Implementation guide for interoperable medicines

This guidance is under active development by NHS England and content may be added or updated on a regular basis.

1. Combination pack instructions

Workaround: Use a free-text `Dosage.additionalInstruction`.

It is common practice to provide a dosage instruction for the combination pack “Migraleve tablets” with instructions for when to take the pink tablets and when to take the yellow tablets. With the current R4 Dosage structure, these instructions would have to be conveyed in free-text using the Dosage.patientInstructions.

In secondary care the individual components of the pack should be prescribed as separate items.

In primary care the combination pack is prescribed and therefore the medication request must reference the medication resource for the dm+d code of the combination product. The medication request then links to 2 dosing instructions which describe how each tablet should be taken.

See an example for Migraleve tablets.

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