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4.10 Resource MedicationAdministration - Content

Describes the event of a patient being given a dose of 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.

4.10.1 Scope and Usage

This resource covers the administration of all medications with the exception of vaccines. It will principally be used within inpatient settings to record the capture of medication administrations including self-administrations of oral medications, injections, intra-venous adjustments, etc. It can also be used in out-patient settings to record allergy shots and other non-immunization administrations. In some cases it might be used for home-health reporting, such as recording self-administered or even device-administered insulin.

4.10.2 Boundaries and Relationships

The Medication domain includes a number of related resources

MedicationPrescription An order for both supply of the medication and the instructions for administration of the medicine to a patient.
MedicationDispense Provision of a supply of a medication with the intention that it is subsequently consumed by a patient (usually in response to a prescription).
MedicationAdministration When a patient actually consumes a medicine, or it is otherwise administered to them
MedicationStatement This is a record of medication being taken by a patient, or that the medication has been given to a patient where the record is the result of a report from the patient, or another clinician. A medication statement is not a part of the prescribe->dispense->administer sequence but is a report that such a sequence (or at least a part of it) did take place resulting in a belief that the patient has received a particular medication.

MedicationAdministration is intended for tracking the administration of non-vaccine medications. Administration of vaccines is intended to be handled using the Immunization resource. Some systems treat immunizations in the same way as any other medication administration. Such systems SHOULD use an immunization resource to represent these. If systems need to use a MedicationAdministration resource to capture vaccinations for workflow or other reasons, they SHOULD also expose an equivalent Immunization instance.

4.10.3 Resource Content

MedicationAdministration (Resource)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 (this element modifies the meaning of other elements)identifier : Identifier 0..*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 (this element modifies the meaning of other elements)status : code 1..1 <<A set of codes indicating the current status of a MedicationAdministrationMedicationAdministrationStatus>>The person or animal to whom the medication was givenpatient : Resource(Patient) 1..1The individual who was responsible for giving the medication to the patientpractitioner : Resource(Practitioner) 1..1The visit or admission the or other contact between patient and health care provider the medication administration was performed as part ofencounter : Resource(Encounter) 0..1The original request, instruction or authority to perform the administrationprescription : Resource(MedicationPrescription) 1..1Set this to true if the record is saying that the medication was NOT administered (this element modifies the meaning of other elements)wasNotGiven : boolean 0..1A code indicating why the administration was not performedreasonNotGiven : CodeableConcept 0..* <<A set of codes indicating the reason why the MedicationAdministration is negated.MedicationAdministrationNegationReason>>An interval of time during which the administration took place. For many administrations, such as swallowing a tablet the lower and upper values of the interval will be the samewhenGiven : Period 1..1Identifies 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 medicationsmedication : Resource(Medication) 0..1The device used in administering the medication to the patient. E.g. a particular infusion pumpdevice : Resource(Device) 0..*DosageThe timing schedule for giving the medication to the patient. This may be a single time point (using dateTime) or it may be a start and end dateTime (Period)timing[x] : dateTime|Period 0..1If set to true or if specified as a CodeableConcept, indicates that the medication is only taken when needed within the specified schedule rather than at every scheduled dose. If a CodeableConcept is present, it indicates the pre-condition for taking the MedicationasNeeded[x] : boolean|CodeableConcept 0..1A coded specification of the anatomic site where the medication first entered the body. E.g. "left arm"site : CodeableConcept 0..1 <<A coded concept describing the site location the medicine enters into or onto the bodyMedicationAdministrationSite>>A code specifying the route or physiological path of administration of a therapeutic agent into or onto the patient. E.g. topical, intravenous, etcroute : CodeableConcept 0..1 <<A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.RouteOfAdministration>>A coded value indicating the method by which the medication was introduced into or onto the body. Most commonly used for injections. Examples: Slow Push; Deep IV. Terminologies used often pre-coordinate this term with the route and or form of administrationmethod : CodeableConcept 0..1 <<A coded concept describing the technique by which the medicine is administeredMedicationAdministrationMethod>>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 injectionquantity : Quantity 0..1Identifies the speed with which the medication was introduced into the patient. Typically the rate for an infusion e.g. 200ml in 2 hours. May also expressed as a rate per unit of time such as 100ml per hour - the duration is then not specified, or is specified in the quantityrate : Ratio 0..1The maximum total quantity of a therapeutic substance that was administered to the patient over the specified period of time. E.g. 1000mg in 24 hoursmaxDosePerPeriod : Ratio 0..1Provides details of how much of the medication was administereddosage0..*

This resource is referenced by Condition and Procedure

<MedicationAdministration xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: extension, modifierExtension, language, text, and contained -->
 <identifier><!-- 0..* Identifier External identifier --></identifier>
 <status value="[code]"/><!-- 1..1 in progress | on hold | completed | entered in error | stopped -->
 <patient><!-- 1..1 Resource(Patient) Who received medication? --></patient>
 <practitioner><!-- 1..1 Resource(Practitioner) Who administered substance? --></practitioner>
 <encounter><!-- 0..1 Resource(Encounter) Encounter administered as part of --></encounter>
 <prescription><!-- 1..1 Resource(MedicationPrescription) 
     Order administration performed against --></prescription>
 <wasNotGiven value="[boolean]"/><!-- 0..1 True if medication not administered -->
 <reasonNotGiven><!-- ?? 0..* CodeableConcept Reason administration not performed --></reasonNotGiven>
 <whenGiven><!-- 1..1 Period Start and end time of administration --></whenGiven>
 <medication><!-- 0..1 Resource(Medication) What was administered? --></medication>
 <device><!-- 0..* Resource(Device) Device used to administer --></device>
 <dosage>  <!-- 0..* Medicine administration instructions to the patient/carer -->
  <timing[x]><!-- 0..1 dateTime|Period When dose(s) were given --></timing[x]>
  <asNeeded[x]><!-- 0..1 boolean|CodeableConcept Take "as needed" f(or x) --></asNeeded[x]>
  <site><!-- 0..1 CodeableConcept Body site administered to --></site>
  <route><!-- 0..1 CodeableConcept Path of substance into body --></route>
  <method><!-- 0..1 CodeableConcept How drug was administered --></method>
  <quantity><!-- 0..1 Quantity Amount administered in one dose --></quantity>
  <rate><!-- 0..1 Ratio Dose quantity per unit of time --></rate>
  <maxDosePerPeriod><!-- 0..1 Ratio Total dose that was consumed per unit of time --></maxDosePerPeriod>
 </dosage>
</MedicationAdministration>

Alternate definitions: Schema/Schematron, Resource Profile

4.10.3.1 Terminology Bindings

PathDefinitionTypeReference
MedicationAdministration.status A set of codes indicating the current status of a MedicationAdministrationFixedhttp://hl7.org/fhir/medication-admin-status
MedicationAdministration.reasonNotGiven A set of codes indicating the reason why the MedicationAdministration is negated.Examplehttp://hl7.org/fhir/vs/reason-medication-not-given-codes
MedicationAdministration.dosage.asNeeded[x] 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.UnknownNo details provided yet
MedicationAdministration.dosage.site A coded concept describing the site location the medicine enters into or onto the bodyExamplehttp://hl7.org/fhir/vs/approach-site-codes
MedicationAdministration.dosage.route A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.Examplehttp://hl7.org/fhir/vs/route-codes
MedicationAdministration.dosage.method A coded concept describing the technique by which the medicine is administeredExamplehttp://hl7.org/fhir/vs/administration-method-codes

4.10.3.2 Constraints

4.10.4 Known Issues

Issue Comments
Medication Resource A medication will typically be referred to by means of a code drawn from a suitable Medicines Terminology. However on occasion a product will be required for which the "recipe" must be specified. This implies a requirement to deal with a choice of either a code or a much more complete resource.
Currently that resource has not been created.
Encounter Administration records are usually tied to some wider grouping of care records. Encounter or Episode of Care is a common name for this. The present MedicationAdministration resource (and the other three yet to be built) link to an Encounter as an identifier, but it may be more appropriate for it to be a full resource.
Contrast Media Is this resource adequate for administering contrast media to a patient?
Author (accountability) Authorship (and any other accountability) is assumed to be dealt with by the standard FHIR methods.

4.10.5 Search Parameters

Search parameters for this resource. The standard parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionPaths
_idtokenThe logical resource id associated with the resource (must be supported by all servers)
_languagetokenThe language of the resource
devicereferenceReturn administrations with this administration device identityMedicationAdministration.device
(Device)
encounterreferenceReturn administrations that share this encounterMedicationAdministration.encounter
(Encounter)
identifiertokenReturn administrations with this external identityMedicationAdministration.identifier
medicationreferenceReturn administrations of this medicationMedicationAdministration.medication
(Medication)
notgiventokenAdministrations that were not madeMedicationAdministration.wasNotGiven
patientreferenceThe identity of a patient to list administrations forMedicationAdministration.patient
(Patient)
prescriptionreferenceThe identity of a prescription to list administrations fromMedicationAdministration.prescription
(MedicationPrescription)
statustokenMedicationAdministration event status (for example one of active/paused/completed/nullified)MedicationAdministration.status
whengivendateDate of administrationMedicationAdministration.whenGiven
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