type: resource-definitionsresource: MedicationAdministration

MedicationAdministration Definitions

MedicationAdministration

Administration of medication to a patient

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.

Cardinality: 0..*

Mappings: workflow=Event; rim=SubstanceAdministration; w5=clinical.medication

MedicationAdministration.identifier

External identifier

Definition: Identifiers associated with this Medication Administration that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server.

Comments: This is a business identifier, not a resource identifier.

Cardinality: 0..*

Type: Identifier

Mappings: workflow=Event.identifier; w5=FiveWs.identifier; rim=.id

MedicationAdministration.basedOn

Plan this is fulfilled by this administration

Definition: A plan that is fulfilled in whole or in part by this MedicationAdministration.

Cardinality: 0..*

Type: Reference(CarePlan)

Mappings: rim=.outboundRelationship[typeCode=FLFS].target

MedicationAdministration.partOf

Part of referenced event

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

Comments: MedicationDispense will be used to indicate waste.

Cardinality: 0..*

Type: Reference(MedicationAdministration, Procedure, MedicationDispense)

Summary: true

Mappings: workflow=Event.partOf; rim=.outboundRelationship[typeCode=COMP]/target[classCode=SBADM or PROC,moodCode=EVN]

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.

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

Cardinality: 1..1

Type: code

Binding: required:medication-admin-status

Summary: true

Is Modifier: true (Reason: This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid)

Mappings: workflow=Event.status; w5=FiveWs.status; v2=RXA-20 Completion Status; rim=.statusCode

MedicationAdministration.statusReason

Reason status of the administration changed

Definition: A code indicating why the status of the administration changed.

Cardinality: 0..*

Type: CodeableConcept

Binding: example:reason-medication-not-given-codes

Mappings: workflow=Event.statusReason; v2=RXA-9 Administration Notes / RXA-18 Substance/Treatment Refusal Reason; rim=.outboundRelationship[typeCode=RSON]/target[classCode=OBS,moodCode=EVN, code="reason not given"].value

MedicationAdministration.category

Type of medication administration

Definition: The type of medication administration.

Comments: The committee will revisit these codes, expecting to use a codesystem from terminology.hl7.org.

Cardinality: 0..*

Type: CodeableConcept

Binding: example:medication-admin-category

Mappings: rim=.inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="type of medication usage"].value

MedicationAdministration.medication

What was administered

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.

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.

Cardinality: 1..1

Type: CodeableReference

Binding: example:medication-codes

Summary: true

Mappings: workflow=Event.code; w5=FiveWs.what[x]; v2=RXA-5 Administered Code; rim=.participation[typeCode=CSM].role[classCode=ADMM]

MedicationAdministration.subject

Who received medication

Definition: The person or animal or group receiving the medication.

Cardinality: 1..1

Type: Reference(Patient, Group)

Summary: true

Mappings: workflow=Event.subject; w5=FiveWs.subject; v2=PID-3 Patient ID List; rim=.participation[typeCode=SBJ].role[classCode=PAT]

MedicationAdministration.encounter

Encounter administered as part of

Definition: The visit, admission, or other contact between patient and health care provider during which the medication administration was performed.

Cardinality: 0..1

Type: Reference(Encounter)

Mappings: workflow=Event.encounter; w5=FiveWs.context; v2=PV1-19 Visit Number; rim=.inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN, code="type of encounter or episode"]

MedicationAdministration.supportingInformation

Additional information to support administration

Definition: Additional information (for example, patient height and weight) that supports the administration of the medication. This attribute can be used to provide documentation of specific characteristics of the patient present at the time of administration. For example, if the dose says "give "x" if the heartrate exceeds "y"", then the heart rate can be included using this attribute.

Cardinality: 0..*

Type: Reference(Resource)

Mappings: w5=FiveWs.context; rim=.outboundRelationship[typeCode=PERT].target[A_SupportingClinicalStatement CMET minimal with many different choices of classCodes(ORG, ENC, PROC, SPLY, SBADM, OBS) and each of the act class codes draws from one or more of the following moodCodes (EVN, DEF, INT PRMS, RQO, PRP, APT, ARQ, GOL)]

MedicationAdministration.occurrence[x]

Specific date/time or interval of time during which the administration took place (or did not take place)

Definition: A specific date/time or interval of time during which the administration took place (or did not take place). For many administrations, such as swallowing a tablet the use of dateTime is more appropriate.

Cardinality: 1..1

Type: dateTime, Period, Timing

Summary: true

Mappings: workflow=Event.occurrence[x]; w5=FiveWs.done[x]; v2=RXA-3 Date/Time Start of Administration / RXA-4 Date/Time End of Administration; rim=.effectiveTime

MedicationAdministration.recorded

When the MedicationAdministration was first captured in the subject's record

Definition: The date the occurrence of the MedicationAdministration was first captured in the record - potentially significantly after the occurrence of the event.

Cardinality: 0..1

Type: dateTime

Summary: true

Mappings: w5=FiveWs.recorded; rim=.participation[typeCode=AUT].time

MedicationAdministration.isSubPotent

An indication that the full ordered dose was not administered

Definition: An indication that the full dose was not administered.

Cardinality: 0..1

Type: boolean

MedicationAdministration.subPotentReason

Reason full dose was not administered

Definition: The reason or reasons why the full dose was not administered.

Cardinality: 0..*

Type: CodeableConcept

Binding: example:administration-subpotent-reason

MedicationAdministration.performer

Who or what performed the medication administration and what type of performance they did

Definition: The performer of the medication treatment. For devices this is the device that performed the administration of the medication. An IV Pump would be an example of a device that is performing the administration. Both the IV Pump and the practitioner that set the rate or bolus on the pump can be listed as performers.

Cardinality: 0..*

Type: BackboneElement

Summary: true

Mappings: workflow=Event.performer; w5=FiveWs.actor; v2=RXA-10 Administering Provider / PRT-5 Participation Person: PRT-4 Participation='AP' (RXA-10 is deprecated); rim=.participation[typeCode=PRF]

MedicationAdministration.performer.function

Type of performance

Definition: Distinguishes the type of involvement of the performer in the medication administration.

Cardinality: 0..1

Type: CodeableConcept

Binding: example:med-admin-perform-function

Mappings: workflow=Event.performer.function; rim=participation[typeCode=PRF].functionCode

MedicationAdministration.performer.actor

Who or what performed the medication administration

Definition: Indicates who or what performed the medication administration.

Cardinality: 1..1

Type: CodeableReference

Summary: true

Mappings: workflow=Event.performer.actor; rim=.role

MedicationAdministration.reason

Reason that supports why the medication was administered

Definition: A code, Condition or observation that supports why the medication was administered.

Cardinality: 0..*

Type: CodeableReference

Binding: example:reason-medication-given-codes

Mappings: workflow=Event.reason; v2=RXE-27 Give Indication; rim=.reasonCode

MedicationAdministration.request

Request administration performed against

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

Comments: This is a reference to the MedicationRequest where the intent is either order or instance-order. It should not reference MedicationRequests where the intent is any other value.

Cardinality: 0..1

Type: Reference(MedicationRequest)

Mappings: workflow=Event.basedOn; v2=ORC-2 Placer Order Number / ORC-3 Filler Order Number; rim=InFullfillmentOf->SubstanceAdministration

MedicationAdministration.device

Device used to administer

Definition: The device that is to be used for the administration of the medication (for example, PCA Pump).

Comments: When all that is known about the device is the type, and not specific instance data, like lot number etc., the device resource can still be used, as described in the Device / DeviceDefinition Boundaries and Relationships section.

Cardinality: 0..*

Type: CodeableReference

Mappings: v2=PRT-10 Participation Device / RXR-3 Administrative Device; rim=device->Access OR device->AssignedDevice

MedicationAdministration.note

Information about the administration

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

Cardinality: 0..*

Type: Annotation

Mappings: workflow=Event.note; rim=.inboundRelationship[typeCode=SUBJ]/source[classCode=OBS,moodCode=EVN,code="annotation"].value

MedicationAdministration.dosage

Details of how medication was taken

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

Cardinality: 0..1

Type: BackboneElement

Constraints: mad-1 | error | If dosage attribute is present then SHALL have at least one of dosage.text or dosage.dose or dosage.rate[x] | (dose.exists() or rate.exists() or text.exists())

Mappings: rim=component->SubstanceAdministrationEvent

MedicationAdministration.dosage.text

Free text dosage instructions e.g. SIG

Definition: Free text dosage can be used for cases where the dosage administered is too complex to code. When coded dosage is present, the free text dosage may still be present for display to humans.

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

Conditions: mad-1

Cardinality: 0..1

Type: string

Mappings: rim=.text

MedicationAdministration.dosage.site

Body site administered to

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

Comments: If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension [[[http://hl7.org/fhir/StructureDefinition/bodySite]]]. May be a summary code, or a reference to a very precise definition of the location, or both.

Cardinality: 0..1

Type: CodeableConcept

Binding: example:approach-site-codes

Mappings: v2=RXR-2 Administration Site / RXR-6 Administration Site Modifier; rim=.approachSiteCode

MedicationAdministration.dosage.route

Path of substance into body

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.

Cardinality: 0..1

Type: CodeableConcept

Binding: example:route-codes

Mappings: v2=RXR-1 Route; rim=.routeCode

MedicationAdministration.dosage.method

How drug was administered

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.

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.

Cardinality: 0..1

Type: CodeableConcept

Binding: example:administration-method-codes

Mappings: v2=RXR-4 Administration Method; rim=.methodCode

MedicationAdministration.dosage.dose

Amount of medication per 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.

Comments: If the administration is not instantaneous (rate is present), this can be specified to convey the total amount administered over period of time of a single administration.

Conditions: mad-1

Cardinality: 0..1

Type: Quantity(SimpleQuantity)

Mappings: v2=RXA-6 Administered Amount / RXA-7 Administered Units; rim=.doseQuantity

MedicationAdministration.dosage.rate[x]

Dose quantity per unit of time

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. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours.

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.

Conditions: mad-1

Cardinality: 0..1

Type: Ratio, Quantity(SimpleQuantity)

Mappings: v2=RXA-12 Administered Per (Time Unit); rim=.rateQuantity

MedicationAdministration.eventHistory

A list of events of interest in the lifecycle

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

Comments: This might 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.

Cardinality: 0..*

Type: Reference(Provenance)

Mappings: rim=.inboundRelationship(typeCode=SUBJ].source[classCode=CACT, moodCode=EVN]