Supply of Products for Healthcare (SUPPLY), published by IHE Pharmacy Technical Committee. This guide is not an authorized publication; it is the continuous build for version 0.3.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/IHE/pharm-supply/ and changes regularly. See the Directory of published versions

Use Case 1 - Medication order, global distribution and administration (floor stock)

Preconditions

A patient, John Smith, is admitted to the hospital by his Physician with acute abdominal pain.

The admissions department has registered John in the hospital information system and an encounter has been created for John Smith.

This encounter specific information has been broadcast via interface to other hospital systems, including the Pharmacy Information System, Computerized Physician Order Entry System, Pharmacy Dispensing System, and Electronic Medication Administration System.

In the ward G1 (where John Smith will be admitted), there is a stock of commonly used medication. Among those is hyoscine butylbromide 10 mg, with trade name BUSCOPAN IBS RELIEF.

The identifier for the “virtual” pharmaceutical product hyoscine butylbromide 10 mg is a code: 603985.

The product is available in ward G1 and in the central pharmacy. The product is labeled as shown below:

(Each box of BUSCOPAN IBS RELIEF is marked with a vendor-issued barcode corresponding to the global trade item number: 5012917021912.)

While the product available is a commercial product, inside the hospital the users do not refer to products by their commercial names. Both the physician and the pharmacists refer to this product as “hyoscine butylbromide 10 mg “ (pharmaceutical product).

Due to a previous bulk purchase, all of the initially available units of BUSCOPAN at the hospital have the same lot number: ABC0001. This lot has an expiry date of 12-2016.The available inventory for hyoscine butylbromide10 mg (BUSCOPAN IBS RELIEF) is as follows¹:

Pharmacy
Item Code	Item name	Lot	Expiry Date	Available qty	Reorder level	Default order qty
. . .
5012917021912	BUSCOPAN IBS RELIEF bx 20 tablets	ABC0001	12-2016	28
		Total:		28	20	50
. . .

Ward G1
Item Code	Item name	Lot	Expiry Date	Available qty	Reorder level	Default order qty
. . .
5012917021912	BUSCOPAN IBS RELIEF bx 20 tablets	ABC0001	12-2016	5
		Total:		5	5	10
. . .

In this case, the Unit of Distribution is the box containing 20 tablets. The unit of use is the tablet. For purpose of reordering, this use case assumes that the pharmacy only considers full boxes.

For this use case alone when a nurse consumes one tablet, the nursing or pharmacy system can determine that there are now one box that is not full but lacking one tablet, and while the pharmacy knows the exact amount of tablets left, it considers that the open box is “in use” and no longer counts for inventory.

In some cases, the number of uses or single doses that can be obtained from each distribution unit is not known – for example when products are fractioned (injectables, or ointments). This would mean that the pharmacy may not have a clear insight into the inventory information for these products.

Due to the health system policy, in this use case, there is no need to check for eligibility – all patients are entitled to any medicinal product. Billing is calculated elsewhere and is not in scope.

Ordering

Upon checking on the patient, and given the diagnosis of Irritable Bowel Syndrome, and seeing no contraindications, the physician uses a Computerized Physician Order Entry system to enter an order for hyoscine butylbromide 10 mg with a defined dosage for patient John Smith.

This order is then presented to the Pharmacist responsible for the patient’s floor. The Pharmacist reviews the orders for appropriate dosing and any contraindications or allergies. Once the review is complete, the Pharmacist approves the order.

The Medication Dispensing System and Medication Administration System are updated with the validated order, as the order is now planned for administration.

Dispensing and Administration

Because the medicinal product has already been distributed to the ward before the patient needing it, there is no need for an explicit dispense in the pharmacy. The medicinal product is to be given to the patient by the nurse, from the ward stock. This means that a specific tablet will be assigned to a patient at the ward (either at administration time, or e.g., in a preparation in the morning shift). This is the act of dispense: when a medicinal product is assigned to a patient. This notion is fundamental throughout this document. In other use cases, the dispense is an explicit action in the pharmacy, but in this case, the dispense is implicitly done by the nurse when picking the medicinal product for the patient.

The nurse consults the Medication Administration System which contains the patients’ Medication Administration Records (MARs) with the planned medications. At the scheduled time, the system may notify the nurse, who then identifies the patient (by manual entry in the system, or with a barcode) (e.g., by scanning the patient’s wrist barcode²), and sees that the medication “hyoscine butylbromide 10 mg “ is required. Since the ward contains some products in their commercial package, the system displays to the nurse the name that can be recognized in the package: BUSCOPAN IBS RELIEF. To administer the medicinal product to the patient, the nurse takes one pack of BUSCOPAN IBS RELIEF from the ward shelf, and scans its barcode. From the scanned barcode – which contains the product’s trade item code (5012917021912), but also possibly other data such as expiry date and lot number, the medicinal product administration system confirms that this is the right medicinal product for the right patient. From the barcode of the medicinal product it is also possible to consult a product data base which would indicate that this is a tablet for oral administration, so the right dose and strength, as well as the right route are also verified, and the system time indicates that it is at the right time). Consulting such database is also the subject of standards like GS1’s GDSN in the supply world, and this example shows its utility for clinical use.

The nursing system informs the Pharmacy Dispensing System and the Computerized Physician Order Entry System that this medicinal product has been consumed and administered in that quantity.

The ward stock level after picking the box is as follows:

Ward G1
Item Code	Item name	Lot	Expiry Date	Available qty	Reorder level	Default order qty
. . .
5012917021912	BUSCOPAN IBS RELIEF bx 20 tablets	ABC0001	12-2016	4
		Total:		4	5	10
. . .

Note: In this case, traceability is limited to the level of the medicinal product, not to its batch number and expiry date. This introduces a traceability constraint which may imply some risk.

If finer traceability is desired, the approach must include lot-traceability or unique item traceability by using AIDC technologies (e.g., barcode) at dispense.

Sequence Diagram