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11.3 Resource MedicationDispense - Content

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

Indicates that a medication product is to be or has been dispensed for a named person/patient. This includes a description of the medication product (supply) provided and the instructions for administering the medication. The medication dispense is the result of a pharmacy system responding to a medication order.

11.3.1 Scope and Usage

This resource covers the supply of medications to a patient. Examples include dispensing and pick-up from an outpatient or community pharmacy, dispensing patient-specific medications from inpatient pharmacy to ward, as well as issuing a single dose from ward stock to a patient for consumption. The medication dispense can be the result of a pharmacy system responding to a medication order.

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

11.3.2 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 the medication 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.

This resource does not deal with the supply or transfer of non-medication related items to a patient.

11.3.3 Background and Context

The supply and the associated administration instructions might not exactly follow the original order (prescription), either because some details were left for completion at this point in the process or because the dispenser exercised their clinical judgment to make some appropriate modification.

11.3.4 References to this Resource

11.3.5 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense TU DomainResource Dispensing a medication to a named patient
+ Rule: whenHandedOver cannot be before whenPrepared

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

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

... partOf 0..* Reference(Procedure | MedicationAdministration) Event that dispense is part of

... status ?!Σ 1..1 code preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
Binding: MedicationDispense Status Codes (Required)
... notPerformedReason 0..1 CodeableReference(DetectedIssue) Why a dispense was not performed
Binding: MedicationDispense Status Reason Codes (Example)
... statusChanged 0..1 dateTime When the status changed
... category 0..* CodeableConcept Type of medication dispense
Binding: MedicationDispense Administration Location Codes (Example)

... medication Σ 1..1 CodeableReference(Medication) What medication was supplied
Binding: SNOMED CT Medication Codes (Example)
... subject Σ 1..1 Reference(Patient | Group) Who the dispense is for
... encounter 0..1 Reference(Encounter) Encounter associated with event
... supportingInformation 0..* Reference(Any) Information that supports the dispensing of the medication

... performer 0..* BackboneElement Who performed event

.... function 0..1 CodeableConcept Who performed the dispense and what they did
Binding: MedicationDispense Performer Function Codes (Example)
.... actor 1..1 Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam | Group) Individual who was performing
... location 0..1 Reference(Location) Where the dispense occurred
... authorizingPrescription 0..* Reference(MedicationRequest) Medication order that authorizes the dispense

... type 0..1 CodeableConcept Trial fill, partial fill, emergency fill, etc
Binding: ActPharmacySupplyType icon (Example)
... quantity 0..1 SimpleQuantity Amount dispensed
... daysSupply 0..1 SimpleQuantity Amount of medication expressed as a timing amount
... fillNumber 0..1 positiveInt A number that represents the known fill this dispense represents
... recorded 0..1 dateTime When the recording of the dispense started
... whenPrepared ΣC 0..1 dateTime When product was packaged and reviewed
... whenHandedOver C 0..1 dateTime When product was given out
... destination 0..1 Reference(Location) Where the medication was/will be sent
... receiver 0..* Reference(Patient | Practitioner | RelatedPerson | Location | PractitionerRole | Group) Who collected the medication or where the medication was delivered

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

... renderedDosageInstruction 0..1 markdown Full representation of the dosage instructions
... dosageInstruction 0..* Dosage How the medication is to be used by the patient or administered by the caregiver

... substitution 0..1 BackboneElement Whether a substitution was performed on the dispense
.... wasSubstituted 1..1 boolean Whether a substitution was or was not performed on the dispense
.... type 0..1 CodeableConcept Code signifying whether a different drug was dispensed from what was prescribed
Binding: ActSubstanceAdminSubstitutionCode icon (Example)
.... reason 0..* CodeableConcept Why was substitution made
Binding: SubstanceAdminSubstitutionReason icon (Example)

.... responsibleParty 0..1 Reference(Practitioner | PractitionerRole | Organization) Who is responsible for the substitution
... eventHistory 0..* Reference(Provenance) A list of relevant lifecycle events


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

11.3.5.1 Terminology Bindings

Path ValueSet Type Documentation
MedicationDispense.status MedicationDispenseStatusCodes Required

MedicationDispense Status Codes
MedicationDispense.notPerformedReason MedicationDispenseStatusReasonCodes Example

MedicationDispense Status Reason Codes
MedicationDispense.category MedicationDispenseAdministrationLocationCodes Example

MedicationDispense Administration Location Codes
MedicationDispense.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.
MedicationDispense.performer.function MedicationDispensePerformerFunctionCodes Example

MedicationDispense Performer Function Codes
MedicationDispense.type ActPharmacySupplyType icon Example

Identifies types of dispensing events
MedicationDispense.substitution.type ActSubstanceAdminSubstitutionCode icon Example

No description
MedicationDispense.substitution.reason SubstanceAdminSubstitutionReason icon Example

No description

11.3.5.2 Constraints

UniqueKeyLevelLocationDescriptionExpression
img mdd-1Rule (base)whenHandedOver cannot be before whenPrepared(whenHandedOver.hasValue() and whenPrepared.hasValue()) implies whenHandedOver >= whenPrepared

11.3.6 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 Returns dispenses of this medicine code MedicationDispense.medication.concept 21 Resources
destination reference Returns dispenses that should be sent to a specific destination MedicationDispense.destination
(Location)
encounter reference Returns dispenses with a specific encounter MedicationDispense.encounter
(Encounter)		 29 Resources
identifier token Returns dispenses with this external identifier MedicationDispense.identifier 65 Resources
location reference Returns dispense for a given location MedicationDispense.location
(Location)
medication reference Returns dispenses of this medicine resource MedicationDispense.medication.reference 4 Resources
patient reference The identity of a patient to list dispenses for MedicationDispense.subject.where(resolve() is Patient)
(Patient)		 65 Resources
performer reference Returns dispenses performed by a specific individual MedicationDispense.performer.actor
(Practitioner, Group, Organization, CareTeam, Device, Patient, PractitionerRole, RelatedPerson)
prescription reference The identity of a prescription to list dispenses from MedicationDispense.authorizingPrescription
(MedicationRequest)		 1 Resources
receiver reference The identity of a receiver to list dispenses for MedicationDispense.receiver
(Practitioner, Group, Patient, PractitionerRole, RelatedPerson, Location)
recorded date Returns dispenses where dispensing activity began on this date MedicationDispense.recorded
responsibleparty reference Returns dispenses with the specified responsible party MedicationDispense.substitution.responsibleParty
(Practitioner, Organization, PractitionerRole)
status token Returns dispenses with a specified dispense status MedicationDispense.status 4 Resources
subject reference The identity of a patient for whom to list dispenses MedicationDispense.subject
(Group, Patient)
type token Returns dispenses of a specific type MedicationDispense.type 11 Resources
whenhandedover date Returns dispenses handed over on this date MedicationDispense.whenHandedOver
whenprepared date Returns dispenses prepared on this date MedicationDispense.whenPrepared