medicine from a list with its strengths and forms rather than typing it, because typing is transcription by another name.

PRN protocols in the system

Every PRN should have a protocol attached to the medicine in the system, not filed in a folder: what it is for, the dose and interval, the maximum in 24 hours, the signs that mean it is needed, what to try first, and the review date. At the point of administration the carer should see the protocol, be prompted for the reason, be warned or blocked if the interval has not passed or the maximum would be exceeded, and be prompted later for the outcome.

The manager needs a PRN report: frequency by resident and by medicine, reasons given, outcomes recorded, and any doses given outside the protocol. That report is what identifies the resident whose PRN has quietly become a regular medicine and the shift on which PRN for agitation is used far more than on others. Without it the monthly audit is guesswork.

Ask the supplier to show you a PRN given too soon and a PRN with no outcome recorded, and what the system does about each.

Controlled drugs with a witness

Controlled drugs need a register with a running balance, and the law requires two signatures for administration in most homes' policies. In an electronic system that means the witness logs in or authenticates on the device at the time of the dose, not that the carer ticks a box saying a witness was present. Ask how the witness is recorded, whether a witness can be added after the event, and how that shows in the audit trail.

The register should record receipts, administrations, returns, disposals and balance checks with the names of both people each time, and produce a printable register for the pharmacist inspector. Balance checks at handover should be a prompted task with a record.

Discrepancies should be impossible to hide: a count that does not match the running balance should raise an alert to the manager and require a recorded explanation. See controlled drugs in care homes for the process the system needs to support.

Stock, ordering and returns

A live stock count, reduced by each dose given and increased by each receipt, is one of the main benefits of an electronic medication administration record, and it is the one most often undermined by poor setup. Ask how the count handles part packs at go-live, liquids and creams, medicines brought in by residents, doses dropped or refused after being popped, and returns to the pharmacy. Ask what the reorder prompt looks like and whether it can be used to build the monthly order.

The stock discrepancy report is the audit tool: for each medicine, expected count against actual count, with the entries that explain the gap. A home that reconciles stock weekly from the report will find missed signatures and errors within days rather than at the monthly audit.

Check that returns and disposals are recorded with a reason and a witness where required, and that the report can show the value or quantity returned each month, because the ICB medicines team will ask.

Homely remedies and the OTC cupboard

Homely remedies are a small area with a lot of inspection findings, and the system should treat them as medicines. Look for an OTC cupboard function that holds the GP-agreed list with dose, interval, maximum and duration, prompts the first-dose checks for interactions and duplicates, records each dose on the MAR with a reason, shows the 24-hour count, flags the 48-hour rule, and keeps a stock record separate from residents' own medicines.

Ask the supplier to show a homely remedy paracetamol being given to a resident who already has prescribed paracetamol and what the system does. The right answer is a warning that cannot be dismissed without a recorded reason.

Residents' own over-the-counter medicines should be recordable in the care plan with the GP or pharmacist confirmation, so the interaction check covers them too.

Reports you will use every month

Ask to see the reports on a demo home with a month of data. The ones that matter are:

• Missed and late doses by resident, medicine, round, shift and staff member.
• PRN use by resident and medicine, with reasons and outcomes and any protocol breaches.
• Stock discrepancies by medicine with the expected and actual counts.
• Controlled drugs register and balance check history.
• Refusals by resident, to feed the consent and capacity review.
• Temperatures for the room and fridge with out-of-range readings and actions.
• Changes to medicines in the period, who made them and who confirmed them.
• Staff activity: who administered what, when, and any pattern of late signing.
• Audit export: a monthly pack that goes straight into the medication audit.

If a report you rely on today is not there, ask whether it can be built and get the answer in writing. Reports that exist only as a spreadsheet export you have to manipulate are not reports.

Integration with the care record

Medicines do not exist on their own. A carer giving a PRN for pain needs to see the pain assessment; a carer giving a covert medicine needs to see the best interests decision; a manager reviewing a fall needs to see the sedatives given that week. An eMAR inside a care record system puts all of that on the same screen. A standalone eMAR can be excellent on the round and strong on pharmacy links but leaves the manager cross-referencing two systems.

There is no single right answer. A nursing home with complex prescribing and a strong pharmacy relationship may prioritise the pharmacy link. A learning disability or mental health service with a lot of PRN for distress, capacity questions and behaviour monitoring will get more from an eMAR that sits inside the care record. Ask both types of supplier the same questions and decide what matters most in your home.

Whatever you choose, the eMAR should feed the incident process: an error recorded on the round should create the incident, not require a second entry somewhere else.

Data, hosting and security

Medication records are special category data under UK GDPR and the home is the data controller. Ask where the data is hosted, and expect a UK data centre. Ask whether your organisation's data is held separately from other customers' data or in a shared database with logical separation, and what that means if another customer's data is compromised. Ask whether the supplier has completed the Data Security and Protection Toolkit and whether they are on the NHS assured solutions list for digital social care records.

Ask about access control: role-based permissions, individual logins for every member of staff, no shared accounts, automatic logout on the device, and a full audit trail of who viewed and changed what. Ask about backups, how often, where, and how quickly the service can be restored.

Ask what happens to your data if you leave. You should be able to export every resident's medication history in a usable format, and the supplier should delete their copy after an agreed period. Get that in the contract. See how to switch care management system without losing records.

Resilience: devices, wifi and fallback

A round cannot stop because the wifi has dropped. Ask whether the app works offline on the device and syncs when the connection returns, and test it in the demo by turning wifi off mid-round. Ask what the home does if a device is lost or broken: a spare device, a web login on any computer, or a printable MAR for the day. Ask how the printed fallback is reconciled back into the system afterwards.

Check the building. Wifi coverage in every bedroom and corridor is the single most common practical failure at go-live. Walk the building with a phone and find the dead spots before the supplier does. Budget for extra access points if needed.

Write the fallback into your business continuity plan, with where the paper MAR is printed from, who prints it and how often it is refreshed, and test it once a year.

Questions to ask the supplier

1. Can I watch a full round on the device my staff will use, with realistic residents including a PRN, a controlled drug, a refusal and a homely remedy?
2. How does the monthly MAR get into the system, which pharmacies do you link with, and what does the home check on receipt?
3. How is a mid-month change entered, who confirms it, and how does it show on the next round?
4. How big is the medicine dictionary and who maintains it?
5. How is a controlled drug witness recorded, and can a witness be added after the event?
6. What does the system do when a PRN is given too soon or the daily maximum would be exceeded?
7. Show me the missed-dose, PRN, stock and temperature reports for a demo home.
8. What happens when the wifi drops mid-round, and what is the paper fallback?
9. Where is our data hosted, is it separated from other customers, and have you completed the DSPT?
10. What is the all-in monthly cost for our home, what is the contract term and notice period, and how do we get our data out?
11. What training and go-live support is included, and who do staff call at 3am?
12. Can you give me two references from homes like mine that switched in the last year?

Costs and contracts

eMAR systems UK suppliers price in different ways: per bed per month, per home per month, a licence plus setup, or a bundle with the care record. Ask for the all-in monthly figure for your home including support, updates, the pharmacy link if there is one, and any charges for additional users or reports. Ask what devices are needed and whether they are included, and what a replacement costs. Ask whether there is a setup or migration fee and what it covers.

Then ask about the contract: the term, the notice period, whether the price is fixed for the term, and what happens to your data on exit. A long contract with a large exit fee is a risk if the system does not suit your home; a monthly rolling arrangement with a free trial lets you test it on real rounds before committing. Kiwi, for example, charges £279.95 per home per month with 30 days free and no contract, and holds each organisation's data in its own database on a UK server; see pricing.

Weigh the cost against what paper costs you now: the audit hours, the pharmacy MAR charges, the errors and the inspection risk. For most homes the arithmetic is not close.

What inspectors will look at

Inspectors do not care which system you use. They care whether medicines are given as prescribed and whether you can prove it. With an electronic system they will ask to see a resident's MAR on screen and follow a dose through: who gave it, when, what the stock count did, and whether the PRN had a reason and an outcome. They will ask for the missed-dose report and what you did about it. They will look at the controlled drugs register and the witness records. They will ask a carer to show them a round on the device and watch whether they are confident.

They will also check the things a system cannot do for you: the fridge is actually at the temperature the log says, the trolley is locked, staff competency is observed and recorded, errors are reviewed, and the audit produces actions. A home that has bought an eMAR and stopped auditing because the system does it is a common finding.

Be ready to explain your fallback, your training and your data security in plain terms. Inspectors increasingly ask about these under the well-led key question.

Switching from paper: how to do it

The switch is where most of the risk sits. A go-live with a chart that does not match the prescriptions, staff who have had an hour's training, and no fallback, produces errors in the first week that take months to recover trust from. Plan it in four stages.

Before go-live

Reconcile every resident's medicines with the pharmacy and the GP, so the first electronic chart is right. Count all stock and enter it. Attach a protocol to every PRN. Enter the homely remedies list. Train every member of staff who administers, including nights, bank and regular agency, and observe each one on the device before they go live. Check wifi in every room. Print a fallback MAR.

Go-live

Start at the beginning of a pharmacy cycle. Have the supplier and a senior on site for the first rounds of each shift. Run the paper chart alongside for the first cycle if your policy requires, and reconcile daily.

First month

The manager runs the missed-dose, PRN and stock reports weekly and acts on them. Treat every discrepancy as an incident. Expect more recorded errors than on paper, because the system is finding what paper hid, and say so to the team.

Ongoing

Move the monthly audit onto the reports, keep observing rounds, and review the setup at three months.

Training and competence on the new system

Training is not a webinar. Every person who administers medicines needs hands-on time on the device with realistic scenarios, and then an observed round signed off by a senior before they administer alone. Night staff, bank staff and regular agency staff are the ones most often missed and the ones most likely to be on shift when something goes wrong.

Build the system into the medication competency assessment so that a new starter is assessed on the eMAR, not on paper. Keep a short guide by the trolley for the rare tasks: adding a witness, recording a return, printing a fallback. Ask the supplier for a training environment where staff can practise without touching live data.

Record training and sign-off in the staff file. When an inspector asks whether the carer they watched was trained on the system, the answer should be a date and a name. HR and training records that hold the competency against the staff member make that simple.

Learning disability and mental health services

In these services the eMAR needs to handle a lot of PRN for distress and anxiety, psychotropic medicines with STOMP review dates, medicines given under the Mental Health Act, capacity and consent recorded at the medicine level, covert administration with the best interests decision visible, and residents who self-administer some or all of their medicines with a risk assessment. Ask the supplier specifically about each of these.

The link to behaviour monitoring matters: a manager reviewing an ABC chart wants to see the PRN given that afternoon on the same screen, and a psychiatrist reviewing a medicine wants the PRN frequency over three months in a report rather than a folder. An eMAR that sits inside the care record with the behaviour and incident records handles this; a standalone one may not.

Ask about residents who move between services or go home for weekends and how medicines going out and coming back are recorded.

Common mistakes

• Going live from an unreconciled paper chart, so the first electronic MAR is already wrong.
• Training a few champions and expecting them to train nights and agency on the job.
• No wifi survey, so the round stops in the far corridor.
• Stock entered as full packs when half were already used, so the count is wrong from day one.
• PRN protocols not attached at go-live, so the PRN checks do nothing.
• Stopping the monthly audit because the system does it, and missing everything the reports flag.
• Signing a long contract before running a real round on the system.
• Not agreeing data export terms, so leaving later means losing the history.

What good looks like on inspection day

A carer on the round can show the inspector the resident's photo, the dose due, the allergy, the PRN last-dose and sign at the trolley without hesitation. The manager can open the missed-dose report for last month, explain the three late doses and what changed. The controlled drugs register on screen matches the cabinet, with a witness on every dose. The PRN report shows a resident whose paracetamol went from PRN to regular after the report flagged it. The medication audit is built from the reports and its actions are closed. The fallback MAR is in the cupboard and the wifi works in every room.

None of that requires a particular supplier. It requires a system chosen for the round, set up properly, and used by a manager who still audits. If you want to see how Kiwi handles the round, PRN, controlled drugs and the OTC cupboard against your own rounds, book a demo, and see eMAR for what it includes.

Final conclusion

Electronic medication management systems remove most of the ways a competent carer is tripped up on a paper round and turn the monthly audit from a day's work into an hour. The choice comes down to the round, the way prescriptions and changes get in, the PRN and controlled drug handling, the reports, the resilience, the data terms and the cost, in that order. Watch a real round, ask the hard questions, get the cost and the exit terms in writing, and plan the switch as carefully as you would plan an inspection. Done that way, the system becomes the strongest evidence you have that medicines in your home are safe.

Frequently asked

What is an eMAR system?

An eMAR system is an electronic medication administration record. It replaces the paper MAR chart with a screen that shows each resident's medicines, prompts the carer through the round, records each dose with a time stamp and the name of the person who gave it, and produces reports on missed doses, PRN use and stock. Most eMAR systems also handle ordering, controlled drugs and homely remedies.

Is an electronic medication system required by CQC?

No. CQC expects medicines to be managed safely and records to be accurate, complete and available, and it accepts paper where that is achieved. Electronic systems make the evidence easier to produce and remove common error routes such as transcription, but they are a means rather than a requirement.

What are the benefits of electronic medication management?

Fewer missed and late doses because the round is prompted and gaps are visible immediately, no handwritten transcription, photo identification of residents, PRN last-dose and maximum checks at the point of administration, live stock counts, controlled drugs with a recorded witness, and audit reports that take minutes rather than hours. The trade-off is device dependence, training and a monthly cost.

How much does an eMAR system cost in the UK?

Pricing varies by supplier and by what is bundled. Some charge per bed per month, some per home, some a licence plus a setup fee. Ask for the total monthly cost for your home including support, updates and any pharmacy link, whether there is a contract term, and what happens to your data if you leave. Devices are usually an additional cost.

How does the pharmacy link work with an eMAR?

Some systems receive the monthly MAR data directly from the supplying pharmacy so the chart is populated without the home typing anything. Others rely on the home entering medicines from the pharmacy labels or the prescription. Ask which pharmacies the supplier integrates with, what the home has to check on receipt either way, and how mid-cycle changes and interim prescriptions are handled.

Should the eMAR be standalone or part of the care record?

Either can work, but an eMAR inside the care record lets a carer see the PRN protocol, the capacity assessment and the daily notes at the point of administration, and lets the manager see medicines alongside incidents and health monitoring. A standalone eMAR may be stronger on pharmacy integration. Decide what matters most for your home and ask both types of supplier the same questions.

What happens if the internet or the device fails during a round?

Ask the supplier before you buy. Good systems keep working offline on the device and sync when the connection returns, and provide a printable MAR as a fallback. Your business continuity plan should say what staff do, where the paper fallback is, and how the records are reconciled afterwards.

Sources

• NICE SC1 Managing medicines in care homes
• CQC: Medicines in health and adult social care guidance
• NHS England Digitising Social Care programme and the Digital Social Care Records assured solutions list
• Data Security and Protection Toolkit (DSPT) for adult social care
• UK GDPR and the Data Protection Act 2018
• Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 12 Safe care and treatment and Regulation 17 Good governance
• Royal Pharmaceutical Society: The Handling of Medicines in Social Care