Stream: Medication
Topic: Diluent modelling/profiling
Jose Veroes (Jul 25 2018 at 01:32):
Hi,
I'm trying to model / profile diluent data elements within MedicationAdministration resource. The business context is that an Medication Order of an IV infusion could not have explicitly stated the diluent (i.e.: 100ml Sodium Chloride 0.9%, 100ml Glucose 5%) as part of the order, but at time of administration, the person who administer it will make note of the diluent used and other data elements (i.e.: 100ml Sodium Chloride 0.9% over at least 30 minutes, 100ml Glucose 5% over at least 30 minutes).
Even though that the diluent could be considered as an ingredient of the medication, its seems that I need to model it in a more flexible way. So, I have think about the following options and wanted to source perspective, comments about the options or accept other options if they have worked for you.
1) As an ingredient of the medication
Note: Diluent might me "added" to the "administration order / task" at time of administration, so the actual medication administered is "fabricated" at time of administration, not at time of ordering
(this looks as the right way to go, but I'm afraid that the composed/fabricated medication will not exist as a Medication resource)
2) As another Medication resource
3) As a domain resource made up several extensions to cater for Diluent values (Medication name → Coding, diluent volume → dosage component as backbone element)
Hope I'm making sense here.
Thanks
Grahame Grieve (Jul 25 2018 at 02:12):
@Dion McMurtrie haven't we talked about this before ?
Jose Veroes (Jul 25 2018 at 03:48):
@Brett Esler @Richard Townley-O'Neill as HL7 AU Medication WG members. Ta
Richard Townley-O'Neill (Jul 25 2018 at 05:27):
Option 1 looks best to me.
The medication adminsitered will often be different to the one requested, e.g. brand and form may be specified on administration.
Jose Veroes (Jul 26 2018 at 03:53):
Option 1 looks best to me.
The medication adminsitered will often be different to the one requested, e.g. brand and form may be specified on administration.
Thanks Richard.
Going with it present a challenge that the medication administered (a compound medication made of main medication + diluent, i.e.: Azithromycin 500 mg + sodium chloride 0.9% 250 mL) exists as a 2 medication resources (as is), hence the challenge of going this way.
Richard Townley-O'Neill (Jul 26 2018 at 04:29):
You could have three medication resources, one for Azithromycin 500 mg, one for sodium chloride 0.9% 250 mL and one for the combnation with the other two referenced as ingredients, one active and one inactive.
That may or may not be useful.
Jose Veroes (Jul 26 2018 at 06:30):
But MedicationAdministration resource is expecting only 1 Medication resource, which align to option 1. I can't assume that the compound medication will exist in the source system to fulfill FHIR as is. The business context is requiring a more flexible way to deal with diluent and the changes that the diluent bring to the Dosage, ie.: 2 rates, a) that represent the vol/time which is the rate of administration, and one that represent the non-vol/time which is commonly refer as the dose rate
Thanks Richard. Appreciate the discussion!
Jose Costa Teixeira (Jul 26 2018 at 07:43):
Option 1. you will have one medication that may not be a standalone resource, but could be a contained resource.
Jose Costa Teixeira (Jul 26 2018 at 07:44):
and that medication has several ingredients (medications), which are the ingredients you need.
Last updated: Apr 12 2022 at 19:14 UTC
