ARCHETYPE Therapeutic direction modified (openEHR-EHR-CLUSTER.therapeutic_direction_modified.v1)

ARCHETYPE IDopenEHR-EHR-CLUSTER.therapeutic_direction_modified.v1
ConceptTherapeutic direction modified
DescriptionStructured details of a single therapeutic direction for an ordered item, such as a medication or blood transfusion order.
UseA direction describes one or more sequential therapeutic administration patterns, coupled with an overall direction duration and details of any repetitive pattern of intended administration outside a single day. 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 dosage directions for a single medication order. The cluster can be renamed in template or at run-time to represent a specific dosing event such as 'loading dose', 'bolus'. This archetype will gnerally be used in the context of a parent INSTRUCTION archetype, primarily Medication order but also for transfusion and dialysis orders.
PurposeTo record structured details of a single therapeutic direction for an ordered therapeutic/prescribable item. Each direction generally applies for a given duration, or fixed number of administrations.
ReferencesDerived from: Therapeutic direction, Published archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited: 2018-02-08]. Available from: http://www.openehr.org/ckm/#showArchetype_1013.1.2753
Medication instruction, Draft Archetype [Internet]. nehta, Australia, nehta Clinical Knowledge Manager [cited: 2015-12-15]. Available from: http://dcm.nehta.org.au/ckm/#showArchetype_1013.1.838

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.

NHS HSCIC Messaging Implementation Manual (GP2GP messages) http://www.uktcregistration.nss.cfh.nhs.uk/trud3

Standards for medication and medical device records – technical annex [Internet]. RCP London. [cited 2015 Dec 15]. Available from: https://www.rcplondon.ac.uk/projects/outputs/standards-medication-and-medical-device-records-technical-annex
Copyright© openEHR Foundation, Alberta Health Services (Canada), openEHR Foundation
AuthorsAuthor name: Ian McNicoll
Organisation: freshEHR Clinical Informatics
Email: ian@freshehr.com
Date originally authored: 2017-03-22
Other Details LanguageAuthor name: Ian McNicoll
Organisation: freshEHR Clinical Informatics
Email: ian@freshehr.com
Date originally authored: 2017-03-22
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: Derived from: Therapeutic direction, Published archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited: 2018-02-08]. Available from: http://www.openehr.org/ckm/#showArchetype_1013.1.2753 Medication instruction, Draft Archetype [Internet]. nehta, Australia, nehta Clinical Knowledge Manager [cited: 2015-12-15]. Available from: http://dcm.nehta.org.au/ckm/#showArchetype_1013.1.838 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. NHS HSCIC Messaging Implementation Manual (GP2GP messages) http://www.uktcregistration.nss.cfh.nhs.uk/trud3 Standards for medication and medical device records – technical annex [Internet]. RCP London. [cited 2015 Dec 15]. Available from: https://www.rcplondon.ac.uk/projects/outputs/standards-medication-and-medical-device-records-technical-annex
  • Current Contact: Ian McNicoll, freshEHR Clinical Informatics, UK
  • Original Namespace: com.oceaninformatics
  • Original Publisher: Ocean Informatics
  • Custodian Namespace: com.oceaninformatics
  • MD5-CAM-1.0.1: 359595F168B053524A6524998E7080FD
  • Build Uid: c7040676-2d44-49cb-a665-500a0b8bc49a
  • Revision: 1.0.0
Keywordsmedication, order, prescribe, therapy, substance, drug, therapeutic, otc, therapeutic good, pharmaceutical, product, posology, treatment, transfusion
Lifecyclepublished
UID423b00ca-b406-459f-a555-615d425926e9
Language useden
Citeable Identifier1013.1.1955
Revision Number1.0.0
items
Direction sequenceDirection sequence: The intended position of this direction within the overall sequence of directions.
For example: ''1' '2', '3'. Where multiple dosage directions are expressed, the 'Direction sequence' makes the order in which they should be executed explicit. For example: (1) 1 tab daily for 3 days, (2) 1 tab twice daily for 4 days, (3) 1 tablet for 7 days.
min: >=1

Dosage Dosage : *
Dosage sequenceDosage sequence: The intended position of this dosage within the overall sequence of dosages.
Dose amountDose amount: The value of the amount of medication administered at one time, as a real number, or range of real numbers, and associated with the Dose unit.
For example: 1, 1.5, 0.125 or 1-2, 12.5-20.5
Choice of:
  •  Quantity
    Property: Qualified real
    Units:
  •  Interval of Quantity
    Lower: Property: Qualified real
    Units:

  •  Text
Dose unitDose unit: The unit which is associated with the Dose amount.
For example: 'tablet','mg'. Coding of the dose unit with a terminology is preferred, where possible.
Calculated doseCalculated dose: *
Dose calculation amountDose calculation amount: The numeric part of the formula used to calculate the dose amount or administration rate where this is dependent on some other factor, such as body weight or surface area.
Choice of:
  •  Text
  •  Quantity
    Property: Qualified real
    Units:
Dose calculation unitDose calculation unit: The unit of the formula used to calculate the dose amount or administration rate where this is dependent on some other factor, such as body weight or surface area.
Ex: "mg/kg/dose" or "mg/m2/dose"
Dose descriptionDose description: Text description of the dose.
For example: "Apply ointment to affected area". This element is intended to allow implementers to use the structures for increasing/tapering dosages without necessarily specifying the doses in a structured way.
TimingTiming: Structured details about the timing pattern for a single day.
For example: 'in the morning', 'at 0600, 1400, 2100'.
Include:
All not explicitly excluded archetypes
Administration rateAdministration rate: The rate at which the medication, such as an infusion, is to be administered.
For example: '200 ml/h'. Use the text data type to record non- or semi-quantifiable instructions.
Choice of:
  •  Quantity
    Property: Flow rate, volume
    Units:
    • ml/h
    • ml/min
    • ml/s
    • l/h
  •  Text
Administration durationAdministration duration: The period of time over which a single dose of the medication or vaccine should be administered.
For example: 'Administer over 10 minutes'.
>=0 seconds
Alternate dose amountAlternate dose amount: An alternate representation of the value of the amount of medication administered at one time, as a real number, or range of real numbers, and associated with the Dose unit.
For example, can be used to represent a unit-dose based value such as 'tabs', when the Dose amount is expressed as an SI unit such as 'mg', or where it is required to express the total amount of an infusion as well as the dose amount of the active ingredient.
Choice of:
  •  Quantity
    Property: Qualified real
    Units:
  •  Interval of Quantity
    Lower: Property: Qualified real
    Units:

Alternate dose unitAlternate dose unit: The unit which is associated with the Alternate dose amount.
Dosage justificationDosage justification: A description of the justification used to calculate a dose amount or administration rate where this is dependent on some other factor.
For example: 'Adjusted for amputation'.
RouteRoute: The route by which the ordered item is to be administered into the subject's body.
or example: 'oral', 'intravenous', or 'topical'. Coding of the route with a terminology is preferred, where possible. Multiple potential routes may be specified.
Structured body siteStructured body site: Structured description of the site of administration of the ordered item. (anatomical location)
Include:
All not explicitly excluded archetypes
Administration method/deviceAdministration method/device: The technique or device by which the ordered item is to be administered.
For example: ' via Z-track injection'; 'via nebuliser'. Coding of the method with a terminology is preferred, where possible.
Direction durationDirection duration: The length of time for which this direction should be applied.
For example: 'for 7 days','Indefinite'. An example of a set of multiple directions, with varying durations might be ... '1 tablet daily for 3 days, 2 tablets daily for 4 days, then 3 tablets Indefinite'.
Choice of:
  •  Coded Text
    • Indefinite [The direction should be continued indefinitely.]
    • Indefinite - not to be discontinued [The direction should be continued indefinitely with a strong recommendation that it never be discontinued.]
  •  Duration
    >=0 seconds
  •  Text
Maximum number of administrationsMaximum number of administrations: The maximum number of administrations to be given for this direction.
Example: 'Give once only' = 1 or '400mg 12hrly for 3 doses' = 3.
min: >=1

Direction repetitionDirection repetition: Structured details about pattern of repetition for each set of daily directions.
For example: 'every 3 days', 'on Thursdays and Sundays', '3 days after onset of menstruation'.
Include:
openEHR-EHR-CLUSTER.timing_repetition.v0 and specialisations
Additional detailsAdditional details: Further details about an ordered item direction.
For example, conditional instructions such as insulin /glucose infusion rates dependent on blood glucose, or detailed administration instructions for particular preparations.
Include:
openEHR-EHR-CLUSTER.conditional_medication_rules.v0 and specialisations
Other contributorsVebjørn Arntzen, Oslo University Hospital, Norway
Koray Atalag, University of Auckland, New Zealand
Silje Ljosland Bakke, Nasjonal IKT HF, Norway (openEHR Editor)
Marcus Baw, openGPSoC / BawMedical Ltd, United Kingdom
John Bennett, NEHTA, Australia
SB BHATTACHARYYA, Sudisa Consultancy Services, India
SBhusan Bhattacharyya, Sudisa Consultancy Services, India
Sharmila Biswas, Australia
Lars Bitsch-Larsen, Haukeland University hospital, Norway
Stephen Chu, NEHTA, Australia (Editor)
Matthew Cordell, NEHTA, Australia
Gail Easterbrook, Flinders Medical Centre, Australia
David Evans, Queensland Health, Australia
Hildegard Franke, freshEHR Clinical Informatics Ltd., United Kingdom
Sarah Gaunt, NEHTA, Australia
Heather Grain, Llewelyn Grain Informatics, Australia
Trina Gregory, cpc, Australia
Robert Hausam, Hausam Consulting LLC, United States
Sam Heard, Ocean Informatics, Australia (Editor)
Evelyn Hovenga, EJSH Consulting, Australia
Mary Kelaher, NEHTA, Australia
Robert L'egan, NEHTA, Australia
Russell Leftwich, Russell B Leftwich MD, United States
Heather Leslie, Ocean Health Systems, Australia (openEHR Editor)
Colin Macfarlane, Elsevier, United Kingdom
Susan McIndoe, Royal District Nursing Service, Australia
David McKillop, NEHTA, Australia
Ian McNicoll, freshEHR Clinical Informatics, United Kingdom (openEHR Editor)
Chris Mitchell, RACGP, Australia
Stewart Morrison, NEHTA, Australia
Andrej Orel, Marand d.o.o., Slovenia
Chris Pearce, Melbourne East GP Network, Australia
Vladimir Pizzo, Hospital Sírio Libanês, Brazil
Camilla Preeston, Royal Australian College of General Practitioners, Australia
Margaret Prichard, NEHTA, Australia
Norwegian Review Summary, Nasjonal IKT HF, Norway
Cathy Richardson, NEHTA, Australia
Robyn Richards, NEHTA - Clinical Terminology, Australia
Anoop Shah, University College London, United Kingdom
Iztok Stotl, UKCLJ, Slovenia
John Taylor, NEHTA, Australia
Nyree Taylor, Ocean Informatics, Australia
Richard Townley-O'Neill, NEHTA, Australia
John Tore Valand, Helse Bergen, Norway (openEHR Editor)
Ines Vaz, UFN, Portugal
Kylie Young, The Royal Australian College of General Practitioners, Australia
Translators
  • Norwegian Bokmal: Silje Ljosland Bakke, Nasjonal IKT HF
  • Portuguese (Brazil): Beatriz de Faria Leao, BLEAO Informática em Saúde, bfleao@terra.com.br, MD, PhD