Stream: implementers
Topic: Ordering medication nursing services
Jose Costa Teixeira (Oct 25 2021 at 15:52):
We want send out the nurse's worklist - bladder care, colon cleaning, and administer some midazolam.
The group that's working on this found that ServiceRequest could be used for all of these - because the focus of this is the services that the nurse should do.
I am not sure about the boundary between ServiceRequest or MedicationRequest. In this case (or in any case), does it make sense to create a ServiceRequest for describing the nurse activity, instead of the MedicationRequest?
Jose Costa Teixeira (Oct 25 2021 at 15:53):
@Melva Peters @Jean Duteau @Emma Jones @Michelle (Moseman) Miller ?
Jose Costa Teixeira (Oct 25 2021 at 15:54):
@Hans Buitendijk I think this may plug into the discussions of order details. Depends on where this discussion is happening.
Melva Peters (Oct 25 2021 at 15:54):
I would have thought that medication administration orders were sent out using MedRequest using a MAR.
Jose Costa Teixeira (Oct 25 2021 at 16:48):
That is my leaning as well, but the boundaries were not clear. So I'm seeking for agreement from Patient Care and OO, and if there's agreement on these boundaries, we should perhaps make it clear in the resource.
Jose Costa Teixeira (Oct 25 2021 at 16:49):
There are more places where this happens. We can order medications using CarePlan as well.
Jose Costa Teixeira (Oct 25 2021 at 16:50):
The concern I have is that if we have all of that, we can't make simple things like a medication list
Hans Buitendijk (Oct 25 2021 at 16:53):
I understood that MedReq would never be used in combination with ServReq. But where there are similarities, e.g., order details, they should be modeled as similar as possible based on a common pattern. So perhaps the Request pattern should be updated with request details and use the recently adopted ServiceRequest. orderDetail as the template.
Jose Costa Teixeira (Oct 25 2021 at 17:05):
We should also provide guidance for implementers about the boundaries. At this moment, there's nothing in servicerequest that says "this should not be used for ordering medications"
Jose Costa Teixeira (Oct 25 2021 at 20:17):
@Hans Buitendijk can I add a Jira tracker item to add to ServiceRequest the information "one shall not use ServiceRequest to provide medication orders or medication service orders" ?
Jose Costa Teixeira (Oct 25 2021 at 20:18):
(in the workflow call today there was good consensus for that)
Jose Costa Teixeira (Oct 25 2021 at 20:18):
also pinging @Bart Decuypere
Bart Decuypere (Oct 26 2021 at 06:56):
@Melva Peters How would you make clear that a MedicationRequest is a Medication Administration Request, in which a physician asks a nurse to administer medication to a patient?
Bart Decuypere (Oct 26 2021 at 07:00):
@Jose Costa Teixeira MedicationRequest.intent does not seem to have a suitable value for this purpose.
Jose Costa Teixeira (Oct 26 2021 at 07:31):
MedicationRequest.intent doesn't need to say "please administer" because that is what MedicationRequest says already
Jose Costa Teixeira (Oct 26 2021 at 07:32):
The intent is whether this is an order for a series of actions, or just for one specific action
Jose Costa Teixeira (Oct 26 2021 at 08:05):
@Bart Decuypere there may be some clarification or changes to do to differentiate those things. Can you please tell us the difference?
Bart Decuypere (Oct 26 2021 at 08:08):
A physician's order to administer the medication is only the order to administer it. Not the order to obtain the medication. A pharmacist will never give you a medication because there is a referral prescription nursing for medication.
Jose Costa Teixeira (Oct 26 2021 at 08:10):
@Arianne van de Wetering I think this is also what you were requesting - a way to clearly separate the "logistics" and "clinical" aspects of the prescription - right ?
Bart Decuypere (Oct 26 2021 at 08:27):
AFAIK, in Belgium a medication prescription (MedicationRequest) is both "clinical" and "logistics", a referral prescription nursing for medication is only "clinical". As the patient is not capable of administring the medication to him/herself, the physician orders a nurse to do so.
Arianne van de Wetering (Oct 26 2021 at 10:13):
In the Netherlands we indeed distinguish explicitly the therapeutical request/intention and the logistics for supplying the medication. In FHIR this has resulted in separate profiles on MedicationRequest (one for the therapeutic information in a concept we call 'medication agreement' and one for the logistic dispense request) and MedicationDispense (again one for the the therapeutic information in a concept we call 'administration agreement' and one for the logistic dispense). More information on those concepts: https://informatiestandaarden.nictiz.nl/wiki/mp:V9_2.0.0_Ontwerp_medicatieproces_ENG#Introduction_of_relevant_terms
Lloyd McKenzie (Oct 26 2021 at 13:24):
The distinction would be reflected in whether there's a MedicationRequest.dispenseRequest. That's what authorizes the distribution of medication. If it's not present, then a MedicationRequest is solely an "order to administer".
Hans Buitendijk (Oct 26 2021 at 17:51):
Sure.
Last updated: Apr 12 2022 at 19:14 UTC
