ARCHETYPE Medication item (openEHR-EHR-CLUSTER.medication_item.v0)

Name: Medication item
License: http://creativecommons.org/licenses/by-sa/3.0/

ARCHETYPE ID	openEHR-EHR-CLUSTER.medication_item.v0
Concept	Medication item
Description	Records details of a medication product, dosage and administration directions, for use within medication recommendation, order, administration and dispensation records.
Use	This archetype will always be used within the context of a parent Entry archetype, such as 'Medication Order' or 'Medication Action' and is designed for outpatient and ambulatory care settings. It may also be used at transitions of care to facilitate medicines reconciliation. Use of the archetype will vary depending on the care setting responsible ... A. Ambulatory care settings (GP, Community, Mental health, some outpatient settings): The medication Name is normally represented by a dm+d product-code (VMP/AMP), which will include the product Strength and Form, and Route is normally not specified. Dosage is generally expressed as a single text string and should be carried in 'Dose Description'. B. Hospital settings (Inpatient and some outpatient settings): The medication Name is normally represented by a dm+d code (VTM), Form and Route are normally specified explicitly and Dosage is generally expressed as Dose / Frequency which should be carried in 'Dose Instructions' as simple text strings. A 'Parsable dose directions element has been added to allow dose amount and timing to be captured in a more structured and computable form but this is recognised as being potentially complex to implement, at least in complete form, safely and consistently across all care settings. The 'Structured dose direction cluster replicates the dose amount and timing content carried in 'Parsable dose directions',only for use in those systems which choose to persist medication data in openEHR format.
Misuse	This archetype has not been designed for use in an inpatient setting, other than at transitions of care to facilitate medicines reconciliation at patient transfer from/to a community setting. It is possible that the archetype would be suitable for inpatient use with some modification or specialisation but this has currently been left out of scope.
Purpose	The Medication Item Cluster records details of a medication, dosage, administration and dispensing instructions. The model is closely aligned with the SCI-XML, dm+d, RCP medication record guidance, HSCIC Dose syntax and GP2GP medication models. It is intended to support both ‘product-based’ prescribing, used in community and most out-patient settings; and ‘dose-based’ prescribing , generally used in in-patient settings. e.g. Product-based prescribing “Citalopram tab 20mg, 1 tab daily”, Dose-based prescribing ”Citalopram, oral, 20 mg once daily”. The archetype may be used to record core details of a medication order, medication action or medication item summary e.g in an unscheduled care summary (KIS, SCR, IHR), referral or discharge letter, or to underpin an API call which returns a medication summary. The archetype may also be used to record discrete medication 'events', the normal approach within an individual application or shared medication record, where each phase of oredering or supplying the medication is stored as separate record. The differences between hospital 'dose-based' prescribing and ambulatory 'product-based' prescribing, currently limit the degree to which the medication record can be made interoperable across care settings, particularly because of the potential complexity of dosage instructions. For clinical safety reasons, fully automated information exchange at transitions of care, without human oversight, is probably undesirable, and in spite of the limitations, the use of a common, structured medication record, will add substantial benefit.
References	HSCIC Messaging Implementation Manual (GP2GP messages) http://www.uktcregistration.nss.cfh.nhs.uk/trud3 NHS Scotland SCI-XML (SCI-Gateway, ECS, ePharmacy) http://www.sci.scot.nhs.uk/products/gateway/gate_down_xml.htm NHS Wales Informatics Service, Integrated Health Record http://www.wales.nhs.uk/nwis/page/52553 DM+D drug dictionary: http://www.dmd.nhs.uk/ Royal College of Physicians, Core Clinical Headings, http://www.rcplondon.ac.uk/projects/standards-core-clinical-information Royal College of Physicians, Standards for structure and content of medications and medical device records: technical annex, http://www.rcplondon.ac.uk/sites/default/files/medication-and-medical-device-records-technical-annex-2013.pdf
Copyright	© openEHR Foundation
Authors	Author name: Dr Ian McNicoll Organisation: Ocean Informatics, UK Email: ian.mcnicoll@oceaninformatics.com Date originally authored: 2013-01-30
Other Details Language	Author name: Dr Ian McNicoll Organisation: Ocean Informatics, UK Email: ian.mcnicoll@oceaninformatics.com Date originally authored: 2013-01-30
Other Details (Language Independent)	Licence: This work is licensed under the Creative Commons Attribution-ShareAlike 3.0 License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/3.0/. Custodian Organisation: Ocean Informatics References: HSCIC Messaging Implementation Manual (GP2GP messages) http://www.uktcregistration.nss.cfh.nhs.uk/trud3 NHS Scotland SCI-XML (SCI-Gateway, ECS, ePharmacy) http://www.sci.scot.nhs.uk/products/gateway/gate_down_xml.htm NHS Wales Informatics Service, Integrated Health Record http://www.wales.nhs.uk/nwis/page/52553 DM+D drug dictionary: http://www.dmd.nhs.uk/ Royal College of Physicians, Core Clinical Headings, http://www.rcplondon.ac.uk/projects/standards-core-clinical-information Royal College of Physicians, Standards for structure and content of medications and medical device records: technical annex, http://www.rcplondon.ac.uk/sites/default/files/medication-and-medical-device-records-technical-annex-2013.pdf Original Namespace: com.oceaninformatics Original Publisher: Ocean Informatics Custodian Namespace: com.oceaninformatics MD5-CAM-1.0.1: 0AACA0132F10B0DCC21D1F2AC42BBCAC Build Uid: cf3deb6a-eab0-4dd1-b6fa-e2c89f2b76f0 Revision: 0.0.1-alpha
Keywords	medication, prescription, dosage, administration, dispensing, drug, therapeutics, pharmacology, pharmacy
Lifecycle	in_development
UID	3dadc5c3-bb22-4669-9567-29ccb844a816
Language used	en
Citeable Identifier	1013.1.1003
Revision Number	0.0.1-alpha
items
Medication name	Medication name: Mandatory medication name coded using a SNOMED CT/dm+d term where possible, allowing plain text for historical/patient reported items , extemporaneous preparations or those not registered in dm+d. e.g.“Citalopram tab 20mg”, "Trimethoprim" Choice of: Text Coded Text Constraint: MedicationName [Any AMP/VMP/VTM/AMPP/VMPP subsets from the dm+d terminology. NHS dm+d AMP ::352201000001139 NHS dm+d AMPP ::352401000001135 NHS dm+d VMP ::352701000001133 NHS dm+d VMPP ::352301000001131 NHS dm+d VTM ::352601000001138] Constraint binding: [dm+d] subset=NHS_dm+d
Form	Form: Form of the medicinal substance e.g capsules, tablets, liquid. Not normally required unless a specific form has been requested by the prescriber. e.g. "Modified Release Capsules" Choice of: Coded Text Constraint: DrugDoseForm [SNOMED CT CFH::DoseForm termset. Any descendant of 421967003 \| drug dose form.] Constraint binding: [SNOMED-CT] subset=CFH::DoseForm Text
Route	Route: Optional medication route, using SNOMED CT terms where possible. Not generally applicable to product-based medication. Should not be used to specify a specific administration site, for which a separate archetype is used e.g. The Route is 'intraocular' the Site may be 'Left eye'. e.g. "Oral", "Intraocular". Note that this element supports multiple Routes to allow a choce to be specified by the prescriber. Choice of: Coded Text Constraint: NHS e-Prescribing route of administration subset [Id : 413001000001136 Original Id : 30201000001137 This is an extract from the SUBSET -BiAnnual-Drug-15.0.1-20130401: SnomedCT_GB1000001_20130401/Subsets/EPrescribing/NHS e-Prescribing route of administration subset] Constraint binding: [SNOMED-CT] subset=NHS e-Prescribing route of administration subset Text
Site	Site: The anatomical site at which the medication is to be administered. e.g. "Left eye" Choice of: Coded Text Constraint: SiteOfMedicationAdministration [Any valid site for the administration of a medication.] Constraint binding: [SNOMED-CT] subset=MedicationAdministrationSite Text
Method	Method: The technique or method by which the medication is to be administered.
Dose directions description	Dose directions description: A single plain text phrase describing the entire medication dosage and administration directions, including dose quantity and medication frequency. e.g. “I tablet at night” or “20mg at 10pm” This is the form of dosage direction text normally available from UK GP systems.
Dose amount description	Dose amount description: A plain text description of medication single dose amount, as described in the AoMRC medication headings. e.g. "30 mg" or "2 tabs". UK Secondary care clinicians and systems normally minimally structure their dose directions, separating Dose amount and Dose timing (often referred to as Dose and Frequency). This format is not normally used in GP systems, which will always import Dose and Frequency descriptions concatenated into the single Dose directions description.
Dose timing description	Dose timing description: A plain text description of medication dose frequency, as described in the AoMRC medication headings. e.g. "Twice a day", "At 8am 2pm and 10pm" . UK Secondary care clinicians and systems normally minimally structure their dose directions, separating Dose amount and Dose timing (often referred to as Dose and Frequency). This format is not normally used in GP systems, which will always import Dose and Frequency descriptions concatenated into the single Dose directions description.
Parsable dose directions	Parsable dose directions: A parsable 'dose syntax' which carries dose strength, dose timing, dose duration and maximum dose information. e.g. "20-30mg ^4/6h prn [180mg /24h]" = 20 to 30 mgs, up to 4-6 hourly as required. Maximum 180mg in 24 hours. The 'as required reason' e.g. 'for pain' should be carried in the Additional Instruction element. Note that this is generally a symptom and is not the same as the Indication which will usually describe a diagnosis or condition. Where supported, this would generally be used to exchange dosage information between systems, while Structured dose directions are likely to be used only within openEHR-based systems. Formalism: text/plain
Structured dose direction	Structured dose direction: A structural representation of the elements carried by the dose syntax in 'Parsable dose strength/timing' i.e. dose strength, dose timing, dose duration and maximum dose. Structured dose directions will normally be used within openEHR systems rather than in cross-system communication but may be helpful where legacy systems expose some structured data e.g Direction duration.
Structured dose amount	Structured dose amount: A structural representation of dose amount. e.g. 20mg or 2 tablets This element will generally only be used when persisting data within systems with 'Parsable dose directions' being used to exchange the same information between systems. Include: openEHR-EHR-CLUSTER.medication_quantity_sct.v1 and specialisations
Structured dose timing	Structured dose timing: A slot containing a structural, computable representation of dose timing and maximum dose. e.g. 20mg or 2 tablets This element will generally only be used when persisting data within systems with 'Parsable dose directions' being used to exchange the same information between systems. Include: All not explicitly excluded archetypes
Dose direction duration	Dose direction duration: The duration of a single dose direction, either as a timed duration such as '7 days' or a text instruction. Where multiple dose directions are required for a course of medication e.g for a tapering or increasing dose, the duration refers to the duration of a single direction, not the whole course. e.g. "for 7 days", "Continue indefinitely". "Continue indefinitely", and "Do not discontinue" are normally applied to medication discharge orders and recommendations. e.g. 20mg or 2 tablets This element will generally only be used when persisting data within systems with 'Parsable dose directions' being used to exchange the same information between systems. Choice of: Coded Text at0042::Continue indefinitely [The medication should be continued indefinitely.] at0043::Do not discontinue [The medication should be continued indefinitely and the prescriber highly recommends that it should never be discontinued. This is an AoMRC Clinical Headings recommendation.] at0055::Stop when course complete. [The medication should be stopped when the currently prescribed course has been completed.] Duration Allowed values: years, months, weeks, days, hours >=0 days
(Additional instruction)	(Additional instruction): Additional multiple dosage or administration instructions as plain text. This may include guidance to the prescriber, patient or person administering the medication. In some settings, specific Administration Instructions may be re-labelled as "Patient advice' or 'Dispensing Instruction' to capture these flavours of instruction. e.g. “Omit morning dose on day of procedure”, "for pain or fever", "Dispense weekly". Runtime name constraint: at0005::Additional instruction [Additional multiple dosage or administration instructions as plain text. This may include guidance to the prescriber, patient or person administering the medication. In some settings, specific Administration Instructions may be re-labelled as "Patient advice' or 'Dispensing Instruction' to capture these flavours of instruction.] at0004::Dispensing instruction [Multiple plain text to record complex dispensing arrangements, particularly for Controlled Drug instalment dispensing. 'Dispensing instructions' may be used as a specific label to overwrite 'Additional instructions' to align with legacy GP system behaviour.] at0027::Patient advice [Multiple plain text instructions intended for patient or carer. 'Patient advice' may be used as a specific label to overwrite 'Additional instructions' to align with legacy GP system behaviour.] at0057::Monitoring [Special instructions realted to monitoring of medication, such as lab tests.]
Course details	Course details: Details of the overall course of medication.
Course status	Course status: The status of this prescription in an ambulatory (outpatient/GP/community) context. at0050::Active [This is an active medication.] at0051::Discontinued [This is a medication that has been issued. dispensed or administered but has now been discontinued.] at0052::Never active [A medication which was ordered or authorised but has been cancelled prior to being issued, dispensed or adiminstered.] at0053::Completed [The medication course has been completed.] at0054::Obsolete [This medication order has been superseded by another.]
Start datetime	Start datetime: The date and/or time that the medication course should begin.
End datetime	End datetime: The date and/or time that the medication course should finish.
Indication	Indication: A free text or Coded text term gving the clinical indication or reason for ordering the medication. Coded terms are preferable. e.g. "Angina". The Indication generally describes a condition or diagnosis.
Link to Indication record	Link to Indication record: A link to the record which contains the Indication for this medication order.
Comment / recommendation	Comment / recommendation: Additional comment or recommendation about the medication course e.g. 'Patient named supply', 'unlicensed medication', 'Foreign brand' or monitoring recommendations.
Total daily dose quantity	Total daily dose quantity: The total daily dose of this medication. This is helpful for estimating optimal adherance to dosing guidance. It may be computed from product/dose strength and frequency or entered manually. Include: openEHR-EHR-CLUSTER.medication_quantity_sct.v1 and specialisations
Other contributors	Marcus Baw, openGPSoC / Baw Medical Ltd, United Kingdom (Editor) Steve Bentley, HSCIC, United Kingdom Colin Brown, SCIMP, United Kingdom Richard Cottrell, NHS Ayrshire and Arran, United Kingdom Leo Fogarty, SCIMP/HSCIC, United Kingdom (Editor) RCP Health Informatics Unit, UK Dr John Williams, GP2GP project, UK Dr Leo Fogarty, GP2GP project, UK Heather Leslie, Ocean Informatics, Australia Dawn MacDermid, United Kingdom Ian McNicoll, Ocean Informatics, United Kingdom (Editor) Barry Melia, NHS Lothian, United Kingdom Paul Miller, SCIMP, United Kingdom (Editor) Mike Robinson, INPS, United Kingdom Laura Sato, Health and Social Care Information Centre, United Kingdom Ian Thompson, SCIMP, United Kingdom (Editor) John Williams, GP2GP, United Kingdom (Editor)
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