DSTU2 FHIR Release 3 (STU)

This page is part of the FHIR Specification (v1.0.2: DSTU (v3.0.2: STU 2). 3). The current version which supercedes this version is 5.0.0 . For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2 R3 R2

Pharmacy Work Group Maturity Level : 2   Trial Use Compartments : Device , Encounter , Patient , Practitioner , RelatedPerson

Detailed Descriptions for the elements in the MedicationAdministration resource.

[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. Summary true true Summary true Summary true
MedicationAdministration
Definition

Describes the event of a patient consuming or otherwise being 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 Comments true

The WG will be updating the MedicationAdministration resource to adjust each affected resource to align with the workflow pattern (see workflow.html).

Invariants Defined on this element
mad-2 : Reason not given is only permitted if wasNotGiven NotGiven is true (xpath: ( expression : reasonNotGiven.empty() or notGiven = true, xpath: not(exists(f:reasonNotGiven) and f:wasNotGiven/@value=false())) f:notGiven/@value=false()))
mad-3 : Reason given is only permitted if wasNotGiven NotGiven is false (xpath: not(exists(f:reasonGiven) ( expression : reasonCode.empty() or notGiven.empty() or notGiven = 'false', xpath: not(exists(f:reasonCode) and f:wasNotGiven/@value=true())) f:notGiven/@value=true()))
MedicationAdministration.identifier
Definition

External identifier - FHIR will generate its own internal 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
MedicationAdministration.definition
Definition

A protocol, guideline, orderset or other definition that was adhered to in whole or in part by this event.

Control 0..*
Type Reference ( PlanDefinition | ActivityDefinition )
Summary true
MedicationAdministration.partOf
Definition

A larger event of which this particular event is a component or step.

Control 0..*
Type Reference ( MedicationAdministration | Procedure )
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
Terminology Binding MedicationAdministrationStatus: A set of codes indicating the current status of a MedicationAdministration. MedicationAdministrationStatus ( Required )
Type code
Is Modifier true
Summary true
Comments

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

MedicationAdministration.patient MedicationAdministration.category
Definition

The person Indicates the type of medication administration and where the medication is expected to be consumed or animal receiving administered.

Control 0..1
Terminology Binding MedicationAdministrationCategory ( Preferred )
Type CodeableConcept
MedicationAdministration.medication[x]
Definition

Identifies the medication. 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 1..1
Terminology Binding SNOMED CT Medication Codes ( Example )
Type CodeableConcept | Reference ( Patient 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.  For example if you require form or lot number, then you must reference the Medication resource. .

MedicationAdministration.practitioner MedicationAdministration.subject
Definition

The individual who was responsible for giving the medication to person or animal or group receiving the patient. medication.

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

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

Control 0..1
Type Reference ( Encounter | EpisodeOfCare )
MedicationAdministration.supportingInformation
Definition

Additional information (for example, patient height and weight) that supports the administration of the medication.

Control 0..*
Type Reference ( Any )
MedicationAdministration.effective[x]
Definition

A specific date/time or interval of time during which the administration took place (or did not take place, when the 'notGiven' attribute is true). For many administrations, such as swallowing a tablet the use of 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.prescription MedicationAdministration.performer
Definition

The original request, instruction or authority individual who was responsible for giving the medication to perform the administration. patient.

Control 0..1 0..*
Summary true
MedicationAdministration.performer.actor
Definition

The device, practitioner, etc. who performed the action.

Control 1..1
Type Reference ( MedicationOrder Practitioner | Patient | RelatedPerson | Device )
Summary true
MedicationAdministration.wasNotGiven MedicationAdministration.performer.onBehalfOf
Definition

The organization the device or practitioner was acting on behalf of.

Control 0..1
Type Reference ( Organization )
MedicationAdministration.notGiven
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
Comments

This element is labeled as a modifier because it indicates that a administration didn't happen.

MedicationAdministration.reasonNotGiven
Definition

A code indicating why the administration was not performed.

Control 0..*
Terminology Binding SNOMED CT Reason Medication Not Given Codes: A set of codes indicating the reason why the MedicationAdministration is negated. Codes ( Example )
Type CodeableConcept
Summary true Invariants Affect this element
mad-2 : Reason not given is only permitted if wasNotGiven NotGiven is true (xpath: ( expression : reasonNotGiven.empty() or notGiven = true, xpath: not(exists(f:reasonNotGiven) and f:wasNotGiven/@value=false())) f:notGiven/@value=false()))
MedicationAdministration.reasonGiven MedicationAdministration.reasonCode
Definition

A code indicating why the medication was given.

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

A specific date/time Condition or interval of time during which the administration took place (or did not take place, when the 'notGiven' attribute is true). For many administrations, such as swallowing a tablet observation that supports why the use of dateTime is more appropriate. medication was administered.

Control 1..1 0..*
Type dateTime Reference ( Condition | Period Observation )
[x] Note Comments See Choice of Data Types for further information about how

This is a reference to a condition that is the reason for the medication request. If only a code exists, use [x] Summary true reasonCode.

MedicationAdministration.medication[x] MedicationAdministration.prescription
Definition

Identifies the medication that was administered. This is either a link to a resource representing the details of the medication The original request, instruction or a simple attribute carrying a code that identifies authority to perform the medication from a known list of medications. administration.

Control 1..1 0..1
Type CodeableConcept | Reference ( Medication MedicationRequest )
MedicationAdministration.device
Definition

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

Control 0..*
Type Reference ( Device )
MedicationAdministration.note
Definition

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

Control 0..1 0..*
Type string Summary Annotation
MedicationAdministration.dosage
Definition

Describes the medication dosage information details e.g. dose, rate, site, route, etc.

Control 0..1
Summary true Invariants Defined on this element
mad-1 : SHALL have at least one of dosage.quantity and dosage.dose or dosage.rate[x] (xpath: exists(f:quantity) ( expression : dose.exists() or exists(f:rateRatio) rate.exists(), xpath: exists(f:dose) or exists(f:rateRange)) To Do The RMIM has priority code on the act relationship. How do we handle this? exists(f:*[starts-with(local-name(.), 'rate')]))
MedicationAdministration.dosage.text
Definition

Free text dosage instructions can be used for cases where the instructions are dosage administered is too complex to code. When coded instructions are dosage is present, the free text instructions dosage may still be present for display to humans taking or administering humans.

The dosage instructions should reflect the medication. dosage of the medication that was administered.

Control 0..1
Type string
MedicationAdministration.dosage.site[x] MedicationAdministration.dosage.site
Definition

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

Control 0..1
Terminology Binding SNOMED CT Anatomical Structure for Administration Site Codes: A coded concept describing the site location the medicine enters into or onto the body. Codes ( Example )
Type CodeableConcept | Reference ( BodySite )
[x] Note Comments See Choice of Data Types for further information about how

If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use [x] Summary true the standard extension body-site-instance . May be a summary code, or a reference to a very precise definition of the location, or both.

MedicationAdministration.dosage.route
Definition

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

Control 0..1
Terminology Binding SNOMED CT 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. Codes ( Example )
Type CodeableConcept
MedicationAdministration.dosage.method
Definition

A coded value indicating the method by which the medication is intended to be or was introduced into or on the body. This attribute will most often NOT be populated. It is most commonly used for injections. For example, Slow Push, Deep IV.

Control 0..1
Terminology Binding MedicationAdministrationMethod : A coded concept describing the technique by which the medicine is administered. SNOMED CT Administration Method Codes ( Example )
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 MedicationAdministration.dosage.dose
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 SimpleQuantity
Summary true Comments

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

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. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Currently we do not specify a default of '1' in the 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 | Range SimpleQuantity
[x] Note See Choice of Data Types for further information about how to use [x]
Summary true Comments

If the rate changes over time, and you want to capture this in MedicationAdministration, then each change should be captured as a distinct MedicationAdministration, with a specific MedicationAdministration.dosage.rate, and the date time when the rate change occurred. Typically, the MedicationAdministration.dosage.rate element is not used to convey an average rate.

MedicationAdministration.eventHistory
Definition

A summary of the events of interest that have occurred, such as when the administration was verified.

Control 0..*
Type Reference ( Provenance )
Comments

This may not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the Provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the Provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.