Stream: implementers
Topic: Total drug dose
Sandy Sorensen (Feb 14 2019 at 17:15):
Hello - Dose under MedicationAdministration is defined as "Amount of medication per dose." How would I represent total dose?
Melva Peters (Feb 14 2019 at 18:13):
Can you provide more information on the specific use case? Do you mean give 250mg per dose up to a maximum dose?
Sandy Sorensen (Feb 21 2019 at 18:41):
The total dose is the total delivered dose of each drug during the reporting period. Prescribed doses or daily doses are not reported. For example, if 50 mg/kg of a drug was given for 5 days, a total dose of 250 mg/kg should be reported.
Jean Duteau (Feb 21 2019 at 18:43):
We haven't had a use case for this data element in the MedicationAdministration, so you would need to represent it using an extension. Having said that, to date, our use cases for MedicationAdministration have been to report a single administration so the idea of a total dose per reporting period does not make sense for the current scope.
Lloyd McKenzie (Feb 21 2019 at 19:13):
If this is reporting information, you might look at MeasureReport. Observation would also be an option.
John Silva (Feb 21 2019 at 22:35):
This seems to also be required for Infusion admin reporting; what you're reporting is the amount given in the specific period, e.g. per hour. This can be reported by knowing the dose rate per unit of volume and calculated by the volume per unit time or it could be from the concentration and the volume, etc.
Jean Duteau (Feb 21 2019 at 22:39):
For infusions, we do have rate which allows you to say, in combination with effectivePeriod, that I have this much per hour over this many hours.
Jean Duteau (Feb 21 2019 at 22:40):
and you could use something similar for total drug dose - use effectivePeriod to say "from day X to day Y" and then dosage would be how much was given over that period. but again, that would sort of be abusing the indicated scope and usage of the resource
Richard Townley-O'Neill (Feb 25 2019 at 02:26):
Would MedicationStatement also be appropriate?
Jean Duteau (Feb 25 2019 at 02:27):
Yes, a statement of use would might work for this use case.
Marten Smits (Feb 23 2021 at 15:50):
I have the same problem reporting the total amount of medication given during a procedure to a quality registry. We only need the total amount for the reporting case period (during the procedure). The registry doesn't want (and need) any more specific data. And clinicians don't want to report more specific data.
Your advise is still to create an extension for this?
Jean Duteau (Feb 23 2021 at 16:15):
as I re-read this thread, I think what you put in the dosage.dose really depends on what you are calling one discrete administration. After all, that is the scope of the resource - to describe what happened in one discrete administration. If you want to communicate a summary of a number of administrations because you don't have the data, then you either need to say that "all of the administrations that occurred during this event, i.e. procedure,encounter,visit, are being considered one administration for purposes of reporting" or you need to use a different resource.
Jean Duteau (Feb 23 2021 at 16:16):
Not having all of the details of your use case, I think that an Observation seems appropriate with a code of "amount of drug given during a procedure" and a valueQuantity.
Jose Costa Teixeira (Feb 23 2021 at 16:50):
for infusion, what IHE has done (a while ago) was to use one MedAdministration for the infusion, and individual MedAdministrations to individual settings or periods.
Jose Costa Teixeira (Feb 23 2021 at 16:51):
This allows interoperability in cases where one system wants the details, the other system just cares about the total.
Jose Costa Teixeira (Feb 23 2021 at 16:52):
But this was for one administration "event" which is an infusion. For "taken this amount over time" would be a good case for Observation (we don't have anything closer, I think).
Marten Smits (Feb 24 2021 at 08:59):
But then I have to create an Observation for each different medication, and have to create codes for observation.code like "amount of penicillin given during procedure", "amount of amoxicillin during procedure" etc?
Since there is no place in Observation to specify a Medication.
Does anyone see a problem with adding a "total dose" extension to dosage?
Jose Costa Teixeira (Feb 24 2021 at 09:34):
for "during procedure" I would not use Observation
Jose Costa Teixeira (Feb 24 2021 at 09:34):
if "procedure" is a time-limite event
Jose Costa Teixeira (Feb 24 2021 at 09:37):
I don't know what is the duration for your "treatment", @Marten Smits . Is it a single clinical session/event, or a seeral-day treatment?
Marten Smits (Feb 24 2021 at 09:41):
It's a colonoscopy, so yes, single clinical session.
Jose Costa Teixeira (Feb 24 2021 at 10:25):
so if you administer bolus of medication (e.g. anesthetics), that for me is one case that you have both:
a) one administration split in several bolus (which is what happens anyway because you have one syringe and administer as you need to adjust the sedation level)
b) one administration in each time you push the syringe.
For me, the parent administration contains the total dosage.
Last updated: Apr 12 2022 at 19:14 UTC
