Medication Requests
Medication requests are the prescriptions for a specific medication, for a patient, combined with instructions for administration of the drug. This category includes both prescriptions for home medication (referred to as “outpatient”) that is picked up at the outpatient clinic pharmacy or at the local pharmacy by the patient for use outside of the hospital (at home or in a nursing home) and prescriptions for medication that will be taken by the patient or administered to the patient in the hospital itself. Either during a clinical admission or during eg. the visit of a patient to the infusion unit or the oncology department in the outpatient clinic.
Related resources:
- MedicationRequest
- Medication
- Practitioner
Overview
| Filter name in app | Priority | FHIR field | Brief description | Example data |
|---|---|---|---|---|
| ID | Must have | MedicationRequest.identifier.value | Unique identifier for medication request. | |
| DBC ID | N/A | Not yet mapped | NL-specific: Unique ID of the DBC code (diagnosis-treatment-combination) that the prescription is linked to. | |
| Episode of care ID | Could have | Not yet mapped | Unique identifier of the Episode of Care that the medication request is linked to. I.e. indicates context in which the drug was prescribed. | |
| Description | Must have | Medication.code.coding.display | The name of the treatment being prescribed to the patient. | Co-trimoxazol, ETANERCEPT, Dexamethasone, Furosemide |
| Indication | Must have | MedicationRequest.reasonCode.coding.display | Reason why / condition for which the medication is administered. | Multiple myeloma, Rheumatoid arthritis, prostate cancer |
| ATC code | Should have | Medication.ingredient.item.itemCodeableConcept.coding.code | WHO classification system for medication. | N02BE01 for paracetamol |
| Brand name | Nice to have | Medication.manufacturer (not yet implemented) | Name of the medication given by the pharmaceutical company producing the drug. | Herceptin (where active substance = trastuzumab and the medication description may be trastuzumab + strength or something). |
| Pharmaceutical Form | Should have | Medication.form.coding.Display | Formulation used to deliver the active substance in the medication to the body site where it's needed. | Tablet, Injection, aerosol, capsule |
| Ingredient | Should have | Medication.ingredient.item.itemCodeableConcept.coding.display | The active substance in the medication | |
| Care plan ID | Could have | Not yet mapped | Unique identifier referencing to the Care Plan that is the context for this prescription | |
| Care plan percentage | Could have | Not yet mapped | Percentage of the dose of treatment prescribed to the patient, relative to the dose planned in the Care Plan. |
100, 80, 50. |
| Prescriber | Could have | MedicationRequest.performer | Name of the care provider (nurse, doctor) that prescripbed the treatment. | Dr. Jane Doe, nurse John Doe. |
| Initial fill and/or duration | Must have | MedicationRequest.dispenseRequest.initialFill.quantity | Amount of medication that is prescribed to the patients with this particular request. Usually contains the amount of tablets, but sometimes contains the total duration of the medication intake, or a combination of amount and duration. | 154 piece 1 piece 16 day 100 gram 100 day |
| Status | Could have | MedicationRequest.status | Status of the medication request. | Active, stopped, verified. |
| Category | Could have | MedicationRequest.category | Type of prescription, or the setting in which the medication will be given. | Home medication, admission medication, clinic, outpatient clinic. |
| Priority | Could have | priority | Indicates how quickly the Medication Request should be addressed with respect to other requests. Depending on the EHR system, this prioritisation may be in relation to all medication requests that are outstanding for 1 single patient, or it's in relation to all medication requests that are outstanding in the overall hospital and/or at the hospital pharmacy. |
Routine, urgent, high, medium, low. |
| Validated | Nice to have | Not yet mapped | Incidates if a pharmacist validated / approved the administration. | 1 (validated) or 0 (not validated) |
| Verification setting | Could have | Not yet mapped | Indicates in what setting the medication was verified or validated. | Admission (planned), ER, A&E. |
| ZI number | N/A | Not yet mapped | NL-specific: code for medication according to the national Z-index | 16613910 |
| Strength value | Should have | Medication.ingredient.strength.value | Amount of active substance in the prescribed medication, eg. 500 mg of paracetamol in 1 tablet. Or concentration of the solution that will be administered, eg. 9 gr/L of NaCl in the bag with 100 ml of physiological salt solution. | 500 (mg), 4 (grams), 10 (units), 900 (mg/L) |
| Strength unit | Should have | Medication.ingredient.strength.unit | Unit associated with strength value. | Milligrams, micrograms, units, mg/ml, g/L. |
| Instruction description | Must have | MedicationRequest.dosageInstruction.text | Textual instruction that describes how to take the medication. | 1 tablet per day, 1 per week, 1 x per day 8 milligrams |
| Course of therapy | Could have | MedicationRequest.courseOfTherapyType.coding.display | Indicates the expected / planned duration of the use of the medication. | Temporary, chronic, adhoc |
| Reason stop | Should have | Not yet mapped | Indicates why prescription of the drug is terminated earlier than originally planned, or terminated without prescribing a follow-up / repetitive prescription. | Adverse reaction, Stopped by pharmacy, ineffective. |
| As needed | Could have | MedicationRequest.dosageInstruction.asNeeded | Indicates if the patient can only use the medication if they need it (i.e. pain killer when they are in pain, corticosteroid cream to treat eczema if it emerges) or if they should take the medication as prescribed (i.e. finish your antibiotics course and take all pills in time; don't create resistant bacteria please). | Yes or no, true or false. |
| Route of administration | Must have | MedicationRequest.route.coding.display | The way in which the medication will be administered or taken by the patient. | Oral, intravenous, subcutaneous |
| Infusion solvent | Could have | Not yet mapped | Solution in which the stock of the drug is dissolved for i.e. IV or subcutaneaous administration. | SODIUMCHLORIDE IV 0,9% 1L LIDOCAINE INJFL 10MG/ML (HCL-1W) AMP 10ML Sodiumchloride 0,9% |
| Dose value | Must have | MedicationRequest.dosageInstruction.doseAndRate.dose.doseQuantity.value | Total dose of active substance that the patient takes in during one single administation of the drug. | 4 (tablets); 500 (milligrams); 10 (grams) |
| Dose unit | Must have | MedicationRequest.dosageInstruction.doseAndRate.dose.doseQuantity.uit | Unit associated with dose. | milligrams, grams, units |
| Dosage duration | Must have | MedicationRequest.dosageInstruction.repeat.duration | Indicates how long the prescribed dose of the medication should be taken in total. | 7 (days) 3 (months), 24 (hours) |
| Dosage duration unit | Must have | MedicationRequest.dosageInstruction.repeat.durationUnit | Unit associated with dosage duration. | Days, months, hours. |
| Frequency value | Must have | MedicationRequest.dosageInstruction.repeat.frequency | Indicates how often the prescribed dose has to be taken. | 1 |
| Frequency unit | Must have | MedicationRequest.dosageInstruction.repeat.periodUnit | Unit associated with frequency. | Day |
| Infusion rate value | Should have | MedicationRequest.dosageInstruction.doseAndRate.rate.rateQuantity.value | The amount of treatment solution (including the solvent) administered per unit of time. | 100, 200, 50. |
| Infusion rate unit | Should have | MedicationRequest.dosageInstruction.doseAndRate.rate.rateQuantity.unit | Unit associated with infusion rate value. | ml/minute, l/hour, ml/hour |
| Duration value | Should have | MedicationRequest.dosageInstruction.timing.repeat.duration | Total duration of the infusion. Infusion time. | 2 (hours), 0.16 (hour). |
| Duration unit | Should have | MedicationRequest.dosageInstruction.timing.repeat.durationUnit | Unit associated with duration value. | Minutes, days, hours. |
| Age at time of event | Must have | Inferred from start date and linked patient | Age of the patient, in years when the medication was prescribed. | |
| Specialism of prescriber | Must have | MedicationRequest.requester | Specialism of the care provider (nurse, doctor) that administered the treatment. | Gastroenterology, endocrinology, oncology |
| Start date* | Must have | MedicationRequest.dosageInstruction.timing.event | Date on which the patient will start taking the medication. | DD-MM-YYYY hh:mm |
| End date* | Should have | Not yet mapped | End date of the course of medication prescribed. | DD-MM-YYYY hh:mm |
| Authored date* | Must have | MedicationRequest.authoredOn | Date on which the care provider prescribed the medication. | DD-MM-YYYY hh:mm |
| Scheduled end date* | Should have | Inferred from MedicationRequest start date + duration | Scheduled end date. | DD-MM-YYYY hh:mm |
| Verification date* | N/A | Not yet mapped | NL-specific: In NL there's a national database care providers can interrogate to see what the patient they are seeing is currently using/what prescriptions are currently active. This date field will contain the date on which the national database was interrogated. | DD-MM-YYYY hh:mm |
| * As can be appreciated from the comments next to these date fields: EHR source systems can be ambivalent with the dates they use. So important to discuss with the data architects and hospital data engineers. |
To be added in the future
| Filter name in app | Priority | FHIR field | Brief description | Example data |
|---|---|---|---|---|
| Volume value | Could have | Not yet mapped | Volume of stock solution of the medication that is added to the bag with the infusion solvent when the pharmacy is preparing the medication, ad hoc, fresh, right before administration. Example: the pharmacy keeps a 10x concentrated stock solution of NaCl, at 90 grams of NaCL in 1L of solvent (90 gr/L). This stock solution will need to be diluted 10x before it's given to the patient. The patient will receive a total volume of 500 mL infusion fluid during the administration. The pharmacist will take 50 mL of the 90 gr/L NaCl stock solution and mix that with 450 mL of infusion solvent and put that in the infusion bag, so that the 10X stock is diluted 10x to the final concentration of 9 gr/L in the infusion bag. With this example, you will find "50 mL" in the volume value and unit fields in CTcue. Not the total volume of 500 mL of the infusion bag. |
20, 500 |
| Volume unit | Could have | Not yet mapped | millilitre, microlitre, liter, ampoule |