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11.2 Resource MedicationAdministration - Content

Pharmacy icon Work GroupMaturity Level: 2 Trial UseSecurity Category: Patient Compartments: Encounter, Group, Patient

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.

11.2.1 Scope and Usage

This resource covers the administration of all medications. Please refer to the Immunization resource/Profile for the treatment of vaccines. It will principally be used within care settings (including inpatient) to record medication administrations, including self-administrations of oral medications, injections, intravenous infusions, etc. It can also be used in outpatient 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.

Note: devices coated with a medication (e.g. heparin) are not typically recorded as a medication administration. However, administration of a medication via an implanted medication pump (e.g., insulin) would be recorded as a MedicationAdministration.

This resource can also be used for recording waste by setting the status to 'not-done' and the statusReason to a code that refers to waste. The remaining fields would support the waste elements, i.e. performer of the waste, quantity of medication wasted, date/time of waste, etc. It is also possible, using the partOf reference to a MedicationDispense, to indicate that this waste occurred as part of a dispense event.

MedicationAdministration is an event resource from a FHIR workflow perspective - see Workflow Event

11.2.2 Boundaries and Relationships

The Medication domain includes a number of related resources

MedicationRequest 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 a medication being taken by a patient or that a 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 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. However, if systems need to use a MedicationAdministration resource to capture vaccinations for workflow or other reasons, a Medication Administration resource may be used but systems SHOULD also create and expose an equivalent Immunization instance.

11.2.3 References to this Resource

11.2.4 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationAdministration TU DomainResource Administration of medication to a patient

Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..* Identifier External identifier

... basedOn 0..* Reference(CarePlan) Plan this is fulfilled by this administration

... partOf Σ 0..* Reference(MedicationAdministration | Procedure | MedicationDispense) Part of referenced event

... statusReason 0..* CodeableConcept Reason administration not performed
Binding: SNOMED CT Reason Medication Not Given Codes (Example)

... category 0..* CodeableConcept Type of medication administration
Binding: MedicationAdministration Location Codes (Example)

... medication Σ 1..1 CodeableReference(Medication) What was administered
Binding: SNOMED CT Medication Codes (Example)
... subject Σ 1..1 Reference(Patient | Group) Who received medication
... encounter 0..1 Reference(Encounter) Encounter administered as part of
... supportingInformation 0..* Reference(Any) Additional information to support administration

... occurrence[x] Σ 1..1 Specific date/time or interval of time during which the administration took place (or did not take place)
.... occurrenceDateTime dateTime
.... occurrencePeriod Period
.... occurrenceTiming Timing
... recorded Σ 0..1 dateTime When the MedicationAdministration was first captured in the subject's record
... isSubPotent 0..1 boolean Full dose was not administered
... subPotentReason 0..* CodeableConcept Reason full dose was not administered
Binding: MedicationAdministration Subpotent Reason (Example)

... performer Σ 0..* BackboneElement Who or what performed the medication administration and what type of performance they did

.... function 0..1 CodeableConcept Type of performance
Binding: MedicationAdministration Performer Function Codes (Example)
.... actor Σ 1..1 CodeableReference(Practitioner | PractitionerRole | Patient | RelatedPerson | Device | Group) Who or what performed the medication administration
... reason 0..* CodeableReference(Condition | Observation | DiagnosticReport | Procedure) Reason that supports why the medication was administered
Binding: Reason Medication Given Codes (Example)

... request 0..1 Reference(MedicationRequest) Request administration performed against
... device 0..* CodeableReference(Device) Device used to administer

... note 0..* Annotation Information about the administration

... dosage C 0..1 BackboneElement Details of how medication was taken
+ Rule: If dosage attribute is present then SHALL have at least one of dosage.text or dosage.dose or dosage.rate[x]
.... text C 0..1 string Free text dosage instructions e.g. SIG
.... site 0..1 CodeableConcept Body site administered to
Binding: SNOMED CT Anatomical Structure for Administration Site Codes (Example)
.... route 0..1 CodeableConcept Path of substance into body
Binding: SNOMED CT Route Codes (Example)
.... method 0..1 CodeableConcept How drug was administered
Binding: SNOMED CT Administration Method Codes (Example)
.... dose C 0..1 SimpleQuantity Amount of medication per dose
.... rate[x] C 0..1 Dose quantity per unit of time
..... rateRatio Ratio
..... rateQuantity SimpleQuantity
... eventHistory 0..* Reference(Provenance) A list of events of interest in the lifecycle


doco Documentation for this format icon

See the Extensions for this resource

 

Additional definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis

11.2.4.1 Terminology Bindings

Path ValueSet Type Documentation
MedicationAdministration.status MedicationAdministrationStatusCodes Required

MedicationAdministration Status Codes
MedicationAdministration.statusReason SNOMEDCTReasonMedicationNotGivenCodes Example

This value set includes all medication refused, medication not administered, and non-administration of necessary drug or medicine codes from SNOMED CT - provided as an exemplar value set.
MedicationAdministration.category MedicationAdministrationLocationCodes Example

MedicationAdministration Location Codes
MedicationAdministration.medication SNOMEDCTMedicationCodes Example

This value set includes all drug or medicament substance codes and all pharmaceutical/biologic products from SNOMED CT - provided as an exemplar value set.
MedicationAdministration.subPotentReason MedicationAdministrationSubpotentReason (a valid code from Administration SubPotent Reason) Example

MedicationAdministration Subpotent Reason
MedicationAdministration.performer.function MedicationAdministrationPerformerFunctionCodes Example

MedicationAdministration Performer Function Codes
MedicationAdministration.reason ReasonMedicationGivenCodes Example

This value set is provided as an example. The value set to instantiate this attribute should be drawn from a robust terminology code system that consists of or contains concepts to support the medication process.
MedicationAdministration.dosage.site SNOMEDCTAnatomicalStructureAdministrationSites Example

This value set includes Anatomical Structure codes from SNOMED CT - provided as an exemplar.
MedicationAdministration.dosage.route SNOMEDCTRouteCodes Example

This value set includes all Route codes from SNOMED CT - provided as an exemplar.
MedicationAdministration.dosage.method SNOMEDCTAdministrationMethodCodes Example

This value set includes some method codes from SNOMED CT - provided as an exemplar

11.2.4.2 Constraints

UniqueKeyLevelLocationDescriptionExpression
img mad-1Rule MedicationAdministration.dosageIf 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())

11.2.5 Known Issues

Issue Comments
Medication Resource A medication will typically be referred to by means of a code drawn from a suitable medication 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.
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.

11.2.6 Medication Administration Lists

11.2.6.1 Medication Administration Record (MAR) Use Case

Medication administrations can be done by:

  • clinician e.g. nurse, physician, other providers
  • patient via self-administration
  • family member e.g. mother for the baby
  • caregiver (non-clinician)
  • devices e.g. IV pumps, insulin pumps, patient-controlled analgesic (PCA) pumps

In order to administer a medication, there is often a list of medications that includes the medication itself e.g code or name , dose, date/time the medication is to be administered and route and in some cases additional administration instructions. A common name for this type of list of medications to be administered and the corresponding record of medication administrations is Medication Administration Record (MAR).

11.2.6.2 Synonyms/Key Definitions

Medication Administration Record (MAR) - a view of a patients medications that need to be administered. Typically, an MAR is seen in settings where there is a requirement to document who, when, what and where information, concerning medications administered to a patient, or if self-administered, taken by a patient. The same record often has two primary functions - first it lists what medications need to be administered and what date and time or time interval, the administration should be done; and second it lists what medications have been administered and the details associated with the administration.

  • Scheduled Medication Administration - this represents a specific medication, a dose, or IV rate, a route of administration, a date and time, dosage instructions, and optionally, it may include a time interval Use the MedicationRequest resource to represent each individual medication administration
Resource Element Clinical Description
MedicationRequest.intent=instance-order Specific instance of a medication order, sometimes called a "child" order of the parent full medication order
MedicationRequest.medication.concept or reference to Medication resource Drug that has been ordered and is to be administered
MedicationRequest.dosage.dose[x] or rate[x] Dose of medication to be administered. If the drug is intravenous, you may represent this administration as a rate.
MedicationRequest.dosageInstructions.dosage.timing.bounds Time the medication should be administered e.g. 10am on a specific date, or at time of sleep, or after breakfast, or over 60 minutes starting at 3pm on a specific date, etc.
MedicationRequest.dosageInstructions.dosage.route Route of administration e.g. oral, intravenous, topical, etc.
MedicationRequest.dosageInstructions.dosage.site Anatomical site where the drug enters the body e.g. subclavian vein

Other attributes may be included, such as those for access sites, dosage instructions, reason, device used, etc. The list of attributes above is meant to help the reader understand the definitions. It is not meant to define what attributes an individual implementation may include in their design.

  • Recording a Medication Administration - this represents a specific medication administration that includes a dose, or IV rate, a route of administration, and optional administration method, a date and time, or in the case of some IV medications a start date/time and end date/time, administration site, name of person who administered the medication, optional details about the administration e.g., patient refused, patient only took a partial dose because they were ill, etc.
Resource Element Clinical Description
MedicationAdministration.medication.concept or reference to Medication resource Drug that has been administered
MedicationAdministration.dosage.dose or rate[x] Dose of medication that was administered. If the drug is intravenous, you may represent this a rate e.g. 60 ml/30 minutes
MedicationAdministration.occurrenceDateTime or .occurrencePeriod Date and time or, date/time of the period over which the medication was administered
MedicationAdministration.dosage.route Route of administration used to administer medication to the patient
MedicationAdministration.dosage.site Anatomical site where the drug administered entered the body e.g. subclavian vein
MedicationAdministration.statusReason The reason for not giving the medication. This is used when the status = not-done.
MedicationAdministration.supportingInformation.reference (resource) Used to capture data such as lab test values or heart rate, or blood pressure values, etc. This type of data is often expressed in the order and is used to determine if the medication should be administered or held.
MedicationAdministration.performer.function (=performer) MedicationAdministration.performer.actor.reference (resource) Identifies who administered the medication. The specific referenced resource could be: Provider, Patient, Device, RelatedPerson
MedicationAdministration.performer.function (=verifier) MedicationAdministration.performer.actor.reference (resource) Identifies who verified the medication to be administered. This is most often a clinician who is verifying the administration for another clinician where there is a requirement for verification prior to administration.

Other attributes may be included e.g. method, reason, etc. The list of attributes above is meant to help the reader understand the definitions. It is not meant to define what attributes an individual implementation may include in their design.

11.2.6.3 Rationale

Scheduled Medication Administration information is used to inform the person who will administer the medication(s) the date/time, and medication specific information e.g., dose, route, method, special instructions for each medication a person is scheduled to take.

Recording Medication Administration details provides a place to capture the data about the actual administration e.g., date/time or time interval of administration, dose, route, method, device, performer, etc.

Depending on the type of application, this type of information may be presented to the user who is administering the medication in an EHR module for medication administration, in a mobile application for the patient or caregiver.

11.2.6.4 Setting

Medication administrations occur in all types of settings e.g. hospitals, outpatient clinics, home, ambulance, ER, etc.

11.2.6.5 Description

The list of medications to be administered, or that have been administered may be captured in an application on a patient's phone, tablet or computer workstation.

The lists may be created by a variety of users or systems, for example:

  • Patient - direct entry into a mobile app
  • Other e.g. parent for a child, caregiver for a patient
  • Electronically e.g., health system auto generates the list from orders/prescriptions known to the system
  • Clinician e.g., user entry within an EHR Medication Administration module
  • Output of a process e.g. medication reconciliation; new or updated medication orders (prescriptions, requests)

Data sources for the medications that are listed on the Medication Administration list determine what will be displayed to a user. Here are two common examples:

Provider view Medication Administration list may include medications that come from:

  • Prescribed by clinicians who have the authority to write these types of medication orders
  • Over-the-counter (OTC) medications that the patient informs/adds to the list - this would include herbals and supplements
  • NOTE: Medication errors may lead to medications potentially showing up on a list of medications to be administered e.g., medication order was written for the wrong patient In this case, the MAR indicates that a medication should be administered to a patient (later found to be in error e.g., wrong patient)
  • NOTE: Medication errors may also lead to medications showing up on a list of administered medications e.g., medication was mistakenly administered to the wrong patient, or the wrong dose was administered, or wrong route was used, etc.

Patient view Medication Administration list may include medications that come:

  • from an identical list as above with the following caveats:
    • The list might not include some medications if the patient is one of the sources for the list and states they are not taking a specific medication, irrespective of whether it was prescribed
    • The patient does not know or has incomplete memory of the medications they have been prescribed
    • The level of detail for each medication might not be as detailed as provider-based list

11.2.7 Search Parameters

Search parameters for this resource. See also the full list of search parameters for this resource, and check the Extensions registry for search parameters on extensions related to this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name Type Description Expression In Common
code token Return administrations of this medication code MedicationAdministration.medication.concept 21 Resources
date date Date administration happened (or did not happen) MedicationAdministration.occurrence.ofType(dateTime) | MedicationAdministration.occurrence.ofType(Period) 1 Resources
device reference Return administrations with this administration device identity MedicationAdministration.device.reference
encounter reference Return administrations that share this encounter MedicationAdministration.encounter
(Encounter)		 2 Resources
identifier token Return administrations with this external identifier MedicationAdministration.identifier 65 Resources
medication reference Return administrations of this medication reference MedicationAdministration.medication.reference 4 Resources
patient reference The identity of a patient to list administrations for MedicationAdministration.subject.where(resolve() is Patient)
(Patient)		 65 Resources
performer reference The identity of the individual who administered the medication MedicationAdministration.performer.actor.reference
performer-device-code token The identity of the individual who administered the medication MedicationAdministration.performer.actor.concept
reason-given reference Reference to a resource (by instance) MedicationAdministration.reason.reference
reason-given-code token Reasons for administering the medication MedicationAdministration.reason.concept
reason-not-given token Reasons for not administering the medication MedicationAdministration.statusReason
request reference The identity of a request to list administrations from MedicationAdministration.request
(MedicationRequest)
status token MedicationAdministration event status (for example one of active/paused/completed/nullified) MedicationAdministration.status 4 Resources
subject reference The identity of the individual or group to list administrations for MedicationAdministration.subject
(Group, Patient)