Stream: implementers
Topic: Planned Medication administrations
Martin Grundberg (Dec 03 2018 at 06:55):
Hi
I was looking into the medication domain. What resource should be used for planned administrations? E.g. a patient should be given a tablett of drug x this evening at 20.00?
The MedicationAdministration resource contains a MedicationAdministrationStatus element, but does not have a Planned status.
It feels strange to use the MedicationDispense resource as nothing has been dispensed (it does not have a planned state either), and the dispensing feels like something else than a planned administration.
How should this use case be handled?
https://www.hl7.org/fhir/medicationadministration.html
https://www.hl7.org/fhir/valueset-medication-admin-status.html
https://www.hl7.org/fhir/medicationdispense.html
Thanks!
Jean Duteau (Dec 03 2018 at 08:16):
You should use a MedicationRequest. You are request that a patient receive a medication. on the request, you would not have a dispenseRequest section as no dispensing is being requested. you would set the MedicationRequest.intent to 'plan'.
Melva Peters (Dec 03 2018 at 15:59):
MedicationAdministration and MedicationDispense are actual events that has taken place. MedicationRequest is an request for a medication. It has an intent attribute that includes "planned".
Martin Grundberg (Dec 04 2018 at 14:39):
Thanks for the answers! I looked at the intent element on MedicationRequest:
proposal The request is a suggestion made by someone/something that doesn't have an intention to ensure it occurs and without providing an authorization to act
plan The request represents an intension to ensure something occurs without providing an authorization for others to act
order The request represents a request/demand and authorization for action
instance-order The request represents an instance for the particular order, for example a medication administration record.
I see two use cases here:
1. The clinician says "patient x should have 2 tablets of drug y 3 times per day for one week" (I see this as the actual "prescription")
*Would this be a MedicationRequest with intent=order?
2. The nurse is presented with an administration chart of all the planned administrations for patient x, e.g. "2 tablets of drug y at 6am", "2 tablets of drug y at 12am" and "2 tablets of drug y at 6pm"
*Wouldnt this be three separate resource instances? (This is the case I asked about in my initial question.)
*You seem both to suggest to set MedicationRequest.intent=plan, but the description for plan doesnt seem to fit this use case (there is authorization by the clinician to act). Could this be seen as three instances of MedicationRequest with intent=instance-order?
Jean Duteau (Dec 04 2018 at 16:58):
Yes, both of your examples would be an actual order and not a plan. A MedRequest with intent=plan would be more akin to a clinician reviewing your health problems and saying "you should start taking low-dose aspirin once a day". There is no authorization implied, but the hope is that the patient will follow the instructions.
Melva Peters (Dec 04 2018 at 20:24):
The intent=instance-order is intended to create separate entries on to a Medication Administration Record for your 2nd use case.
Jose Costa Teixeira (Dec 09 2018 at 09:42):
instance-order was introduced exactly for that purpose: "a patient should be given a tablet of drug x this evening at 20.00"
Last updated: Apr 12 2022 at 19:14 UTC
