DSTU2

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4.10.7 4.14.7 Resource MedicationAdministration - Formal Definitions Detailed Descriptions

Formal definitions Detailed Descriptions for the elements in the MedicationAdministration resource.

MedicationAdministration
Definition

Describes the event of a patient consuming or otherwise being given a dose of administered a medication. This may be as simple as swallowing a tablet or it may be a long running infusion. Related resources tie this event to the authorizing prescription, and the specific encounter between patient and health care practitioner.

Control 1..1
Summary true
Invariants Defined on this element
Inv-2 mad-2 : Reason not given is only permitted if wasNotGiven is true (xpath: not(exists(f:reasonNotGiven)) or f:wasNotGiven='true') not(exists(f:reasonNotGiven) and f:wasNotGiven/@value=false()))
mad-3 : Reason given is only permitted if wasNotGiven is false (xpath: not(exists(f:reasonGiven) and f:wasNotGiven/@value=true()))
MedicationAdministration.identifier
Definition

External identifier - FHIR will generate its own internal IDs identifiers (probably URLs) which do not need to be explicitly managed by the resource. The identifier here is one that would be used by another non-FHIR system - for example an automated medication pump would provide a record each time it operated; an administration while the patient was off the ward might be made with a different system and entered after the event. Particularly important if these records have to be updated.

Note This is a business identifer, not a resource identifier (see discussion )
Control 0..*
Type Identifier
Is Modifier Summary true
MedicationAdministration.status
Definition

Will generally be set to show that the administration has been completed. For some long running administrations such as infusions it is possible for an administration to be started but not completed or it may be paused while some other process is under way.

Control 1..1
Binding MedicationAdministrationStatus: A set of codes indicating the current status of a MedicationAdministration (see http://hl7.org/fhir/medication-admin-status MedicationAdministration. for values) ( Required )
Type code
Is Modifier true
Summary true
MedicationAdministration.patient
Definition

The person or animal to whom receiving the medication was given. medication.

Control 1..1
Type Resource Reference ( Patient )
Summary true
MedicationAdministration.practitioner
Definition

The individual who was responsible for giving the medication to the patient.

Control 1..1 0..1
Type Resource Reference ( Practitioner | Patient | RelatedPerson )
Summary true
MedicationAdministration.encounter
Definition

The visit or visit, admission the or other contact between patient and health care provider the medication administration was performed as part of.

Control 0..1
Type Resource Reference ( Encounter )
Summary true
MedicationAdministration.prescription
Definition

The original request, instruction or authority to perform the administration.

Control 1..1 0..1
Type Resource Reference ( MedicationPrescription MedicationOrder )
Summary true
MedicationAdministration.wasNotGiven
Definition

Set this to true if the record is saying that the medication was NOT administered.

Control 0..1
Type boolean
Is Modifier true
Meaning if Missing If this is missing, then the medication was administered
Summary true
MedicationAdministration.reasonNotGiven
Definition

A code indicating why the administration was not performed.

Control 0..*
Binding MedicationAdministrationNegationReason: ( Reason Medication Not Given Codes: See http://hl7.org/fhir/vs/reason-medication-not-given-codes A set of codes indicating the reason why the MedicationAdministration is negated. ( Example )
Type CodeableConcept
Summary true
Invariants Affect this element
Inv-2 mad-2 : Reason not given is only permitted if wasNotGiven is true (xpath: not(exists(f:reasonNotGiven)) or f:wasNotGiven='true') not(exists(f:reasonNotGiven) and f:wasNotGiven/@value=false()))
MedicationAdministration.whenGiven MedicationAdministration.reasonGiven
Definition

A code indicating why the medication was given.

Control 0..*
Binding Reason Medication Given Codes: A set of codes indicating the reason why the MedicationAdministration was made. ( Example )
Type CodeableConcept
Summary true
Invariants Affect this element
mad-3 : Reason given is only permitted if wasNotGiven is false (xpath: not(exists(f:reasonGiven) and f:wasNotGiven/@value=true()))
MedicationAdministration.effectiveTime[x]
Definition An

A specific date/time or interval of time during which the administration took place. place (or did not take place, when the 'notGiven' attribute is true). For many administrations, such as swallowing a tablet the lower and upper values use of the interval will be the same. dateTime is more appropriate.

Control 1..1
Type dateTime | Period
[x] Note See Choice of Data Types for further information about how to use [x]
Summary true
MedicationAdministration.medication MedicationAdministration.medication[x]
Definition

Identifies the medication that was administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications.

Control 0..1 1..1
Type Resource CodeableConcept | Reference ( Medication )
[x] Note See Choice of Data Types for further information about how to use [x]
Summary true
Comments

If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended. Note: do not use Medication.name to describe the administered medication. When the only available information is a text description of the medication, Medication.code.text should be used.

MedicationAdministration.device
Definition

The device used in administering the medication to the patient. E.g. For example, a particular infusion pump.

Control 0..*
Type Resource Reference ( Device )
Summary true
MedicationAdministration.dosage MedicationAdministration.note
Definition Provides details of how much of

Extra information about the medication was administered. administration that is not conveyed by the other attributes.

Control 0..* 0..1
Invariants Type Defined on this element string Inv-1 : SHALL have at least one of dosage.quantity and dosage.rate (xpath: exists(f:quantity) or exists(f:rate))
To Do Summary The RMIM has priority code on the act relationship. How do we handle this?. true
MedicationAdministration.dosage.timing[x] MedicationAdministration.dosage
Definition The timing schedule for giving

Describes the medication to the patient. This may be a single time point (using dateTime) or it may be a start and end dateTime (Period). dosage information details e.g. dose, rate, site, route, etc.

Control 0..1
Type Summary dateTime | Period true
Comments Invariants This is generally only relevant if the administration record represents a summary Defined on this element
mad-1 : SHALL have at least one of multiple administrations. dosage.quantity and dosage.rate[x] (xpath: exists(f:quantity) or exists(f:rateRatio) or exists(f:rateRange))
To Do Is this in The RMIM has priority code on the 80% for an administration record? If so, need to explain how. 2014/01/22 HG: Changed data type. act relationship. How do we handle this?
MedicationAdministration.dosage.asNeeded[x] MedicationAdministration.dosage.text
Definition If set to true or if specified as a CodeableConcept, indicates that the medication is only taken when needed within

Free text dosage instructions can be used for cases where the specified schedule rather than at every scheduled dose. If a CodeableConcept is instructions are too complex to code. When coded instructions are present, it indicates the pre-condition free text instructions may still be present for display to humans taking or administering the Medication. medication.

Control 0..1
Binding Type MedicationAsNeededReason: A coded concept identifying the pre-condition that should hold prior to consuming a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up", etc. string
Type Summary boolean | CodeableConcept true
MedicationAdministration.dosage.site MedicationAdministration.dosage.site[x]
Definition

A coded specification of the anatomic site where the medication first entered the body. E.g. For example, "left arm".

Control 0..1
Binding MedicationAdministrationSite: ( SNOMED CT Anatomical Structure for Administration Site Codes: See http://hl7.org/fhir/vs/approach-site-codes A coded concept describing the site location the medicine enters into or onto the body. ( Example )
Type CodeableConcept | Reference ( BodySite )
[x] Note See Choice of Data Types for further information about how to use [x]
Summary true
MedicationAdministration.dosage.route
Definition

A code specifying the route or physiological path of administration of a therapeutic agent into or onto the patient. E.g. For example, topical, intravenous, etc.

Control 0..1
Binding RouteOfAdministration: ( SNOMED CT Route Codes: See http://hl7.org/fhir/vs/route-codes A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject. ( Example )
Type CodeableConcept
Summary true
MedicationAdministration.dosage.method
Definition

A coded value indicating the method by which the medication is intended to be or was introduced into or onto on the body. Most This attribute will most often NOT be populated. It is most commonly used for injections. Examples: For example, Slow Push; Push, Deep IV. Terminologies used often pre-coordinate this term with the route and or form of administration.

Control 0..1
Binding MedicationAdministrationMethod: ( See http://hl7.org/fhir/vs/administration-method-codes ) MedicationAdministrationMethod : A coded concept describing the technique by which the medicine is administered.
Type CodeableConcept
Summary true
Comments

One of the reasons this attribute is not used often, is that the method is often pre-coordinated with the route and/or form of administration. This means the codes used in route or form may pre-coordinate the method in the route code or the form code. The implementation decision about what coding system to use for route or form code will determine how frequently the method code will be populated e.g. if route or form code pre-coordinate method code, then this attribute will not be populated often; if there is no pre-coordination then method code may be used frequently.

MedicationAdministration.dosage.quantity
Definition

The amount of the medication given at one administration event. Use this value when the administration is essentially an instantaneous event such as a swallowing a tablet or giving an injection.

Control 0..1
Type Quantity SimpleQuantity
Summary true
Comments

If the administration is not instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount administered over period of time of a single administration (as indicated by schedule).

MedicationAdministration.dosage.rate MedicationAdministration.dosage.rate[x]
Definition

Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 200ml in 2 hours. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time such as 100ml e.g. 500 ml per hour - the duration is then 2 hours. Currently we do not specified, or is specified specify a default of '1' in the quantity. denominator, but this is being discussed. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours.

Control 0..1
Type Ratio Comments If the rate changes over time, each change should be captured as a distinct "dosage" repetition. This element should *not* be used to convey an average rate. MedicationAdministration.dosage.maxDosePerPeriod | Range
Definition [x] Note The maximum total quantity See Choice of a therapeutic substance that was administered Data Types for further information about how to the patient over the specified period of time. E.g. 1000mg in 24 hours. use [x]
Control Summary 0..1 true
Type Ratio Comments To Do How is

If the rate changes over time, and you want to capture this relevant when capturing an administration already performed? Is it in MedicationAdministration, then each change should be captured as a distinct MedicationAdministration, with a specific MedicationAdministration.dosage.rate, and the 80%?. date time when the rate change occurred. Typically, the MedicationAdministration.dosage.rate element is not used to convey an average rate.

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