Using Spot Checks to Reduce Medication Errors in Domiciliary Care
Medication support is one of the highest-risk activities delivered in domiciliary care. Providers rely heavily on supervision, spot checks and quality assurance to evidence that delegated medication tasks are carried out safely and consistently within agreed service models and care pathways.
This article focuses specifically on how spot checks can be used to reduce medication errors, strengthen assurance, and demonstrate control to commissioners and the CQC.
Why medication errors occur in homecare
In domiciliary care, medication errors commonly arise from:
- Infrequent observation of practice
- Assumptions of competence after training
- Rushed visits due to time pressures
- Inconsistent MAR completion
- Poor escalation when discrepancies occur
Spot checks provide one of the few direct opportunities to observe how medication support is actually delivered in people’s homes.
What medication-focused spot checks should cover
Effective spot checks go beyond checking whether medication was given. They typically include:
- Confirmation of identity and consent
- Reading and following the MAR accurately
- Correct preparation and administration method
- Recording immediately after administration
- Recognition and escalation of discrepancies
Operational Example 1: Reducing MAR recording errors
Context: A provider identified recurring MAR gaps during monthly audits, but could not pinpoint why errors were happening.
Support approach: Targeted spot checks were introduced during medication calls for a sample of staff across different teams.
Day-to-day delivery detail: Supervisors observed medication support in real time, focusing on how MARs were read, where they were stored, and when entries were completed. Immediate feedback was provided following the visit.
How effectiveness is evidenced: MAR audit errors reduced significantly within two months, and repeat spot checks showed sustained improvement.
Operational Example 2: Spot checks for complex medication regimes
Context: Several people supported required complex medication schedules, including PRN medication and time-critical doses.
Support approach: The provider introduced risk-based spot checks prioritising complex medication packages.
Day-to-day delivery detail: Spot checks assessed whether staff understood PRN protocols, could explain escalation thresholds, and recorded rationale for administration or omission.
How effectiveness is evidenced: Fewer medication-related incidents were reported, and staff confidence improved during supervision reviews.
Operational Example 3: Learning from near misses
Context: Near misses were being logged but not consistently translated into learning.
Support approach: Spot checks were used following near-miss reports to observe practice and reinforce learning.
Day-to-day delivery detail: Supervisors reviewed the near-miss scenario with staff during the visit, checked real-time practice, and agreed corrective actions.
How effectiveness is evidenced: Improved quality of near-miss reporting and reduced repeat issues.
Commissioner Expectation: Safe delegation and oversight
Commissioner expectation: Commissioners expect providers to evidence how delegated medication tasks are monitored and assured. Spot checks provide visible, practical assurance that policies translate into safe practice.
Regulator / Inspector Expectation (CQC): Safe medicines management
Regulator / Inspector expectation (CQC): Inspectors expect providers to know whether medication is administered safely in people’s homes. Spot checks should demonstrate learning, oversight and timely action when risks are identified.
Governance and reporting
Medication-focused spot checks should feed into:
- Medication audit outcomes
- Supervision and competency reviews
- Incident and near-miss analysis
- Service-level quality reports
When used properly, spot checks become a preventative safety tool rather than a reactive compliance exercise.