Clinical scenario for examples of Medication List and Medication Statement

In this scenario, a patient is admitted as an inpatient; most of their regular medicines are continued however one is stopped because of an adverse reaction. FHIR examples show the patient’s medications could be expressed in FHIR at each step of the journey from before admission through to discharge, using a Medication List i.e. a FHIR List of MedicationStatement resources. The detailed content of the example MedicationStatement resources illustrate how information about medications is expected to change in the data from step to step of the patient’s journey.

The purpose of these examples is to illustrate FHIR usage based on a simple clinical scenario.

Scenarios

1) GP Record

Example list of medications as recorded in a GP system.

Repeat

• Bendroflumethiazide 2.5mg tablets – 1 tablet every morning
• Bisoprolol 1.25mg tablets – 1 tablet every morning
• Nifedipress MR 20mg tablet 1 tablet twice a day
• Ramipril 2.5mg tablet – 1 tablet in the morning
• Atorvastatin 20mg tablet – 1 tablet at night
• Durogesic DTrans 25 microgram/hour transdermal patches – Apply one patch every 72 hours
• Hydrocortisone 1% Cream – Apply to the affected area twice a day
• Latanoprost 50micrograms/ml eye drops 0.2ml unit dose preservative free – Instil one drop into the left eye at night

Acute

• Amoxicillin 500mg capsules, one capsule three times a day for 7 days (Note: issued more than 6 months ago therefore not carried forward into the list of medicines on admission)

2) Rheumatology Clinic

Example list of medications for the patient as recorded at an outpatient clinic.

• Enbrel (Etanercept) 50mg/1ml solution for injection pre-filled syringes, Inject 50mg subcutaneously once a week (Note: prescribed by brand (AMP level) as it’s a biologic)

3) Medicines on admission

Example list of medications based on the following medications as recorded on the patient's admission to hospital

From GP data

• Bendroflumethiazide 2.5mg tablets – 1 tablet every morning
• Bisoprolol 1.25mg tablets – 1 tablet every morning
• Nifedipress MR 20mg tablet 1 tablet twice a day
• Ramipril 2.5mg tablet – 1 tablet in the morning
• Atorvastatin 20mg tablet – 1 tablet at night
• Durogesic DTrans 25 microgram/hour transdermal patches – Apply one patch every 72 hours
• Hydrocortisone 1% Cream – Apply to the affected area twice a day
• Latanoprost 50micrograms/ml eye drops 0.2ml unit dose preservative free – Instil one drop into the left eye at night

From Rheumatology Clinic

• Enbrel (Etanercept) 50mg/1ml solution for injection pre-filled syringes, Inject 50mg subcutaneously once a week (Note: prescribed by brand (AMP level) as it’s a biologic)

Patient self-medication

Information provided by the patient verbally during admission.

• Ibuprofen 200mg tablets, 2-3 tablets three times a day
• Paracetamol 500mg tablets 2 tablets four times a day

4) Inpatient medication

Example list of inpatient medications based on the medications below.

• Bendroflumethiazide 2.5mg tablets – 1 tablet every morning
• Bisoprolol 1.25mg oral every morning
• Nifedipress MR 20mg tablet oral - 1 tablet twice a day (Note: prescribed at AMP level as brand required)
• Ramipril 2.5mg every morning
• Atorvastatin 20mg at night
• Paracetamol 1g oral, every 4 hours, PRN pain
• Durogesic DTrans 25 microgram/hour transdermal patches – Apply one patch every 72 hours (Note: prescribed at AMP level as brand required)
• Hydrocortisone 1% Cream – Apply to the affected area twice a day (Note: prescribed at VMP level for correct dosage form)
• Latanoprost 50micrograms/ml eye drops 0.2ml unit dose preservative free – Instil one drop into the left eye at night (Note: prescribed at VMP level for correct dosage form)
• Enbrel (Etanercept) 50mg/1ml solution for injection pre-filled syringes, Inject 50mg subcutaneously once a week (Note: prescribed by brand (AMP level) as it’s a biologic)
• Ibuprofen 400mg oral, three times a day – STOPPED due to GI bleed

5) Discharge summary

Example list of discharge medications based on the medications below

• Bendroflumethiazide 2.5mg tablets – 1 tablet every morning
• Bisoprolol 1.25mg tablets – 1 tablet every morning
• Nifedipress MR 20mg tablet 1 tablet twice a day
• Ramipril 2.5mg tablet – 1 tablet in the morning
• Atorvastatin 20mg tablet – 1 tablet at night
• Paracetamol 500mg tablets, 2 tablets four times a day PRN
• Durogesic DTrans 25 microgram/hour transdermal patches – Apply one patch every 72 hours
• Hydrocortisone 1% Cream – Apply to the affected area twice a day
• Latanoprost 50micrograms/ml eye drops 0.2ml unit dose preservative free – Instil one drop into the left eye at night
• Ibuprofen 400mg oral, three times a day – STOPPED due to GI bleed
• Enbrel (Etanercept) 50mg/1ml solution for injection pre-filled syringes, Inject 50mg subcutaneously once a week (Note: prescribed by brand (AMP level) as it’s a biologic; Rheumatology treatment continuing)