Optional Second Witness Tick Box for High-Risk Medications

The addition of an optional “Second Witness Required” tick box to the Add Drug screen within Atlas eMAR. This feature would enable services to designate individual medications—outside of standard Controlled Drug protocols—as requiring a second staff signature upon administration.

Rationale

While controlled drugs currently trigger a mandatory witness signature, a growing number of safeguarding and governance concerns highlight the need for similar accountability mechanisms for other high-risk medications.

Examples include:

• Lorazepam – where safeguarding teams now request evidence of a second person confirming the dose and clinical justification for use.

• Antipsychotic medications – to demonstrate that pharmaceutical restraint is not being used without multi-staff agreement.

• Insulin – where best practice supports dual checking to minimise the risk of dosage errors.

• Anticancer or cytotoxic drugs – due to their high-risk profiles.

Proposed Feature Design

• New Tick Box Label: “Second Witness Required for Administration”

• Location: Add Drug screen (same area as “Allow Out of Hours” or similar toggles)

• Functionality:

  • When ticked, the system will require two staff signatures for medication administration.

  • Both signatures must confirm dose, timing, and optionally a reason (especially for PRN medications).

  • Can be enabled per individual medication and per resident, supporting person-centred practice.

  • Visibility/auditing of this function should appear in MAR records and reporting dashboards.

Benefits

• Aligns with safeguarding recommendations and best practice clinical guidance.

• Supports quality assurance and audit trails for high-risk medicines.

• Offers services flexibility to tailor practices based on risk, resident need, or local policy.

• Reduces risk of medication error through dual confirmation.

• Reinforces the principle of informed, shared clinical decision-making, especially where PRN use may overlap with restrictive practices.

Conclusion

Introducing a customisable “Second Witness Required” tick box within the Add Drug screen would significantly enhance medication safety and compliance within Atlas eMAR. It would enable providers to proactively meet regulatory expectations while maintaining flexible, person-centred care delivery.