Stream: implementers
Topic: MedicationRequest: handling carrier solution
Fabrice Aupert (Nov 10 2017 at 10:56):
Hi all,
I'm new to FHIR and to Zulip, sorry if this topic has already been discussed or documented somewhere, I was not able to find it.
In the context of an hospital, a physician may prescribe a continuous injection of a 'preparation' made of several drugs. This prescription will be handled by a nurse who will have to prepare this prescription into a bag before administration.
Typically this prescription will have a main product (e.g. morphine) and some additional products (e.g. Sodium chloride) which can be classified as carrier solution, adjuvant, etc
How should we handle this in terms of Medication and MedicationRequest?
Could we use basedOn?
MedicationRequest A (Medication=main product) - id=medreqA
- MedicationRequest B (Medication=carrier solution) - basedOn=medreqA
Thanks.
Fabrice
Lloyd McKenzie (Nov 10 2017 at 12:20):
If it's handled as a single Medication that is prepared before administration, then you'd handle it as a compound - and use Medication.ingredient to describe the mixture. If it's handled as multiple separate bags hanging on an IV, then you'd have separate MedicationRequests and could potentially use RequestGroup to identify timing and/or conditional dependencies between them. MedicationRequest.basedOn is to let you assert that one request is based on the authorization of another request. So it lets you say "Plan B is based on recommendation A" or "Presciption C is based on Plan B and recommendation A" or "Encoded order D is based on prescription C" or "Instance order E is based on Prescription C and Encoded order D". The content of all requests in a "basedOn" chain should be consistent (i.e. same patient and more-or-less same drug, allowing for permitted substitutions and strength adjustments)
Fabrice Aupert (Nov 10 2017 at 13:22):
Hi Lloyd. Thanks for the info, that's very helpful.
Jose Costa Teixeira (Nov 10 2017 at 15:45):
i think Lloyd's guidance is similar to this:
If two different drugs are to be administered at the same time, and if the group of these drugs does not have one unique ID, this is represented by a group of medication requests (i.e., one single request group, with two requests, each representing one medication item.
An example is “Drug A 500 mg and Drug B 150 mg”. Most compound products may be described this way.
Jose Costa Teixeira (Nov 10 2017 at 15:47):
If, however, the grouped composite medication can also be represented in an unequivocal way as a single product (even if as free text), then this can be represented as a single medication.
Put simply, it is recommended to specify a combination of products with a unique resource that unequivocally represents that combination, if that is possible and that unique code exists.
If not, then the combination needs to be described by a group of its constituents.
Last updated: Apr 12 2022 at 19:14 UTC
