DSTU2 QA Preview

This page is part of the FHIR Specification (v1.0.0: DSTU 2 Ballot 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

F.??.4 StructureDefinition: QICore-MedicationAdministration - Detailed Descriptions

Definitions for the qicore-medicationadministration Profile.

MedicationAdministration(QICore-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.

Control0..*
TypeMedicationAdministration
MedicationAdministration.id
Definition

The logical id of the resource, as used in the url for the resource. Once assigned, this value never changes.

Control0..1
Typeid
Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Bundles always have an id, though it is usually a generated UUID.

MedicationAdministration.meta
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.

Control0..1
TypeMeta
MedicationAdministration.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

Control0..1
Typeuri
Is Modifiertrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element as much as possible.

MedicationAdministration.language
Definition

The base language in which the resource is written.

Control0..1
BindingA human language
The codes SHALL be taken from http://tools.ietf.org/html/bcp47
Typecode
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

MedicationAdministration.text
Definition

A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Control0..1 This element is affected by the following invariants: dom-1
TypeNarrative
Alternate Namesnarrative, html, xhtml, display
Comments

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative.

MedicationAdministration.contained
Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

Control0..*
TypeResource
Alternate Namesinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.

MedicationAdministration.extension
Definition

May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

MedicationAdministration.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

MedicationAdministration.identifier
Definition

External identifier - FHIR will generate its own internal IDs (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.

Control0..*
TypeIdentifier
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.

Control1..1
BindingA set of codes indicating the current status of a MedicationAdministration
The codes SHALL be taken from MedicationAdministrationStatus
Typecode
Is Modifiertrue
Must Supporttrue
MedicationAdministration.patient
Definition

The person or animal to whom the medication was given.

Control1..1
TypeReference(QICore-Patient)
Must Supporttrue
MedicationAdministration.practitioner
Definition

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

Control0..1
TypeChoice of: Reference(QICore-Practitioner), Reference(QICore-Patient), Reference(QICore-RelatedPerson)
MedicationAdministration.encounter
Definition

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

Control0..1
TypeReference(QICore-Encounter)
Must Supporttrue
MedicationAdministration.prescription
Definition

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

Control0..1
TypeReference(QICore-MedicationOrder)
MedicationAdministration.wasNotGiven
Definition

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

Control0..1
Typeboolean
Is Modifiertrue
Must Supporttrue
Meaning if MissingIf this is missing, then the medication was administered
MedicationAdministration.reasonNotGiven
Definition

A code indicating why the administration was not performed.

Control0..* This element is affected by the following invariants: mad-2
BindingA set of codes indicating the reason why the MedicationAdministration is negated.
For example codes, see Reason Medication Not Given Codes
TypeCodeableConcept
Must Supporttrue
InvariantsDefined on this element
mad-2: Reason not given is only permitted if wasNotGiven is true (xpath: not(exists(f:reasonNotGiven) and f:wasNotGiven/@value='false'))
MedicationAdministration.reasonGiven
Definition

A code indicating why the medication was given.

Control0..* This element is affected by the following invariants: mad-3
BindingA set of codes indicating the reason why the MedicationAdministration was made.
For example codes, see Reason Medication Given Codes
TypeCodeableConcept
Must Supporttrue
InvariantsDefined on 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

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.

Control1..1
TypeChoice of: dateTime, Period
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
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.

Control1..1
BindingThe set of RxNorm codes to represent medications
The codes SHOULD be taken from Medication Clinical Drug (RxNorm)
TypeChoice of: CodeableConcept, Reference(QICore-Medication)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
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. a particular infusion pump.

Control0..*
TypeReference(QICore-Device)
MedicationAdministration.note
Definition

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

Control0..1
Typestring
MedicationAdministration.dosage
Definition

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

Control0..1
TypeBackboneElement
InvariantsDefined on this element
mad-1: SHALL have at least one of dosage.quantity and dosage.rate (xpath: exists(f:quantity) or exists(f:rate))
MedicationAdministration.dosage.id
Definition

unique id for the element within a resource (for internal references).

Control0..1
Typeid
MedicationAdministration.dosage.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

MedicationAdministration.dosage.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content, modifiers
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

MedicationAdministration.dosage.text
Definition

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

Control0..1
Typestring
MedicationAdministration.dosage.site[x]
Definition

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

Control0..1
BindingA coded concept describing the site location the medicine enters into or onto the body
For example codes, see SNOMED CT Anatomical Structure for Administration Site Codes
TypeChoice of: CodeableConcept, Reference(BodySite)
[x] NoteSee Choice of Data Types for further information about how to use [x]
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. topical, intravenous, etc.

Control0..1
BindingA coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject
For example codes, see SNOMED CT Route Codes
TypeCodeableConcept
Must Supporttrue
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. Examples: Slow Push, Deep IV. 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.

Control0..1
BindingA coded concept describing the technique by which the medicine is administered
TypeCodeableConcept
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.

Control0..1
TypeQuantity(SimpleQuantity)
Must Supporttrue
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[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.

Control0..1
TypeChoice of: Ratio, Range
[x] NoteSee Choice of Data Types for further information about how to use [x]
Comments

If the rate changes over time, and you want to capture this in Medication Administration, then each change should be captured as a distinct Medication Administration, 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.