ARCHETYPE Medication order (openEHR-EHR-INSTRUCTION.medication_order.v0)

Name: Medication order
License: http://creativecommons.org/licenses/by-sa/4.0/

ARCHETYPE ID	openEHR-EHR-INSTRUCTION.medication_order.v0
Concept	Medication order
Description	Instructions for use of a medication, vaccine or other therapeutic item.
Use	Use to record the instructions for use of a medication, vaccine or other therapeutic item. It is intended to be used for any type of medication and related order, whether prescribed by a health professional or available for purchase 'over the counter'. The scope of this medication archetype also includes orders for vaccinations or other therapeutic goods, such as bandages or other items that are applied or administered to have a therapeutic effect which have a common pattern for data recording. This archetype is designed to be used in a number of clinical contexts, including but not limited to: a record in a clinical consultation (COMPOSITION.encounter); a written prescription by a physician, dentist, nurse practitioner, or other designated health professional for a medication to be dispensed and administered (within a COMPOSITION.prescription); an item in a current medication list, prescription or drug chart (within COMPOSITION.medication_list); and an item in a summary document such as transfer of care (COMPOSITION.transfer_summary) or a referral (COMPOSITION.request). In most cases the order will be simple - for a single item with uncomplicated instructions for dispensing and administration. However this archetype is also designed to allow for more complex orders. For example: a reducing dose of predisolone over a period of weeks; a sliding scale of insulin, with dosing dependent on test results; multiple medications prescribed simultaneously as part of a single drug regimen, such as a triple therapy for peptic ulcer; and intravenous administration of medications or nutrition supplements. The archetype has been designed to allow for a range of complexity, from: simple narrative instructions for orders like 'Frusemide 40mg two tablets in the morning and one at lunch' to ensure compatibility with existing systems; through to structured detail for dose, route and timing to represent a fully computable specification. It has also been designed so that a single medication order structure can represent: complex sequential medication orders using the same preparation strength to be supported within a single order structure; and mutiple medication orders can be chained in circumstances where different medications or preparations need to be given sequentially. The amount of the medication is usually represented in terms of a number and corresponding dose unit, however there can also be a narrative statement to ensure compatibility with existing systems and also coverage of all scenarios. Cluster archetypes have been used to represent some of the content for two reasons: in situations where the content has been identifed as being also used in other clinical contexts, in particular the paired ACTION.medication archetype for recording actual dispensing, administration etc; and to remove less commonly used content from the core archetype framework.
Misuse	Not to be used to record the activities related to carrying out the order for medication, vaccine or therapeutic good, such as details about actual administration or dispensing. Use the ACTION.medication for this purpose. Not to be used to record the ordering of blood products. Use the INSTRUCTION.transfusion for this purpose. Not to be used to record the order for insertion of implants or medical devices such as pacemakers and defibrillators. Use the INSTRUCTION.procedure for this purpose.
Purpose	To record the instructions for use of a medication, vaccine or other therapeutic item.
References	openEHR Foundation Medication archetypes http://www.openehr.org/knowledge NEHTA's Therapeutic Good Use Data Group from the NEHTA Website http://www.nehta.gov.au Intermountain Healthcare Medication order model, Personal Communication to Sam Heard by Dr Stan Huff. Royal Australian College of General Practitioners. Fact Sheet: Medicines List. 2010.
Copyright	© openEHR Foundation
Authors	Author name: Sam Heard Organisation: NEHTA Email: sam.heard@oceaninformatics.com Date originally authored: 2015-10-21
Other Details Language	Author name: Sam Heard Organisation: NEHTA Email: sam.heard@oceaninformatics.com Date originally authored: 2015-10-21
Other Details (Language Independent)	Licence: This work is licensed under the Creative Commons Attribution-ShareAlike 4.0 License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/4.0/. Custodian Organisation: Ocean Informatics References: openEHR Foundation Medication archetypes http://www.openehr.org/knowledge NEHTA's Therapeutic Good Use Data Group from the NEHTA Website http://www.nehta.gov.au Intermountain Healthcare Medication order model, Personal Communication to Sam Heard by Dr Stan Huff. Royal Australian College of General Practitioners. Fact Sheet: Medicines List. 2010. Original Namespace: com.oceaninformatics Original Publisher: Ocean Informatics Custodian Namespace: com.oceaninformatics MD5-CAM-1.0.1: 2341A784013BE9A43AD7A0D1D9583EBD Build Uid: 00ef5c2c-6c81-4036-a640-3b18a8be4523 Revision: 0.0.1-alpha
Keywords	medication, order, prescribe, therapy, substance, drug, therapeutic, otc, therapeutic good
Lifecycle	in_development
UID	eb8b4694-b6ae-4855-a069-950522c3f9e3
Language used	en
Citeable Identifier	1013.1.1518
Revision Number	0.0.1-alpha
activities
Order	Order: Order.
Medication item	Medication item: Identification of the medication, vaccine or other therapeutic item being ordered. It is strongly recommended that the 'Medication item' be coded with a terminology capable of triggering decision support, where possible. The extent of coding may vary from the simple name of the medication item through to structured details about the actual medication pack to be used. Free text entry should only be used if there is no appropriate terminology available.
Preparation	Preparation: Structured details about the strength and form of the overall preparation. For example: the form, strength, any diluents or mixture of ingredients. Include: openEHR-EHR-CLUSTER.medication_preparation.v0 and specialisations
Route	Route: The route of administration. For example: 'oral', 'intravenous', or 'topical'.
Dose directions description	Dose directions description: Complete narrative description about how the medication is to be used. Including the amount, when to take it and additional instructions for use. Where the medication dose directions are fully carried by the structured, computable dose directions, this element should carry the narrative equivalent, generally auto-generated. If it is not possible to represent the intended dosage directions fully in computable form, partial representation is not recommended, and the directions should be only recorded in narrative form using this data element.
Parsable dose directions	Parsable dose directions: The structured, parsable and computable representation of the dose directions. Generally this is only used when passing information between legacy systems. For example: '10mg bd; 20mg n' as used by the NHS Dose syntax (in development). Formalism: text/html, text/plain, text/xml, text/rtf
Dose amount description	Dose amount description: The narrative description of the dose amount of the medication, vaccine or other therapeutic item. Will generally only be used for legacy formats where dose directions are simply split between textual representations of dose and amount.
Dose timing description	Dose timing description: The narrative description of the dose frequency and other timing of the medication, vaccine or other therapeutic item. Will generally only be used for legacy formats where dose directions are simply split between textual representations of dose and amount.
Dose direction	Dose direction: Details about a dose direction for the medication order. For example: '1 tab in the morning, 1 tab at night, for 3 weeks, on Mondays, Wednesdays and Fridays'. This cluster allows multiple occurrences to enable representation of a complete set of dose directions for a single medication order.
Direction sequence	Direction sequence: The intended sequence of this dose direction within the overall sequence of dose directions. min: >=1
Dose pattern	Dose pattern: The combination of a medication amount associated with a single medication timing. For example: '2 tablets at 6pm' or '20mg three times per day'. Please note: this cluster allows multiple occurrences to enable representation of a complete set of dose patterns for a single dose direction.
Dose amount	Dose amount: The value of the amount of medication as a real number. For example: 1, 1.5, 0.125 or 1-2, 12.5-20.5 Choice of: Quantity Property: Qualified real Units: >=0.0 (UCUM: 1) Interval of Quantity Lower: Property: Qualified real Units: >=0.0 (UCUM: 1) Upper: Property: Qualified real Units: >=0.0 (UCUM: 1)
Dose unit	Dose unit: The dose unit of the amount of medication. For example: 'tablet','mg'. Coding of the dose unit with a terminology is preferred, where possible.
Dose timing	Dose timing: Structured details about the timing of a single use or administration. For example: 'in the morning', 'at 0600, 1400, 2100'. Include: openEHR-EHR-CLUSTER.daily_timing.v0 and specialisations
Direction duration	Direction duration: The duration of this dose direction. For exampe: 'for 7 days','Indefinite'. Choice of: Coded Text at0067::Indefinite [The direction should be continued indefinitely.] at0068::Indefinite - Do not discontinue [The direction should be continued indefinitely and discontinuation is not recommended.] Duration >=0 seconds
Direction repetition	Direction repetition: Structured details about pattern of repetition for each set of daily dose directions. For exampe: 'every 3 days', 'on Thursdays and Sundays', '3 days after onset of menstruation'. Include: openEHR-EHR-CLUSTER.timing_repetition.v0 and specialisations
Medication safety	Medication safety: Details about medication safety for the medication, vaccine or other therapeutic item.
Maximum dose	Maximum dose: Details about the maximum dose allowed over a defined period. For example: 'up to 1gram per day'. This cluster allows multiple occurrences to enable representation of multiple maximum doses that apply to different time periods.
Maximum amount	Maximum amount: The maximum amount of medication allowed in the allowed period. For example: 1, 1.5, 0.125. Property: Qualified real Units: >=0.0 (UCUM: 1)
Maximum amount dose unit	Maximum amount dose unit: The dose unit for the maximum amount allowed. For example: 'tablet','mg'. Coding of the dose unit with a terminology is preferred, where possible.
Maximum class amount	Maximum class amount: The maximum amount of this medication item, expressed as a percentage of the total dose for this class of medication during the allowed period. Where diferent drugs of the same class are used, such as anti-pschotics, each drug may be allocated a nominal percentage figure which represents its contribution to a maximal 100% dose (usually per day). In some circumstances the ordering clinician may want to override the 100% limit to a greater or smaller amount. Percent Numerator: 0.0..100.0 Assumed value: 100.0 Assumed value: false
Allowed period	Allowed period: The allowed period of time. >=0 years
Exceptional dose override?	Exceptional dose override?: Confirmation by the prescriber that the normal dose has been overridden due to exceptional circumstances?
Cumulative maximum dose	Cumulative maximum dose: Details about the maximum total dose allowed over a lifetime.
Maximum amount	Maximum amount: The maximum amount of medication allowed in the allowed period. For example: 1, 1.5, 0.125. Property: Qualified real Units: >=0.0 (UCUM: 1)
Maximum amount dose unit	Maximum amount dose unit: The dose unit for the maximum amount allowed. For example: 'tablet','mg'. Coding of the dose unit with a terminology is preferred, where possible.
Dose goal	Dose goal: Details about the proposed total daily amount of medication. The dose goal will record the expected effective dose, and thus support titration of an initial low dose towards the effective dose over a period of time.
Total daily dose amount	Total daily dose amount: The amount of medication which is intended to be taken each day if the medication is administered as intended. Property: Qualified real Units: >=0.0 (UCUM: 1)
Total daily dose unit	Total daily dose unit: The dose unit associated with the total daily dose amount. The dose units are normally scientific units such as mg, ml rather than 'tablets'.
Additional instruction	Additional instruction: An additional instruction on how to use the medication, vaccine or other therapeutic good. For example: 'take with food'. This data element allows multiple occurrences.
Patient guidance	Patient guidance: An additional instruction directed primarily at the patient or carers. For example: 'To reduce your blood pressure', 'To thin your blood', 'Avoid grapefruit'. This data element allows multiple occurrences.
Monitoring instruction	Monitoring instruction: An additional instruction which gives advice on appropriate monitoring of the medication. For example: 'Please check renal function in 2 weeks'. This data element allows multiple occurrences.
Clinical indication	Clinical indication: The clinical reason for ordering the medication, vaccine or other therapeutic good. For example: 'Angina'. Coding of the clinical indication with a terminology is preferred, where possible. This data element allows multiple occurrences.
Therapeutic intent	Therapeutic intent: The overall theraputic intent of the medication. For example: 'palliative', 'low-dose propylaxis'.
Course details	Course details: Details about the intended course of the medication.
Order start date/time	Order start date/time: The date and optional time to commence use of the medication, vaccine or other therapeutic good.
Order stop date/time	Order stop date/time: The date and optional time to cease use of the medication, vaccine or other therapeutic good.
Order start criterion	Order start criterion: A condition which, when met, requires the commencement of administration or use. For example: 'Start if symptoms recur'.
Order stop criterion	Order stop criterion: A condition which, when met, requires the cessation of administration or use. For example: 'Stop after symptoms disappear''.
Duration of course already complete	Duration of course already complete: The time period during which the patient has already been using the medication, vaccine or other therapeutic good, as a part of the proposed overall course but prior to the issue of this order. For example: To record that the patient had been taking antibiotics 3 days prior to hospital admission, in the context of a 7 day course. Allowed values: weeks, days, hours >=0 hours
Administrations already complete	Administrations already complete: The number of administrations of the medication, vaccine or other therapeutic good that have been completed, as part of the proposed overall course but prior to the issue of this order. For example: To record that the patient had been taking antibiotics three days prior to hospital admission, in the context of a 7-day course.
Course summary	Course summary: Summary information about the medication, such as current status or key dates, generally used in non-prescription contexts. Course summary may be required when transmitting medication information between systems. For example: as part of a referral, emergency patient summary or discharge communication. Include: openEHR-EHR-CLUSTER.medication_course_summary.v0 and specialisations
Administration directions	Administration directions: Details about the administration of the medication, vaccine or other therapeutic good.
Administration instruction	Administration instruction: An additional instruction directed primarily at the person administering the medication, vaccine or therapeutic good. This data element allows multiple occurrences.
Dose administration duration	Dose administration duration: The period of time over which a single dose of the medication or vaccine should be administered. For example: 'Administer over 10 minutes'. Allowed values: days, hours, minutes, seconds >=0 hours
Infusion administration rate	Infusion administration rate: The rate at which the medication infusion is to be administered. For example: 1 drop per minute. Use the text data typeto record non- or semi-quantifiable instructions. Choice of: Quantity Property: Flow rate, volume Units: >=0.0 l/h >=0.0 ml/min >=0.0 ml/s >=0.0 ml/h Text
Infusion purpose	Infusion purpose: The purpose of the infusion. at0137::Baseline electrolyte infusion [The infusion provides baseline hydration.] at0138::Active medication infusion [The infusion carries an active pharmaceutical ingredient.]
Body site	Body site: Identification of the site of administration of the medication, vaccine or therapeutic good. For example: 'left upper arm', 'intravenous catheter right hand'.
Structured body site	Structured body site: Structured description of the site of administration of the medication, vaccine or therapeutic good. Include: openEHR-EHR-CLUSTER.anatomical_location.v1 and specialisations or openEHR-EHR-CLUSTER.anatomical_location_clock.v0 and specialisations or openEHR-EHR-CLUSTER.anatomical_location_relative.v1 and specialisations
Delivery method	Delivery method: The method by which the medication is to be delivered. For example: 'via nebuliser'.
Delivery device	Delivery device: Details of the medical device used to assist with delivery of the medication. Include: openEHR-EHR-CLUSTER.device.v1 and specialisations
Administration details	Administration details: Additional structured details about the administration of the medication, vaccine or other therapeutic good. Include: All not explicitly excluded archetypes
Dispense directions	Dispense directions: Details about the dispensing of the medication, vaccine or other therapeutic good.
Dispense instruction	Dispense instruction: An additional instruction directed primarily at the person dispensing the medication, vaccine or therapeutic good.
Dispense supply	Dispense supply: Details about the amount of medication to be supplied by the dispenser.
Dispense description	Dispense description: Narrative description of amount of medication to be dispensed. For example: '30 tablets'. This data element is intended for use in clinical situations where dispensingthis cannot be handled by a structured expression. Where the dispensing directions are fully carried by the structured, computable dose directions, this element should carry the narrative equivalent, generally auto-generated. If it is not possible to represent the intended dosage directions fully in computable form, partial representation is not recommended, and the directions should be only recorded in narrative form using this data element.
Dispense amount	Dispense amount: The amount of medication, vaccine or therapeutic good to be dispensed. For example: 1, 1.5, or 0.125. Property: Qualified real Units: >=0.0 (UCUM: 1)
Dispense unit	Dispense unit: The dose unit or pack unit associated with the dispense amount. For example: 'tablets', 'packs', ml'.
Duration of supply	Duration of supply: The period of time for which the medication should be dispensed. The dispenser is asked to supply sufficient quantity of medication to cover the defined period. Allowed values: years, months, weeks >=0 years
Start date	Start date: The date after which the medication is permitted to be dispensed for the first time. May be used to control the time of dispensing of medications with potential for abuse. For example: benzodiazepines or analgesics.
Substitution permitted	Substitution permitted: Indicates if substitution of a bioequivalent medication, vaccine or therapeutic good during dispensing is acceptable to the prescribing clinician. In many jurisdictions, substitution of a prescribed medication, vaccine or other therapeutic good as a generic form or with a different brand name, which has been determined as bioequivalent, is allowed at the point of dispense or supply.
Substitution reason	Substitution reason: The reason for a substitution or non-substitution decision.
Priority	Priority: An indicator of the urgency with which the medication should be dispensed.
Dispense details	Dispense details: Additional structured details about the dispense of the medication, vaccine or other therapeutic good. Include: All not explicitly excluded archetypes
Authorisation details	Authorisation details: Details of authorisation of the medication, vaccine or other therapeutic good. For example: details of repeat supply. This SLOT allows for local variation in the different jurisdictions regarding medication authorisation and re-authorisation to be managed. Include: openEHR-EHR-CLUSTER.medication_authorisation.v0 and specialisations
protocol
Order identifier	Order identifier: Unique identifier for the medication order.
Dosage formula	Dosage formula: The formula used to calculate the Dose amount or administration rate where this is dependent on some other factor such as patient weight. For example: 10mg/kg/day.
Extension	Extension: Additional information required to capture local content or to align with other reference models/formalisms. For example: local information requirements or additional metadata to align with FHIR or CIMI equivalents. Include: All not explicitly excluded archetypes
Other contributors	Silje Ljosland Bakke, Helse Bergen HF, Norway (Editor) John Bennett, NEHTA, Australia Sharmila Biswas, Australia Stephen Chu, NEHTA, Australia (Editor) Matthew Cordell, NEHTA, Australia Gail Easterbrook, Flinders Medical Centre, Australia David Evans, Queensland Health, Australia Sarah Gaunt, NEHTA, Australia Trina Gregory, cpc, Australia Sam Heard, Ocean Informatics, Australia (Editor) Mary Kelaher, NEHTA, Australia Robert L'egan, NEHTA, Australia Heather Leslie, Ocean Informatics, Australia (Editor) Susan McIndoe, Royal District Nursing Service, Australia David McKillop, NEHTA, Australia Chris Mitchell, RACGP, Australia Stewart Morrison, NEHTA, Australia Chris Pearce, Melbourne East GP Network, Australia Camilla Preeston, Royal Australian College of General Practitioners, Australia Margaret Prichard, NEHTA, Australia Cathy Richardson, NEHTA, Australia Robyn Richards, NEHTA - Clinical Terminology, Australia John Taylor, NEHTA, Australia Richard Townley-O'Neill, NEHTA, Australia (Editor) Kylie Young, The Royal Australian College of General Practitioners, Australia Ian McNicoll, freshEHR Clinical Informatics Ltd., UK
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