Connectathon 11 Snapshot

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4.22.7 Resource MedicationAdministration - Detailed Descriptions

Detailed Descriptions for the elements in the MedicationAdministration resource.

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.

Control1..1
Summarytrue
InvariantsDefined on this element
mad-2: Reason not given is only permitted if wasNotGiven is true (expression: reasonNotGiven.empty() or wasNotGiven = 'true', xpath: not(exists(f:reasonNotGiven) and f:wasNotGiven/@value=false()))
mad-3: Reason given is only permitted if wasNotGiven is false (expression: reasonGiven.empty() or wasNotGiven = 'false', xpath: not(exists(f:reasonGiven) and f:wasNotGiven/@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.

NoteThis is a business identifer, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
Summarytrue
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
BindingMedicationAdministrationStatus: A set of codes indicating the current status of a MedicationAdministration. (Required)
Typecode
Is Modifiertrue
Summarytrue
MedicationAdministration.patient
Definition

The person or animal receiving the medication.

Control1..1
TypeReference(Patient)
Summarytrue
MedicationAdministration.practitioner
Definition

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

Control0..1
TypeReference(Practitioner | Patient | RelatedPerson)
Summarytrue
MedicationAdministration.encounter
Definition

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

Control0..1
TypeReference(Encounter)
Summarytrue
MedicationAdministration.prescription
Definition

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

Control0..1
TypeReference(MedicationOrder)
Summarytrue
MedicationAdministration.wasNotGiven
Definition

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

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

A code indicating why the administration was not performed.

Control0..*
BindingReason Medication Not Given Codes: A set of codes indicating the reason why the MedicationAdministration is negated. (Example)
TypeCodeableConcept
Summarytrue
InvariantsAffect this element
mad-2: Reason not given is only permitted if wasNotGiven is true (expression: reasonNotGiven.empty() or wasNotGiven = 'true', xpath: not(exists(f:reasonNotGiven) and f:wasNotGiven/@value=false()))
MedicationAdministration.reasonGiven
Definition

A code indicating why the medication was given.

Control0..*
BindingReason Medication Given Codes: A set of codes indicating the reason why the MedicationAdministration was made. (Example)
TypeCodeableConcept
Summarytrue
InvariantsAffect this element
mad-3: Reason given is only permitted if wasNotGiven is false (expression: reasonGiven.empty() or wasNotGiven = '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
TypedateTime|Period
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summarytrue
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
TypeCodeableConcept|Reference(Medication)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summarytrue
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. For example, a particular infusion pump.

Control0..*
TypeReference(Device)
Summarytrue
MedicationAdministration.note
Definition

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

Control0..1
Typestring
Summarytrue
MedicationAdministration.dosage
Definition

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

Control0..1
Summarytrue
InvariantsDefined on this element
mad-1: SHALL have at least one of dosage.quantity and dosage.rate[x] (expression: quantity or rate[x], xpath: exists(f:quantity) or exists(f:rateRatio) or exists(f:rateRange))
To DoThe RMIM has priority code on the act relationship. How do we handle this?
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
Summarytrue
MedicationAdministration.dosage.site[x]
Definition

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

Control0..1
BindingSNOMED CT Anatomical Structure for Administration Site Codes: A coded concept describing the site location the medicine enters into or onto the body. (Example)
TypeCodeableConcept|Reference(BodySite)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summarytrue
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.

Control0..1
BindingSNOMED 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. (Example)
TypeCodeableConcept
Summarytrue
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.

Control0..1
BindingMedicationAdministrationMethod: A coded concept describing the technique by which the medicine is administered.
TypeCodeableConcept
Summarytrue
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.

Control0..1
TypeSimpleQuantity
Summarytrue
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
TypeRatio|Range
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summarytrue
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.