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.

3. RESOLVED: Periods of no medicine administration

Resolved: Specific a dosage with a doseAndRate with a quantity of 0 (zero).

As part of a MedicationRequest

See the examples of Lidocaine medicated plasters and Microgynon tablets.

As part of a MedicationAdministration or MedicationStatement

Within medicine administration records it is important, for certain medication, to clearly state periods where no medication was administered.

Two approaches are possible within the FHIR standard.

The first is to infer periods of no administration where there are no MedicationAdministration or MedicationStatement records that cover a given period of time. This approach is not recommended as not all records will be defined using an effectivePeriod.start and effectivePeriod.end date/time range. Some records will just be recorded with an effectiveDateTime. Depending on how specific the dosage instruction has been defined, the expected administration period could be calculated. However this approach is based on assumptions, not facts.

The second and our preferred solution is to record a zero quantity and a status of "on-hold" within a MedicationAdministration or MedicationStatement record for a medicine for a specific effectivePeriod. This example is an administration record of a 1-hour pause during a Heperain infusion. The rateQuantity is "0" (zero). The status is "on-hold".

See the example of administration records following Heparin infusions.

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