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.

Dosage Examples - Infusions

To illustrate how the FHIR Dosage structure should be used for inpatient infusion use cases.

Infusions are complex because they may be dispensed and prepared in three ways;

  1. Dispensed and prepared by the hospital pharmacy and delivered to the ward
  2. Dispensed by the hospital pharmacy and prepared on the ward
  3. Dispensed by the hospital pharmacy as a pre-prepared and dm+d coded product for the ward

This difference changes the use of the MedicationDispense resources. The initiating MedicationRequest and any resulting MedicationAdministration resource should not be different due to the above but we will verify this as part of creating these implementation guidance examples.

Note: This page is work-in-progress and may be subject to change.

Ceftriaxone continuous infusion

Clinical Scenario

The patient requires 1 gram of Ceftriaxone to be infused over 30 minutes, once a day, for 5 days, for pneumonia.

Prescribing Event

This MedicationRequest is created by the EPMA system for the prescription/order for Ceftriaxone via an infusion. This resource would be made available to the hospital pharmacy.

<MedicationRequest xmlns="http://hl7.org/fhir">
    <id value="34eb3c92-76e6-48c2-9691-aa1f0b58369b" />
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
    </meta>
    <medicationCodeableConcept>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="19841008" />
            <display value="Ceftriaxone" />
        </coding>
    </medicationCodeableConcept>
    <subject>
        <reference value="Patient/UKCore-Patient-RichardSmith-Example" />
    </subject>
    <reasonCode>
        <coding>
            <system value="http://snomed.info/sct" />
            <code value="233604007" />
            <display value="Pneumonia" />
        </coding>
    </reasonCode>
    <dosageInstruction>
        <text value="Continuous infusion 1 gram - Intravenous - over 30 minutes - daily - for 5 days" />
        <timing>
            <repeat>
                <boundsDuration>
                    <value value="5" />
                    <unit value="day" />
                    <system value="http://unitsofmeasure.org" />
                    <code value="d" />
                </boundsDuration>
                <duration value="30" />
                <durationUnit value="min" />
                <frequency value="1" />
                <period value="1" />
                <periodUnit value="d" />
            </repeat>
        </timing>
        <route>
            <coding>
                <system value="https://dmd.nhs.uk" />
                <code value="47625008" />
                <display value="Intravenous" />
            </coding>
        </route>
        <method>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="261754007" />
                <display value="Continuous infusion" />
            </coding>
        </method>
        <doseAndRate>
            <doseQuantity>
                <value value="1" />
                <unit value="gram" />
                <system value="http://unitsofmeasure.org" />
                <code value="g" />
            </doseQuantity>
        </doseAndRate>
    </dosageInstruction>
</MedicationRequest>

{
    "resourceType": "MedicationRequest",
    "id": "34eb3c92-76e6-48c2-9691-aa1f0b58369b",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
        ]
    },
    "subject": {
        "reference": "Patient/UKCore-Patient-RichardSmith-Example"
    },
    "medicationCodeableConcept": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "19841008",
                "display": "Ceftriaxone"
            }
        ]
    },
    "reasonCode":  [
        {
            "coding":  [
                {
                    "system": "http://snomed.info/sct",
                    "code": "233604007",
                    "display": "Pneumonia"
                }
            ]
        }
    ],
    "dosageInstruction":  [
        {
            "text": "Continuous infusion 1 gram - Intravenous - over 30 minutes - daily - for 5 days",
            "timing": {
                "repeat": {
                    "boundsDuration": {
                        "value": 5,
                        "unit": "day",
                        "system": "http://unitsofmeasure.org",
                        "code": "d"
                    },
                    "duration": 30,
                    "durationUnit": "min",
                    "frequency": 1,
                    "period": 1,
                    "periodUnit": "d"
                }
            },
            "method": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "261754007",
                        "display": "Continuous infusion"
                    }
                ]
            },
            "route": {
                "coding":  [
                    {
                        "system": "https://dmd.nhs.uk",
                        "code": "47625008",
                        "display": "Intravenous"
                    }
                ]
            },
            "doseAndRate":  [
                {
                    "doseQuantity": {
                        "value": 1,
                        "unit": "gram",
                        "system": "http://unitsofmeasure.org",
                        "code": "g"
                    }
                }
            ]
        }
    ]
}
MedicationRequest.id[0]34eb3c92-76e6-48c2-9691-aa1f0b58369b
MedicationRequest.meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
MedicationRequest.medication[0].coding[0].system[0]https://dmd.nhs.uk
MedicationRequest.medication[0].coding[0].code[0]19841008
MedicationRequest.medication[0].coding[0].display[0]Ceftriaxone
MedicationRequest.subject[0].reference[0]Patient/UKCore-Patient-RichardSmith-Example
MedicationRequest.reasonCode[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.reasonCode[0].coding[0].code[0]233604007
MedicationRequest.reasonCode[0].coding[0].display[0]Pneumonia
MedicationRequest.dosageInstruction[0].text[0]Continuous infusion 1 gram - Intravenous - over 30 minutes - daily - for 5 days
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].bounds[0].value[0]5
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].bounds[0].unit[0]day
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].bounds[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].bounds[0].code[0]d
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].duration[0]30
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].durationUnit[0]min
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].frequency[0]1
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].period[0]1
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].periodUnit[0]d
MedicationRequest.dosageInstruction[0].route[0].coding[0].system[0]https://dmd.nhs.uk
MedicationRequest.dosageInstruction[0].route[0].coding[0].code[0]47625008
MedicationRequest.dosageInstruction[0].route[0].coding[0].display[0]Intravenous
MedicationRequest.dosageInstruction[0].method[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].method[0].coding[0].code[0]261754007
MedicationRequest.dosageInstruction[0].method[0].coding[0].display[0]Continuous infusion
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].value[0]1
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].unit[0]gram
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].code[0]g
MedicationRequest

Dispensing Event: Prepared by Pharmacy

Note: This example is work-in-progress and may be subject to change.

If the infusion is to be prepared by the hospital pharamcy team.

This Bundle is created by the pharmacy system for what has been dispensed. A bundle is used in this example because it contains two resources. A Medication resource details the two ingredients that have been used to prepare the infusion. A MedicationDispense references the Medication and details the dosing instruction for the infusion. This bundle would be made available to the ward EPMA system.

<Bundle xmlns="http://hl7.org/fhir">
    <type value="message" />
    <entry>
        <fullUrl value="urn:uuid:682858a9-3942-412d-9ae5-71a2f17f7c5b" />
        <resource>
            <MessageHeader>
                <id value="682858a9-3942-412d-9ae5-71a2f17f7c5b" />
                <eventCoding>
                    <system value="http://snomed.info/sct" />
                    <code value="373784005" />
                    <display value="Dispensing medication" />
                </eventCoding>
                <source>
                    <endpoint value="https://myendpoint.nhs.uk/" />
                </source>
                <focus>
                    <reference value="7b36eb7b-ea3f-44fb-87c9-dfa51e4b6d5b" />
                    <type value="MedicationDispense" />
                </focus>
            </MessageHeader>
        </resource>
    </entry>
    <entry>
        <fullUrl value="urn:uuid:11dc9519-b6e8-41bb-bce5-f6f724b743bc" />
        <resource>
            <Medication>
                <id value="11dc9519-b6e8-41bb-bce5-f6f724b743bc" />
                <meta>
                    <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Medication" />
                </meta>
                <code>
                    <text value="Ceftriaxone 1g in 50mL Sodium chloride 0.9% solution for infusion" />
                </code>
                <form>
                    <coding>
                        <system value="https://dmd.nhs.uk" />
                        <code value="385229008" />
                        <display value="Solution for infusion" />
                    </coding>
                </form>
                <ingredient>
                    <itemCodeableConcept>
                        <coding>
                            <system value="https://dmd.nhs.uk" />
                            <code value="22824911000001102" />
                            <display value="Ceftriaxone 1g powder for solution for infusion vials (Kent Pharma (UK) Ltd)" />
                        </coding>
                    </itemCodeableConcept>
                    <strength>
                        <numerator>
                            <value value="1" />
                            <unit value="gram" />
                            <system value="http://unitsofmeasure.org" />
                            <code value="g" />
                        </numerator>
                        <denominator>
                            <value value="1" />
                        </denominator>
                    </strength>
                </ingredient>
                <ingredient>
                    <itemCodeableConcept>
                        <coding>
                            <system value="https://dmd.nhs.uk" />
                            <code value="4880711000001109" />
                            <display value="Sodium chloride 0.9% infusion 50ml Mini-Bag Viaflex bags (Baxter Healthcare Ltd)" />
                        </coding>
                    </itemCodeableConcept>
                    <strength>
                        <numerator>
                            <value value="50" />
                            <unit value="millilitre" />
                            <system value="http://unitsofmeasure.org" />
                            <code value="ml" />
                        </numerator>
                        <denominator>
                            <value value="1" />
                        </denominator>
                    </strength>
                </ingredient>
            </Medication>
        </resource>
    </entry>
    <entry>
        <fullUrl value="urn:uuid:7b36eb7b-ea3f-44fb-87c9-dfa51e4b6d5b" />
        <resource>
            <MedicationDispense>
                <id value="7b36eb7b-ea3f-44fb-87c9-dfa51e4b6d5b" />
                <meta>
                    <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationDispense" />
                </meta>
                <status value="completed" />
                <medicationReference>
                    <reference value="11dc9519-b6e8-41bb-bce5-f6f724b743bc" />
                    <type value="Medication" />
                </medicationReference>
                <subject>
                    <reference value="Patient/UKCore-Patient-RichardSmith-Example" />
                </subject>
                <authorizingPrescription>
                    <reference value="34eb3c92-76e6-48c2-9691-aa1f0b58369b" />
                    <type value="MedicationRequest" />
                </authorizingPrescription>
                <quantity>
                    <value value="5" />
                    <unit value="bag" />
                    <system value="http://snomed.info/sct" />
                    <code value="428672001" />
                </quantity>
                <dosageInstruction>
                    <text value="Continuous infusion 50 millilitre - Intravenous - over 30 minutes - daily - for 5 days" />
                    <timing>
                        <repeat>
                            <boundsDuration>
                                <value value="5" />
                                <unit value="day" />
                                <system value="http://unitsofmeasure.org" />
                                <code value="d" />
                            </boundsDuration>
                            <duration value="30" />
                            <durationUnit value="min" />
                            <frequency value="1" />
                            <period value="1" />
                            <periodUnit value="d" />
                        </repeat>
                    </timing>
                    <route>
                        <coding>
                            <system value="https://dmd.nhs.uk" />
                            <code value="47625008" />
                            <display value="Intravenous" />
                        </coding>
                    </route>
                    <method>
                        <coding>
                            <system value="http://snomed.info/sct" />
                            <code value="261754007" />
                            <display value="Continuous infusion" />
                        </coding>
                    </method>
                    <doseAndRate>
                        <doseQuantity>
                            <value value="50" />
                            <unit value="millilitre" />
                            <system value="http://unitsofmeasure.org" />
                            <code value="ml" />
                        </doseQuantity>
                    </doseAndRate>
                </dosageInstruction>
            </MedicationDispense>
        </resource>
    </entry>
</Bundle>

{
    "resourceType": "Bundle",
    "type": "message",
    "entry":  [
        {
            "fullUrl": "urn:uuid:682858a9-3942-412d-9ae5-71a2f17f7c5b",
            "resource": {
                "resourceType": "MessageHeader",
                "id": "682858a9-3942-412d-9ae5-71a2f17f7c5b",
                "eventCoding": {
                    "system": "http://snomed.info/sct",
                    "code": "373784005",
                    "display": "Dispensing medication"
                },
                "source": {
                    "endpoint": "https://myendpoint.nhs.uk/"
                },
                "focus":  [
                    {
                        "reference": "7b36eb7b-ea3f-44fb-87c9-dfa51e4b6d5b",
                        "type": "MedicationDispense"
                    }
                ]
            }
        },
        {
            "fullUrl": "urn:uuid:11dc9519-b6e8-41bb-bce5-f6f724b743bc",
            "resource": {
                "resourceType": "Medication",
                "id": "11dc9519-b6e8-41bb-bce5-f6f724b743bc",
                "meta": {
                    "profile":  [
                        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Medication"
                    ]
                },
                "form": {
                    "coding":  [
                        {
                            "system": "https://dmd.nhs.uk",
                            "code": "385229008",
                            "display": "Solution for infusion"
                        }
                    ]
                },
                "code": {
                    "text": "Ceftriaxone 1g in 50mL Sodium chloride 0.9% solution for infusion"
                },
                "ingredient":  [
                    {
                        "itemCodeableConcept": {
                            "coding":  [
                                {
                                    "system": "https://dmd.nhs.uk",
                                    "code": "22824911000001102",
                                    "display": "Ceftriaxone 1g powder for solution for infusion vials (Kent Pharma (UK) Ltd)"
                                }
                            ]
                        },
                        "strength": {
                            "numerator": {
                                "value": 1,
                                "unit": "gram",
                                "system": "http://unitsofmeasure.org",
                                "code": "g"
                            },
                            "denominator": {
                                "value": 1
                            }
                        }
                    },
                    {
                        "itemCodeableConcept": {
                            "coding":  [
                                {
                                    "system": "https://dmd.nhs.uk",
                                    "code": "4880711000001109",
                                    "display": "Sodium chloride 0.9% infusion 50ml Mini-Bag Viaflex bags (Baxter Healthcare Ltd)"
                                }
                            ]
                        },
                        "strength": {
                            "numerator": {
                                "value": 50,
                                "unit": "millilitre",
                                "system": "http://unitsofmeasure.org",
                                "code": "ml"
                            },
                            "denominator": {
                                "value": 1
                            }
                        }
                    }
                ]
            }
        },
        {
            "fullUrl": "urn:uuid:7b36eb7b-ea3f-44fb-87c9-dfa51e4b6d5b",
            "resource": {
                "resourceType": "MedicationDispense",
                "id": "7b36eb7b-ea3f-44fb-87c9-dfa51e4b6d5b",
                "meta": {
                    "profile":  [
                        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationDispense"
                    ]
                },
                "subject": {
                    "reference": "Patient/UKCore-Patient-RichardSmith-Example"
                },
                "status": "completed",
                "medicationReference": {
                    "reference": "11dc9519-b6e8-41bb-bce5-f6f724b743bc",
                    "type": "Medication"
                },
                "authorizingPrescription":  [
                    {
                        "reference": "34eb3c92-76e6-48c2-9691-aa1f0b58369b",
                        "type": "MedicationRequest"
                    }
                ],
                "quantity": {
                    "value": 5,
                    "unit": "bag",
                    "system": "http://snomed.info/sct",
                    "code": "428672001"
                },
                "dosageInstruction":  [
                    {
                        "text": "Continuous infusion 50 millilitre - Intravenous - over 30 minutes - daily - for 5 days",
                        "timing": {
                            "repeat": {
                                "boundsDuration": {
                                    "value": 5,
                                    "unit": "day",
                                    "system": "http://unitsofmeasure.org",
                                    "code": "d"
                                },
                                "duration": 30,
                                "durationUnit": "min",
                                "frequency": 1,
                                "period": 1,
                                "periodUnit": "d"
                            }
                        },
                        "method": {
                            "coding":  [
                                {
                                    "system": "http://snomed.info/sct",
                                    "code": "261754007",
                                    "display": "Continuous infusion"
                                }
                            ]
                        },
                        "route": {
                            "coding":  [
                                {
                                    "system": "https://dmd.nhs.uk",
                                    "code": "47625008",
                                    "display": "Intravenous"
                                }
                            ]
                        },
                        "doseAndRate":  [
                            {
                                "doseQuantity": {
                                    "value": 50,
                                    "unit": "millilitre",
                                    "system": "http://unitsofmeasure.org",
                                    "code": "ml"
                                }
                            }
                        ]
                    }
                ]
            }
        }
    ]
}
Bundle.type[0]message
Bundle.entry[0].fullUrl[0]urn:uuid:682858a9-3942-412d-9ae5-71a2f17f7c5b
Bundle.entry[0].resource[0].id[0]682858a9-3942-412d-9ae5-71a2f17f7c5b
Bundle.entry[0].resource[0].event[0].system[0]http://snomed.info/sct
Bundle.entry[0].resource[0].event[0].code[0]373784005
Bundle.entry[0].resource[0].event[0].display[0]Dispensing medication
Bundle.entry[0].resource[0].source[0].endpoint[0]https://myendpoint.nhs.uk/
Bundle.entry[0].resource[0].focus[0].reference[0]7b36eb7b-ea3f-44fb-87c9-dfa51e4b6d5b
Bundle.entry[0].resource[0].focus[0].type[0]MedicationDispense
Bundle.entry[1].fullUrl[0]urn:uuid:11dc9519-b6e8-41bb-bce5-f6f724b743bc
Bundle.entry[1].resource[0].id[0]11dc9519-b6e8-41bb-bce5-f6f724b743bc
Bundle.entry[1].resource[0].meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-Medication
Bundle.entry[1].resource[0].code[0].text[0]Ceftriaxone 1g in 50mL Sodium chloride 0.9% solution for infusion
Bundle.entry[1].resource[0].form[0].coding[0].system[0]https://dmd.nhs.uk
Bundle.entry[1].resource[0].form[0].coding[0].code[0]385229008
Bundle.entry[1].resource[0].form[0].coding[0].display[0]Solution for infusion
Bundle.entry[1].resource[0].ingredient[0].item[0].coding[0].system[0]https://dmd.nhs.uk
Bundle.entry[1].resource[0].ingredient[0].item[0].coding[0].code[0]22824911000001102
Bundle.entry[1].resource[0].ingredient[0].item[0].coding[0].display[0]Ceftriaxone 1g powder for solution for infusion vials (Kent Pharma (UK) Ltd)
Bundle.entry[1].resource[0].ingredient[0].strength[0].numerator[0].value[0]1
Bundle.entry[1].resource[0].ingredient[0].strength[0].numerator[0].unit[0]gram
Bundle.entry[1].resource[0].ingredient[0].strength[0].numerator[0].system[0]http://unitsofmeasure.org
Bundle.entry[1].resource[0].ingredient[0].strength[0].numerator[0].code[0]g
Bundle.entry[1].resource[0].ingredient[0].strength[0].denominator[0].value[0]1
Bundle.entry[1].resource[0].ingredient[1].item[0].coding[0].system[0]https://dmd.nhs.uk
Bundle.entry[1].resource[0].ingredient[1].item[0].coding[0].code[0]4880711000001109
Bundle.entry[1].resource[0].ingredient[1].item[0].coding[0].display[0]Sodium chloride 0.9% infusion 50ml Mini-Bag Viaflex bags (Baxter Healthcare Ltd)
Bundle.entry[1].resource[0].ingredient[1].strength[0].numerator[0].value[0]50
Bundle.entry[1].resource[0].ingredient[1].strength[0].numerator[0].unit[0]millilitre
Bundle.entry[1].resource[0].ingredient[1].strength[0].numerator[0].system[0]http://unitsofmeasure.org
Bundle.entry[1].resource[0].ingredient[1].strength[0].numerator[0].code[0]ml
Bundle.entry[1].resource[0].ingredient[1].strength[0].denominator[0].value[0]1
Bundle.entry[2].fullUrl[0]urn:uuid:7b36eb7b-ea3f-44fb-87c9-dfa51e4b6d5b
Bundle.entry[2].resource[0].id[0]7b36eb7b-ea3f-44fb-87c9-dfa51e4b6d5b
Bundle.entry[2].resource[0].meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationDispense
Bundle.entry[2].resource[0].status[0]completed
Bundle.entry[2].resource[0].medication[0].reference[0]11dc9519-b6e8-41bb-bce5-f6f724b743bc
Bundle.entry[2].resource[0].medication[0].type[0]Medication
Bundle.entry[2].resource[0].subject[0].reference[0]Patient/UKCore-Patient-RichardSmith-Example
Bundle.entry[2].resource[0].authorizingPrescription[0].reference[0]34eb3c92-76e6-48c2-9691-aa1f0b58369b
Bundle.entry[2].resource[0].authorizingPrescription[0].type[0]MedicationRequest
Bundle.entry[2].resource[0].quantity[0].value[0]5
Bundle.entry[2].resource[0].quantity[0].unit[0]bag
Bundle.entry[2].resource[0].quantity[0].system[0]http://snomed.info/sct
Bundle.entry[2].resource[0].quantity[0].code[0]428672001
Bundle.entry[2].resource[0].dosageInstruction[0].text[0]Continuous infusion 50 millilitre - Intravenous - over 30 minutes - daily - for 5 days
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].bounds[0].value[0]5
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].bounds[0].unit[0]day
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].bounds[0].system[0]http://unitsofmeasure.org
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].bounds[0].code[0]d
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].duration[0]30
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].durationUnit[0]min
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].frequency[0]1
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].period[0]1
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].periodUnit[0]d
Bundle.entry[2].resource[0].dosageInstruction[0].route[0].coding[0].system[0]https://dmd.nhs.uk
Bundle.entry[2].resource[0].dosageInstruction[0].route[0].coding[0].code[0]47625008
Bundle.entry[2].resource[0].dosageInstruction[0].route[0].coding[0].display[0]Intravenous
Bundle.entry[2].resource[0].dosageInstruction[0].method[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[2].resource[0].dosageInstruction[0].method[0].coding[0].code[0]261754007
Bundle.entry[2].resource[0].dosageInstruction[0].method[0].coding[0].display[0]Continuous infusion
Bundle.entry[2].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].value[0]50
Bundle.entry[2].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].unit[0]millilitre
Bundle.entry[2].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].system[0]http://unitsofmeasure.org
Bundle.entry[2].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].code[0]ml
Bundle

Dispensing Event: Prepared by Ward

Note: This example is work-in-progress and may be subject to change.

If the infusion is to be prepared by the hospital ward team.

This Bundle is created by the pharmacy system for what has been dispensed. A bundle is used in this example because it contains two MedicationDispense resources. The first is for the Ceftriaxone powder. The second is for the Sodium chloride diluent. This bundle would be made available to the ward EPMA system. The infusion would be prepared on the ward.

<Bundle xmlns="http://hl7.org/fhir">
    <type value="transaction" />
    <entry>
        <fullUrl value="urn:uuid:b74a61af-3a12-4d55-9e7a-949fff9f713a" />
        <resource>
            <MedicationDispense>
                <id value="b74a61af-3a12-4d55-9e7a-949fff9f713a" />
                <meta>
                    <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationDispense" />
                </meta>
                <status value="completed" />
                <medicationCodeableConcept>
                    <coding>
                        <system value="https://dmd.nhs.uk" />
                        <code value="22824911000001102" />
                        <display value="Ceftriaxone 1g powder for solution for infusion vials (Kent Pharma (UK) Ltd)" />
                    </coding>
                </medicationCodeableConcept>
                <subject>
                    <reference value="Patient/UKCore-Patient-RichardSmith-Example" />
                </subject>
                <authorizingPrescription>
                    <reference value="34eb3c92-76e6-48c2-9691-aa1f0b58369b" />
                    <type value="MedicationRequest" />
                </authorizingPrescription>
                <quantity>
                    <value value="5" />
                    <unit value="vial" />
                    <system value="http://snomed.info/sct" />
                    <code value="415818006" />
                </quantity>
                <dosageInstruction>
                    <text value="Continuous infusion 1 gram - Intravenous - over 30 minutes - daily - for 5 days" />
                    <timing>
                        <repeat>
                            <boundsDuration>
                                <value value="5" />
                                <unit value="day" />
                                <system value="http://unitsofmeasure.org" />
                                <code value="d" />
                            </boundsDuration>
                            <duration value="30" />
                            <durationUnit value="min" />
                            <frequency value="1" />
                            <period value="1" />
                            <periodUnit value="d" />
                        </repeat>
                    </timing>
                    <route>
                        <coding>
                            <system value="https://dmd.nhs.uk" />
                            <code value="47625008" />
                            <display value="Intravenous" />
                        </coding>
                    </route>
                    <method>
                        <coding>
                            <system value="http://snomed.info/sct" />
                            <code value="261754007" />
                            <display value="Continuous infusion" />
                        </coding>
                    </method>
                    <doseAndRate>
                        <doseQuantity>
                            <value value="1" />
                            <unit value="gram" />
                            <system value="http://unitsofmeasure.org" />
                            <code value="g" />
                        </doseQuantity>
                    </doseAndRate>
                </dosageInstruction>
            </MedicationDispense>
        </resource>
    </entry>
    <entry>
        <fullUrl value="urn:uuid:0ec3b0f4-91fa-42eb-a324-a29ff01c71b4" />
        <resource>
            <MedicationDispense>
                <id value="0ec3b0f4-91fa-42eb-a324-a29ff01c71b4" />
                <meta>
                    <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationDispense" />
                </meta>
                <status value="completed" />
                <medicationCodeableConcept>
                    <coding>
                        <system value="https://dmd.nhs.uk" />
                        <code value="4880711000001109" />
                        <display value="Sodium chloride 0.9% infusion 50ml Mini-Bag Viaflex bags (Baxter Healthcare Ltd)" />
                    </coding>
                </medicationCodeableConcept>
                <authorizingPrescription>
                    <reference value="34eb3c92-76e6-48c2-9691-aa1f0b58369b" />
                    <type value="MedicationRequest" />
                </authorizingPrescription>
                <quantity>
                    <value value="5" />
                    <unit value="bag" />
                    <system value="http://snomed.info/sct" />
                    <code value="428672001" />
                </quantity>
                <dosageInstruction>
                    <text value="Continuous infusion 100 millilitre - Intravenous - over 30 minutes - daily - for 5 days" />
                    <timing>
                        <repeat>
                            <boundsDuration>
                                <value value="5" />
                                <unit value="day" />
                                <system value="http://unitsofmeasure.org" />
                                <code value="d" />
                            </boundsDuration>
                            <duration value="30" />
                            <durationUnit value="min" />
                            <frequency value="1" />
                            <period value="1" />
                            <periodUnit value="d" />
                        </repeat>
                    </timing>
                    <route>
                        <coding>
                            <system value="https://dmd.nhs.uk" />
                            <code value="47625008" />
                            <display value="Intravenous" />
                        </coding>
                    </route>
                    <method>
                        <coding>
                            <system value="http://snomed.info/sct" />
                            <code value="261754007" />
                            <display value="Continuous infusion" />
                        </coding>
                    </method>
                    <doseAndRate>
                        <doseQuantity>
                            <value value="50" />
                            <unit value="millilitre" />
                            <system value="http://unitsofmeasure.org" />
                            <code value="ml" />
                        </doseQuantity>
                    </doseAndRate>
                </dosageInstruction>
            </MedicationDispense>
        </resource>
    </entry>
</Bundle>

{
    "resourceType": "Bundle",
    "type": "transaction",
    "entry":  [
        {
            "fullUrl": "urn:uuid:b74a61af-3a12-4d55-9e7a-949fff9f713a",
            "resource": {
                "resourceType": "MedicationDispense",
                "id": "b74a61af-3a12-4d55-9e7a-949fff9f713a",
                "meta": {
                    "profile":  [
                        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationDispense"
                    ]
                },
                "subject": {
                    "reference": "Patient/UKCore-Patient-RichardSmith-Example"
                },
                "status": "completed",
                "medicationCodeableConcept": {
                    "coding":  [
                        {
                            "system": "https://dmd.nhs.uk",
                            "code": "22824911000001102",
                            "display": "Ceftriaxone 1g powder for solution for infusion vials (Kent Pharma (UK) Ltd)"
                        }
                    ]
                },
                "authorizingPrescription":  [
                    {
                        "reference": "34eb3c92-76e6-48c2-9691-aa1f0b58369b",
                        "type": "MedicationRequest"
                    }
                ],
                "quantity": {
                    "value": 5,
                    "unit": "vial",
                    "system": "http://snomed.info/sct",
                    "code": "415818006"
                },
                "dosageInstruction":  [
                    {
                        "text": "Continuous infusion 1 gram - Intravenous - over 30 minutes - daily - for 5 days",
                        "timing": {
                            "repeat": {
                                "boundsDuration": {
                                    "value": 5,
                                    "unit": "day",
                                    "system": "http://unitsofmeasure.org",
                                    "code": "d"
                                },
                                "duration": 30,
                                "durationUnit": "min",
                                "frequency": 1,
                                "period": 1,
                                "periodUnit": "d"
                            }
                        },
                        "method": {
                            "coding":  [
                                {
                                    "system": "http://snomed.info/sct",
                                    "code": "261754007",
                                    "display": "Continuous infusion"
                                }
                            ]
                        },
                        "route": {
                            "coding":  [
                                {
                                    "system": "https://dmd.nhs.uk",
                                    "code": "47625008",
                                    "display": "Intravenous"
                                }
                            ]
                        },
                        "doseAndRate":  [
                            {
                                "doseQuantity": {
                                    "value": 1,
                                    "unit": "gram",
                                    "system": "http://unitsofmeasure.org",
                                    "code": "g"
                                }
                            }
                        ]
                    }
                ]
            }
        },
        {
            "fullUrl": "urn:uuid:0ec3b0f4-91fa-42eb-a324-a29ff01c71b4",
            "resource": {
                "resourceType": "MedicationDispense",
                "id": "0ec3b0f4-91fa-42eb-a324-a29ff01c71b4",
                "meta": {
                    "profile":  [
                        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationDispense"
                    ]
                },
                "status": "completed",
                "medicationCodeableConcept": {
                    "coding":  [
                        {
                            "system": "https://dmd.nhs.uk",
                            "code": "4880711000001109",
                            "display": "Sodium chloride 0.9% infusion 50ml Mini-Bag Viaflex bags (Baxter Healthcare Ltd)"
                        }
                    ]
                },
                "authorizingPrescription":  [
                    {
                        "reference": "34eb3c92-76e6-48c2-9691-aa1f0b58369b",
                        "type": "MedicationRequest"
                    }
                ],
                "quantity": {
                    "value": 5,
                    "unit": "bag",
                    "system": "http://snomed.info/sct",
                    "code": "428672001"
                },
                "dosageInstruction":  [
                    {
                        "text": "Continuous infusion 100 millilitre - Intravenous - over 30 minutes - daily - for 5 days",
                        "timing": {
                            "repeat": {
                                "boundsDuration": {
                                    "value": 5,
                                    "unit": "day",
                                    "system": "http://unitsofmeasure.org",
                                    "code": "d"
                                },
                                "duration": 30,
                                "durationUnit": "min",
                                "frequency": 1,
                                "period": 1,
                                "periodUnit": "d"
                            }
                        },
                        "method": {
                            "coding":  [
                                {
                                    "system": "http://snomed.info/sct",
                                    "code": "261754007",
                                    "display": "Continuous infusion"
                                }
                            ]
                        },
                        "route": {
                            "coding":  [
                                {
                                    "system": "https://dmd.nhs.uk",
                                    "code": "47625008",
                                    "display": "Intravenous"
                                }
                            ]
                        },
                        "doseAndRate":  [
                            {
                                "doseQuantity": {
                                    "value": 50,
                                    "unit": "millilitre",
                                    "system": "http://unitsofmeasure.org",
                                    "code": "ml"
                                }
                            }
                        ]
                    }
                ]
            }
        }
    ]
}
Bundle.type[0]transaction
Bundle.entry[0].fullUrl[0]urn:uuid:b74a61af-3a12-4d55-9e7a-949fff9f713a
Bundle.entry[0].resource[0].id[0]b74a61af-3a12-4d55-9e7a-949fff9f713a
Bundle.entry[0].resource[0].meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationDispense
Bundle.entry[0].resource[0].status[0]completed
Bundle.entry[0].resource[0].medication[0].coding[0].system[0]https://dmd.nhs.uk
Bundle.entry[0].resource[0].medication[0].coding[0].code[0]22824911000001102
Bundle.entry[0].resource[0].medication[0].coding[0].display[0]Ceftriaxone 1g powder for solution for infusion vials (Kent Pharma (UK) Ltd)
Bundle.entry[0].resource[0].subject[0].reference[0]Patient/UKCore-Patient-RichardSmith-Example
Bundle.entry[0].resource[0].authorizingPrescription[0].reference[0]34eb3c92-76e6-48c2-9691-aa1f0b58369b
Bundle.entry[0].resource[0].authorizingPrescription[0].type[0]MedicationRequest
Bundle.entry[0].resource[0].quantity[0].value[0]5
Bundle.entry[0].resource[0].quantity[0].unit[0]vial
Bundle.entry[0].resource[0].quantity[0].system[0]http://snomed.info/sct
Bundle.entry[0].resource[0].quantity[0].code[0]415818006
Bundle.entry[0].resource[0].dosageInstruction[0].text[0]Continuous infusion 1 gram - Intravenous - over 30 minutes - daily - for 5 days
Bundle.entry[0].resource[0].dosageInstruction[0].timing[0].repeat[0].bounds[0].value[0]5
Bundle.entry[0].resource[0].dosageInstruction[0].timing[0].repeat[0].bounds[0].unit[0]day
Bundle.entry[0].resource[0].dosageInstruction[0].timing[0].repeat[0].bounds[0].system[0]http://unitsofmeasure.org
Bundle.entry[0].resource[0].dosageInstruction[0].timing[0].repeat[0].bounds[0].code[0]d
Bundle.entry[0].resource[0].dosageInstruction[0].timing[0].repeat[0].duration[0]30
Bundle.entry[0].resource[0].dosageInstruction[0].timing[0].repeat[0].durationUnit[0]min
Bundle.entry[0].resource[0].dosageInstruction[0].timing[0].repeat[0].frequency[0]1
Bundle.entry[0].resource[0].dosageInstruction[0].timing[0].repeat[0].period[0]1
Bundle.entry[0].resource[0].dosageInstruction[0].timing[0].repeat[0].periodUnit[0]d
Bundle.entry[0].resource[0].dosageInstruction[0].route[0].coding[0].system[0]https://dmd.nhs.uk
Bundle.entry[0].resource[0].dosageInstruction[0].route[0].coding[0].code[0]47625008
Bundle.entry[0].resource[0].dosageInstruction[0].route[0].coding[0].display[0]Intravenous
Bundle.entry[0].resource[0].dosageInstruction[0].method[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[0].resource[0].dosageInstruction[0].method[0].coding[0].code[0]261754007
Bundle.entry[0].resource[0].dosageInstruction[0].method[0].coding[0].display[0]Continuous infusion
Bundle.entry[0].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].value[0]1
Bundle.entry[0].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].unit[0]gram
Bundle.entry[0].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].system[0]http://unitsofmeasure.org
Bundle.entry[0].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].code[0]g
Bundle.entry[1].fullUrl[0]urn:uuid:0ec3b0f4-91fa-42eb-a324-a29ff01c71b4
Bundle.entry[1].resource[0].id[0]0ec3b0f4-91fa-42eb-a324-a29ff01c71b4
Bundle.entry[1].resource[0].meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationDispense
Bundle.entry[1].resource[0].status[0]completed
Bundle.entry[1].resource[0].medication[0].coding[0].system[0]https://dmd.nhs.uk
Bundle.entry[1].resource[0].medication[0].coding[0].code[0]4880711000001109
Bundle.entry[1].resource[0].medication[0].coding[0].display[0]Sodium chloride 0.9% infusion 50ml Mini-Bag Viaflex bags (Baxter Healthcare Ltd)
Bundle.entry[1].resource[0].authorizingPrescription[0].reference[0]34eb3c92-76e6-48c2-9691-aa1f0b58369b
Bundle.entry[1].resource[0].authorizingPrescription[0].type[0]MedicationRequest
Bundle.entry[1].resource[0].quantity[0].value[0]5
Bundle.entry[1].resource[0].quantity[0].unit[0]bag
Bundle.entry[1].resource[0].quantity[0].system[0]http://snomed.info/sct
Bundle.entry[1].resource[0].quantity[0].code[0]428672001
Bundle.entry[1].resource[0].dosageInstruction[0].text[0]Continuous infusion 100 millilitre - Intravenous - over 30 minutes - daily - for 5 days
Bundle.entry[1].resource[0].dosageInstruction[0].timing[0].repeat[0].bounds[0].value[0]5
Bundle.entry[1].resource[0].dosageInstruction[0].timing[0].repeat[0].bounds[0].unit[0]day
Bundle.entry[1].resource[0].dosageInstruction[0].timing[0].repeat[0].bounds[0].system[0]http://unitsofmeasure.org
Bundle.entry[1].resource[0].dosageInstruction[0].timing[0].repeat[0].bounds[0].code[0]d
Bundle.entry[1].resource[0].dosageInstruction[0].timing[0].repeat[0].duration[0]30
Bundle.entry[1].resource[0].dosageInstruction[0].timing[0].repeat[0].durationUnit[0]min
Bundle.entry[1].resource[0].dosageInstruction[0].timing[0].repeat[0].frequency[0]1
Bundle.entry[1].resource[0].dosageInstruction[0].timing[0].repeat[0].period[0]1
Bundle.entry[1].resource[0].dosageInstruction[0].timing[0].repeat[0].periodUnit[0]d
Bundle.entry[1].resource[0].dosageInstruction[0].route[0].coding[0].system[0]https://dmd.nhs.uk
Bundle.entry[1].resource[0].dosageInstruction[0].route[0].coding[0].code[0]47625008
Bundle.entry[1].resource[0].dosageInstruction[0].route[0].coding[0].display[0]Intravenous
Bundle.entry[1].resource[0].dosageInstruction[0].method[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[1].resource[0].dosageInstruction[0].method[0].coding[0].code[0]261754007
Bundle.entry[1].resource[0].dosageInstruction[0].method[0].coding[0].display[0]Continuous infusion
Bundle.entry[1].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].value[0]50
Bundle.entry[1].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].unit[0]millilitre
Bundle.entry[1].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].system[0]http://unitsofmeasure.org
Bundle.entry[1].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].code[0]ml
Bundle

Dispensing Event: Dispensed by Pharmacy using a pre-prepared product

Note: This example is work-in-progress and may be subject to change.

Pre-prepared and dm+d coded Ceftriaxone 1g/50ml infusion bags products are dispensed to the ward.

<Bundle xmlns="http://hl7.org/fhir">
    <type value="message" />
    <entry>
        <fullUrl value="urn:uuid:ee6f0a35-4e84-4b75-8b22-c2111878e548" />
        <resource>
            <MessageHeader>
                <id value="ee6f0a35-4e84-4b75-8b22-c2111878e548" />
                <eventCoding>
                    <system value="http://snomed.info/sct" />
                    <code value="373784005" />
                    <display value="Dispensing medication" />
                </eventCoding>
                <source>
                    <endpoint value="https://myendpoint.nhs.uk/" />
                </source>
                <focus>
                    <reference value="b74a61af-3a12-4d55-9e7a-949fff9f713a" />
                    <type value="MedicationDispense" />
                </focus>
            </MessageHeader>
        </resource>
    </entry>
    <entry>
        <fullUrl value="urn:uuid:b74a61af-3a12-4d55-9e7a-949fff9f713a" />
        <resource>
            <MedicationDispense>
                <id value="b74a61af-3a12-4d55-9e7a-949fff9f713a" />
                <meta>
                    <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationDispense" />
                </meta>
                <status value="completed" />
                <medicationCodeableConcept>
                    <coding>
                        <system value="https://dmd.nhs.uk" />
                        <code value="22102811000001100" />
                        <display value="Ceftriaxone 1g/50ml infusion bags (Special Order)" />
                    </coding>
                </medicationCodeableConcept>
                <subject>
                    <reference value="Patient/UKCore-Patient-RichardSmith-Example" />
                </subject>
                <authorizingPrescription>
                    <reference value="34eb3c92-76e6-48c2-9691-aa1f0b58369b" />
                    <type value="MedicationRequest" />
                </authorizingPrescription>
                <quantity>
                    <value value="5" />
                    <unit value="bag" />
                    <system value="http://snomed.info/sct" />
                    <code value="428672001" />
                </quantity>
                <dosageInstruction>
                    <text value="Continuous infusion 1 gram - Intravenous - over 30 minutes - daily - for 5 days" />
                    <timing>
                        <repeat>
                            <boundsDuration>
                                <value value="5" />
                                <unit value="day" />
                                <system value="http://unitsofmeasure.org" />
                                <code value="d" />
                            </boundsDuration>
                            <duration value="30" />
                            <durationUnit value="min" />
                            <frequency value="1" />
                            <period value="1" />
                            <periodUnit value="d" />
                        </repeat>
                    </timing>
                    <route>
                        <coding>
                            <system value="https://dmd.nhs.uk" />
                            <code value="47625008" />
                            <display value="Intravenous" />
                        </coding>
                    </route>
                    <method>
                        <coding>
                            <system value="http://snomed.info/sct" />
                            <code value="261754007" />
                            <display value="Continuous infusion" />
                        </coding>
                    </method>
                    <doseAndRate>
                        <doseQuantity>
                            <value value="1" />
                            <unit value="bag" />
                            <system value="http://snomed.info/sct" />
                            <code value="428672001" />
                        </doseQuantity>
                    </doseAndRate>
                </dosageInstruction>
            </MedicationDispense>
        </resource>
    </entry>
</Bundle>

{
    "resourceType": "Bundle",
    "type": "message",
    "entry":  [
        {
            "fullUrl": "urn:uuid:ee6f0a35-4e84-4b75-8b22-c2111878e548",
            "resource": {
                "resourceType": "MessageHeader",
                "id": "ee6f0a35-4e84-4b75-8b22-c2111878e548",
                "eventCoding": {
                    "system": "http://snomed.info/sct",
                    "code": "373784005",
                    "display": "Dispensing medication"
                },
                "source": {
                    "endpoint": "https://myendpoint.nhs.uk/"
                },
                "focus":  [
                    {
                        "reference": "b74a61af-3a12-4d55-9e7a-949fff9f713a",
                        "type": "MedicationDispense"
                    }
                ]
            }
        },
        {
            "fullUrl": "urn:uuid:b74a61af-3a12-4d55-9e7a-949fff9f713a",
            "resource": {
                "resourceType": "MedicationDispense",
                "id": "b74a61af-3a12-4d55-9e7a-949fff9f713a",
                "meta": {
                    "profile":  [
                        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationDispense"
                    ]
                },
                "status": "completed",
                "medicationCodeableConcept": {
                    "coding":  [
                        {
                            "system": "https://dmd.nhs.uk",
                            "code": "22102811000001100",
                            "display": "Ceftriaxone 1g/50ml infusion bags (Special Order)"
                        }
                    ]
                },
                "subject": {
                    "reference": "Patient/UKCore-Patient-RichardSmith-Example"
                },
                "authorizingPrescription":  [
                    {
                        "reference": "34eb3c92-76e6-48c2-9691-aa1f0b58369b",
                        "type": "MedicationRequest"
                    }
                ],
                "quantity": {
                    "value": 5,
                    "unit": "bag",
                    "system": "http://snomed.info/sct",
                    "code": "428672001"
                },
                "dosageInstruction":  [
                    {
                        "text": "Continuous infusion 1 gram - Intravenous - over 30 minutes - daily - for 5 days",
                        "timing": {
                            "repeat": {
                                "boundsDuration": {
                                    "value": 5,
                                    "unit": "day",
                                    "system": "http://unitsofmeasure.org",
                                    "code": "d"
                                },
                                "duration": 30,
                                "durationUnit": "min",
                                "frequency": 1,
                                "period": 1,
                                "periodUnit": "d"
                            }
                        },
                        "route": {
                            "coding":  [
                                {
                                    "system": "https://dmd.nhs.uk",
                                    "code": "47625008",
                                    "display": "Intravenous"
                                }
                            ]
                        },
                        "method": {
                            "coding":  [
                                {
                                    "system": "http://snomed.info/sct",
                                    "code": "261754007",
                                    "display": "Continuous infusion"
                                }
                            ]
                        },
                        "doseAndRate":  [
                            {
                                "doseQuantity": {
                                    "value": 1,
                                    "unit": "bag",
                                    "system": "http://snomed.info/sct",
                                    "code": "428672001"
                                }
                            }
                        ]
                    }
                ]
            }
        }
    ]
}
Bundle.type[0]message
Bundle.entry[0].fullUrl[0]urn:uuid:ee6f0a35-4e84-4b75-8b22-c2111878e548
Bundle.entry[0].resource[0].id[0]ee6f0a35-4e84-4b75-8b22-c2111878e548
Bundle.entry[0].resource[0].event[0].system[0]http://snomed.info/sct
Bundle.entry[0].resource[0].event[0].code[0]373784005
Bundle.entry[0].resource[0].event[0].display[0]Dispensing medication
Bundle.entry[0].resource[0].source[0].endpoint[0]https://myendpoint.nhs.uk/
Bundle.entry[0].resource[0].focus[0].reference[0]b74a61af-3a12-4d55-9e7a-949fff9f713a
Bundle.entry[0].resource[0].focus[0].type[0]MedicationDispense
Bundle.entry[1].fullUrl[0]urn:uuid:b74a61af-3a12-4d55-9e7a-949fff9f713a
Bundle.entry[1].resource[0].id[0]b74a61af-3a12-4d55-9e7a-949fff9f713a
Bundle.entry[1].resource[0].meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationDispense
Bundle.entry[1].resource[0].status[0]completed
Bundle.entry[1].resource[0].medication[0].coding[0].system[0]https://dmd.nhs.uk
Bundle.entry[1].resource[0].medication[0].coding[0].code[0]22102811000001100
Bundle.entry[1].resource[0].medication[0].coding[0].display[0]Ceftriaxone 1g/50ml infusion bags (Special Order)
Bundle.entry[1].resource[0].subject[0].reference[0]Patient/UKCore-Patient-RichardSmith-Example
Bundle.entry[1].resource[0].authorizingPrescription[0].reference[0]34eb3c92-76e6-48c2-9691-aa1f0b58369b
Bundle.entry[1].resource[0].authorizingPrescription[0].type[0]MedicationRequest
Bundle.entry[1].resource[0].quantity[0].value[0]5
Bundle.entry[1].resource[0].quantity[0].unit[0]bag
Bundle.entry[1].resource[0].quantity[0].system[0]http://snomed.info/sct
Bundle.entry[1].resource[0].quantity[0].code[0]428672001
Bundle.entry[1].resource[0].dosageInstruction[0].text[0]Continuous infusion 1 gram - Intravenous - over 30 minutes - daily - for 5 days
Bundle.entry[1].resource[0].dosageInstruction[0].timing[0].repeat[0].bounds[0].value[0]5
Bundle.entry[1].resource[0].dosageInstruction[0].timing[0].repeat[0].bounds[0].unit[0]day
Bundle.entry[1].resource[0].dosageInstruction[0].timing[0].repeat[0].bounds[0].system[0]http://unitsofmeasure.org
Bundle.entry[1].resource[0].dosageInstruction[0].timing[0].repeat[0].bounds[0].code[0]d
Bundle.entry[1].resource[0].dosageInstruction[0].timing[0].repeat[0].duration[0]30
Bundle.entry[1].resource[0].dosageInstruction[0].timing[0].repeat[0].durationUnit[0]min
Bundle.entry[1].resource[0].dosageInstruction[0].timing[0].repeat[0].frequency[0]1
Bundle.entry[1].resource[0].dosageInstruction[0].timing[0].repeat[0].period[0]1
Bundle.entry[1].resource[0].dosageInstruction[0].timing[0].repeat[0].periodUnit[0]d
Bundle.entry[1].resource[0].dosageInstruction[0].route[0].coding[0].system[0]https://dmd.nhs.uk
Bundle.entry[1].resource[0].dosageInstruction[0].route[0].coding[0].code[0]47625008
Bundle.entry[1].resource[0].dosageInstruction[0].route[0].coding[0].display[0]Intravenous
Bundle.entry[1].resource[0].dosageInstruction[0].method[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[1].resource[0].dosageInstruction[0].method[0].coding[0].code[0]261754007
Bundle.entry[1].resource[0].dosageInstruction[0].method[0].coding[0].display[0]Continuous infusion
Bundle.entry[1].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].value[0]1
Bundle.entry[1].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].unit[0]bag
Bundle.entry[1].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].system[0]http://snomed.info/sct
Bundle.entry[1].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].code[0]428672001
Bundle

Administration Event: Using infusion prepared by pharmacy or ward

Note: This example is work-in-progress and may be subject to change.

An administration record using an infusion prepared either by the pharmacy or on the ward. There would be five administration records, one for each infusion, on each day.

<Bundle xmlns="http://hl7.org/fhir">
    <type value="message" />
    <entry>
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                    <system value="http://snomed.info/sct" />
                    <code value="18629005" />
                    <display value="Administration of medication" />
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                <source>
                    <endpoint value="https://myendpoint.nhs.uk/" />
                </source>
                <focus>
                    <reference value="843b54b7-1479-43a3-9931-99f10d621181" />
                    <type value="MedicationAdministration" />
                </focus>
            </MessageHeader>
        </resource>
    </entry>
    <entry>
        <fullUrl value="urn:uuid:11dc9519-b6e8-41bb-bce5-f6f724b743bc" />
        <resource>
            <Medication>
                <id value="11dc9519-b6e8-41bb-bce5-f6f724b743bc" />
                <meta>
                    <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Medication" />
                </meta>
                <code>
                    <text value="Ceftriaxone 1g in 50mL Sodium chloride 0.9% solution for infusion" />
                </code>
                <form>
                    <coding>
                        <system value="https://dmd.nhs.uk" />
                        <code value="385229008" />
                        <display value="Solution for infusion" />
                    </coding>
                </form>
                <ingredient>
                    <itemCodeableConcept>
                        <coding>
                            <system value="https://dmd.nhs.uk" />
                            <code value="22824911000001102" />
                            <display value="Ceftriaxone 1g powder for solution for infusion vials (Kent Pharma (UK) Ltd)" />
                        </coding>
                    </itemCodeableConcept>
                    <strength>
                        <numerator>
                            <value value="1" />
                            <unit value="gram" />
                            <system value="http://unitsofmeasure.org" />
                            <code value="g" />
                        </numerator>
                        <denominator>
                            <value value="1" />
                        </denominator>
                    </strength>
                </ingredient>
                <ingredient>
                    <itemCodeableConcept>
                        <coding>
                            <system value="https://dmd.nhs.uk" />
                            <code value="4880711000001109" />
                            <display value="Sodium chloride 0.9% infusion 50ml Mini-Bag Viaflex bags (Baxter Healthcare Ltd)" />
                        </coding>
                    </itemCodeableConcept>
                    <strength>
                        <numerator>
                            <value value="50" />
                            <unit value="millilitre" />
                            <system value="http://unitsofmeasure.org" />
                            <code value="ml" />
                        </numerator>
                        <denominator>
                            <value value="1" />
                        </denominator>
                    </strength>
                </ingredient>
            </Medication>
        </resource>
    </entry>
    <entry>
        <fullUrl value="urn:uuid:7b36eb7b-ea3f-44fb-87c9-dfa51e4b6d5b" />
        <resource>
            <MedicationAdministration>
                <id value="843b54b7-1479-43a3-9931-99f10d621181" />
                <meta>
                    <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationAdministration" />
                </meta>
                <status value="completed" />
                <medicationReference>
                    <reference value="11dc9519-b6e8-41bb-bce5-f6f724b743bc" />
                    <type value="Medication" />
                </medicationReference>
                <subject>
                    <reference value="Patient/UKCore-Patient-RichardSmith-Example" />
                </subject>
                <effectiveDateTime value="2022-02-28T17:06:00+00:00" />
                <request>
                    <reference value="34eb3c92-76e6-48c2-9691-aa1f0b58369b" />
                    <type value="MedicationRequest" />
                </request>
                <dosage>
                    <route>
                        <coding>
                            <system value="https://dmd.nhs.uk" />
                            <code value="47625008" />
                            <display value="Intravenous" />
                        </coding>
                    </route>
                    <method>
                        <coding>
                            <system value="http://snomed.info/sct" />
                            <code value="261754007" />
                            <display value="Continuous infusion" />
                        </coding>
                    </method>
                    <dose>
                        <value value="100" />
                        <unit value="millilitre" />
                        <system value="http://unitsofmeasure.org" />
                        <code value="ml" />
                    </dose>
                </dosage>
            </MedicationAdministration>
        </resource>
    </entry>
</Bundle>

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                                "system": "http://snomed.info/sct",
                                "code": "261754007",
                                "display": "Continuous infusion"
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                    "dose": {
                        "value": 100,
                        "unit": "millilitre",
                        "system": "http://unitsofmeasure.org",
                        "code": "ml"
                    }
                }
            }
        }
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}
Bundle.type[0]message
Bundle.entry[0].fullUrl[0]urn:uuid:682858a9-3942-412d-9ae5-71a2f17f7c5b
Bundle.entry[0].resource[0].id[0]682858a9-3942-412d-9ae5-71a2f17f7c5b
Bundle.entry[0].resource[0].event[0].system[0]http://snomed.info/sct
Bundle.entry[0].resource[0].event[0].code[0]18629005
Bundle.entry[0].resource[0].event[0].display[0]Administration of medication
Bundle.entry[0].resource[0].source[0].endpoint[0]https://myendpoint.nhs.uk/
Bundle.entry[0].resource[0].focus[0].reference[0]843b54b7-1479-43a3-9931-99f10d621181
Bundle.entry[0].resource[0].focus[0].type[0]MedicationAdministration
Bundle.entry[1].fullUrl[0]urn:uuid:11dc9519-b6e8-41bb-bce5-f6f724b743bc
Bundle.entry[1].resource[0].id[0]11dc9519-b6e8-41bb-bce5-f6f724b743bc
Bundle.entry[1].resource[0].meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-Medication
Bundle.entry[1].resource[0].code[0].text[0]Ceftriaxone 1g in 50mL Sodium chloride 0.9% solution for infusion
Bundle.entry[1].resource[0].form[0].coding[0].system[0]https://dmd.nhs.uk
Bundle.entry[1].resource[0].form[0].coding[0].code[0]385229008
Bundle.entry[1].resource[0].form[0].coding[0].display[0]Solution for infusion
Bundle.entry[1].resource[0].ingredient[0].item[0].coding[0].system[0]https://dmd.nhs.uk
Bundle.entry[1].resource[0].ingredient[0].item[0].coding[0].code[0]22824911000001102
Bundle.entry[1].resource[0].ingredient[0].item[0].coding[0].display[0]Ceftriaxone 1g powder for solution for infusion vials (Kent Pharma (UK) Ltd)
Bundle.entry[1].resource[0].ingredient[0].strength[0].numerator[0].value[0]1
Bundle.entry[1].resource[0].ingredient[0].strength[0].numerator[0].unit[0]gram
Bundle.entry[1].resource[0].ingredient[0].strength[0].numerator[0].system[0]http://unitsofmeasure.org
Bundle.entry[1].resource[0].ingredient[0].strength[0].numerator[0].code[0]g
Bundle.entry[1].resource[0].ingredient[0].strength[0].denominator[0].value[0]1
Bundle.entry[1].resource[0].ingredient[1].item[0].coding[0].system[0]https://dmd.nhs.uk
Bundle.entry[1].resource[0].ingredient[1].item[0].coding[0].code[0]4880711000001109
Bundle.entry[1].resource[0].ingredient[1].item[0].coding[0].display[0]Sodium chloride 0.9% infusion 50ml Mini-Bag Viaflex bags (Baxter Healthcare Ltd)
Bundle.entry[1].resource[0].ingredient[1].strength[0].numerator[0].value[0]50
Bundle.entry[1].resource[0].ingredient[1].strength[0].numerator[0].unit[0]millilitre
Bundle.entry[1].resource[0].ingredient[1].strength[0].numerator[0].system[0]http://unitsofmeasure.org
Bundle.entry[1].resource[0].ingredient[1].strength[0].numerator[0].code[0]ml
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Bundle.entry[2].resource[0].meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationAdministration
Bundle.entry[2].resource[0].status[0]completed
Bundle.entry[2].resource[0].medication[0].reference[0]11dc9519-b6e8-41bb-bce5-f6f724b743bc
Bundle.entry[2].resource[0].medication[0].type[0]Medication
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Bundle.entry[2].resource[0].effective[0]2022-02-28T17:06:00+00:00
Bundle.entry[2].resource[0].request[0].reference[0]34eb3c92-76e6-48c2-9691-aa1f0b58369b
Bundle.entry[2].resource[0].request[0].type[0]MedicationRequest
Bundle.entry[2].resource[0].dosage[0].route[0].coding[0].system[0]https://dmd.nhs.uk
Bundle.entry[2].resource[0].dosage[0].route[0].coding[0].code[0]47625008
Bundle.entry[2].resource[0].dosage[0].route[0].coding[0].display[0]Intravenous
Bundle.entry[2].resource[0].dosage[0].method[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[2].resource[0].dosage[0].method[0].coding[0].code[0]261754007
Bundle.entry[2].resource[0].dosage[0].method[0].coding[0].display[0]Continuous infusion
Bundle.entry[2].resource[0].dosage[0].dose[0].value[0]100
Bundle.entry[2].resource[0].dosage[0].dose[0].unit[0]millilitre
Bundle.entry[2].resource[0].dosage[0].dose[0].system[0]http://unitsofmeasure.org
Bundle.entry[2].resource[0].dosage[0].dose[0].code[0]ml
Bundle

Administration Event: Using a pre-prepared infusion product

Note: This example is work-in-progress and may be subject to change.

An administration record using a pre-prepared and dm+d coded Ceftriaxone 1g/50ml infusion bags product. There would be five administration records, one for each infusion, on each day.

<MedicationAdministration xmlns="http://hl7.org/fhir">
    <id value="cc191603-72c0-4e65-86ee-a149a2dc81d4" />
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationAdministration" />
    </meta>
    <status value="completed" />
    <medicationCodeableConcept>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="22102811000001100" />
            <display value="Ceftriaxone 1g/50ml infusion bags (Special Order)" />
        </coding>
    </medicationCodeableConcept>
    <subject>
        <reference value="Patient/UKCore-Patient-RichardSmith-Example" />
    </subject>
    <effectiveDateTime value="2022-02-28T16:52:00+00:00" />
    <request>
        <reference value="34eb3c92-76e6-48c2-9691-aa1f0b58369b" />
        <type value="MedicationRequest" />
    </request>
    <dosage>
        <route>
            <coding>
                <system value="https://dmd.nhs.uk" />
                <code value="47625008" />
                <display value="Intravenous" />
            </coding>
        </route>
        <method>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="261754007" />
                <display value="Continuous infusion" />
            </coding>
        </method>
        <dose>
            <value value="1" />
            <unit value="bag" />
            <system value="http://snomed.info/sct" />
            <code value="428672001" />
        </dose>
    </dosage>
</MedicationAdministration>

{
    "resourceType": "MedicationAdministration",
    "id": "cc191603-72c0-4e65-86ee-a149a2dc81d4",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationAdministration"
        ]
    },
    "status": "completed",
    "medicationCodeableConcept": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "22102811000001100",
                "display": "Ceftriaxone 1g/50ml infusion bags (Special Order)"
            }
        ]
    },
    "subject": {
        "reference": "Patient/UKCore-Patient-RichardSmith-Example"
    },
    "effectiveDateTime": "2022-02-28T16:52:00+00:00",
    "request": {
        "reference": "34eb3c92-76e6-48c2-9691-aa1f0b58369b",
        "type": "MedicationRequest"
    },
    "dosage": {
        "route": {
            "coding":  [
                {
                    "system": "https://dmd.nhs.uk",
                    "code": "47625008",
                    "display": "Intravenous"
                }
            ]
        },
        "method": {
            "coding":  [
                {
                    "system": "http://snomed.info/sct",
                    "code": "261754007",
                    "display": "Continuous infusion"
                }
            ]
        },
        "dose": {
            "value": 1,
            "unit": "bag",
            "system": "http://snomed.info/sct",
            "code": "428672001"
        }
    }
}
MedicationAdministration.id[0]cc191603-72c0-4e65-86ee-a149a2dc81d4
MedicationAdministration.meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationAdministration
MedicationAdministration.status[0]completed
MedicationAdministration.medication[0].coding[0].system[0]https://dmd.nhs.uk
MedicationAdministration.medication[0].coding[0].code[0]22102811000001100
MedicationAdministration.medication[0].coding[0].display[0]Ceftriaxone 1g/50ml infusion bags (Special Order)
MedicationAdministration.subject[0].reference[0]Patient/UKCore-Patient-RichardSmith-Example
MedicationAdministration.effective[0]2022-02-28T16:52:00+00:00
MedicationAdministration.request[0].reference[0]34eb3c92-76e6-48c2-9691-aa1f0b58369b
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MedicationAdministration.dosage[0].dose[0].value[0]1
MedicationAdministration.dosage[0].dose[0].unit[0]bag
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MedicationAdministration.dosage[0].dose[0].code[0]428672001
MedicationAdministration

Chlorphenamine single bolus infusion

Clinical Scenario

TBC

Prescribing Event

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MedicationRequest.dosageInstruction[0].timing[0].repeat[0].duration[0]1
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MedicationRequest

Calcium Gluconate continuous infusion

Clinical Scenario

The patient requires a loading dose of 20 ml Calcium Gluconate 10% in a diluent of 100 ml Glucose 5%.

Followed by a maintenance dose of Calcium gluconate 10% as a continuous infusion at a rate of 2 ml per hour via an intravenous central route.

Prescribing Event - Loading Dose

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Bundle.entry[1].resource[0].amount[0].numerator[0].unit[0]mL
Bundle.entry[1].resource[0].amount[0].numerator[0].system[0]http://unitsofmeasure.org
Bundle.entry[1].resource[0].amount[0].numerator[0].code[0]mL
Bundle.entry[1].resource[0].amount[0].denominator[0].value[0]1
Bundle.entry[1].resource[0].ingredient[0].item[0].coding[0].system[0]https://dmd.nhs.uk
Bundle.entry[1].resource[0].ingredient[0].item[0].coding[0].code[0]111138002
Bundle.entry[1].resource[0].ingredient[0].item[0].coding[0].display[0]Glucose
Bundle.entry[1].resource[0].ingredient[0].strength[0].numerator[0].value[0]5
Bundle.entry[1].resource[0].ingredient[0].strength[0].numerator[0].unit[0]%
Bundle.entry[1].resource[0].ingredient[0].strength[0].numerator[0].system[0]http://unitsofmeasure.org
Bundle.entry[1].resource[0].ingredient[0].strength[0].numerator[0].code[0]%
Bundle.entry[1].resource[0].ingredient[0].strength[0].denominator[0].value[0]1
Bundle.entry[2].fullUrl[0]Medication/72c5dfc7-e865-436c-b67a-937c10ec14b9
Bundle.entry[2].resource[0].id[0]72c5dfc7-e865-436c-b67a-937c10ec14b9
Bundle.entry[2].resource[0].meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-Medication
Bundle.entry[2].resource[0].text[0].status[0]generated
Bundle.entry[2].resource[0].text[0].div[0]Calcium gluconate 10% 20mL Glucose 5% 100mL
Bundle.entry[2].resource[0].code[0].text[0]Calcium gluconate 10% 20mL Glucose 5% 100mL
Bundle.entry[2].resource[0].ingredient[0].item[0].reference[0]Medication/0547f17f-7d46-4667-88a7-4c19a6d521d8
Bundle.entry[2].resource[0].ingredient[0].item[0].display[0]Calcium gluconate 10% 20mL
Bundle.entry[2].resource[0].ingredient[1].item[0].reference[0]Medication/aa3d3b67-e390-4b67-98ea-f7a04533f727
Bundle.entry[2].resource[0].ingredient[1].item[0].display[0]Glucose 5% 100mL
Bundle.entry[3].fullUrl[0]MedicationRequest/bd4cbd2e-99af-4deb-a2bc-e1b1fc804120
Bundle.entry[3].resource[0].id[0]bd4cbd2e-99af-4deb-a2bc-e1b1fc804120
Bundle.entry[3].resource[0].meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
Bundle.entry[3].resource[0].status[0]active
Bundle.entry[3].resource[0].intent[0]order
Bundle.entry[3].resource[0].medication[0].reference[0]Medication/72c5dfc7-e865-436c-b67a-937c10ec14b9
Bundle.entry[3].resource[0].medication[0].display[0]Calcium gluconate 10% 20mL Glucose 5% 100mL
Bundle.entry[3].resource[0].subject[0].reference[0]Patient/UKCore-Patient-RichardSmith-Example
Bundle.entry[3].resource[0].reasonCode[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[3].resource[0].reasonCode[0].coding[0].code[0]5291005
Bundle.entry[3].resource[0].reasonCode[0].coding[0].display[0]Hypocalcaemia
Bundle.entry[3].resource[0].dosageInstruction[0].text[0]Continuous infusion - 120mL
Bundle.entry[3].resource[0].dosageInstruction[0].additionalInstruction[0].text[0]May repeat until patient is asymptomatic
Bundle.entry[3].resource[0].dosageInstruction[0].timing[0].repeat[0].duration[0]10
Bundle.entry[3].resource[0].dosageInstruction[0].timing[0].repeat[0].durationUnit[0]min
Bundle.entry[3].resource[0].dosageInstruction[0].route[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[3].resource[0].dosageInstruction[0].route[0].coding[0].code[0]47625008
Bundle.entry[3].resource[0].dosageInstruction[0].route[0].coding[0].display[0]Intravenous
Bundle.entry[3].resource[0].dosageInstruction[0].method[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[3].resource[0].dosageInstruction[0].method[0].coding[0].code[0]261754007
Bundle.entry[3].resource[0].dosageInstruction[0].method[0].coding[0].display[0]Continuous infusion
Bundle.entry[3].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].value[0]120
Bundle.entry[3].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].unit[0]millilitre
Bundle.entry[3].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].system[0]http://unitsofmeasure.org
Bundle.entry[3].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].code[0]mL
Bundle.entry[3].resource[0].substitution[0].allowed[0]False
Bundle

Prescribing Event - Maintenance Dose

<MedicationRequest xmlns="http://hl7.org/fhir">
    <id value="34eb3c92-76e6-48c2-9691-aa1f0b58369b" />
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
    </meta>
    <medicationCodeableConcept>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="33456711000001109" />
            <display value="Calcium gluconate 10% solution for injection 50ml vials" />
        </coding>
    </medicationCodeableConcept>
    <subject>
        <reference value="Patient/UKCore-Patient-RichardSmith-Example" />
    </subject>
    <reasonCode>
        <coding>
            <system value="http://snomed.info/sct" />
            <code value="5291005" />
            <display value="Hypocalcemia" />
        </coding>
    </reasonCode>
    <dosageInstruction>
        <text value="Continuous infusion 2 millilitre per hour - Intravenous central route" />
        <route>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="418114005" />
                <display value="Intravenous central route" />
            </coding>
        </route>
        <method>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="261754007" />
                <display value="Continuous infusion" />
            </coding>
        </method>
        <doseAndRate>
            <rateQuantity>
                <value value="2" />
                <unit value="millilitre per hour" />
                <system value="http://unitsofmeasure.org" />
                <code value="ml/h" />
            </rateQuantity>
        </doseAndRate>
    </dosageInstruction>
</MedicationRequest>

{
    "resourceType": "MedicationRequest",
    "id": "34eb3c92-76e6-48c2-9691-aa1f0b58369b",
    "meta": {
        "profile":  [
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    },
    "subject": {
        "reference": "Patient/UKCore-Patient-RichardSmith-Example"
    },
    "medicationCodeableConcept": {
        "coding":  [
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                "system": "https://dmd.nhs.uk",
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    "reasonCode":  [
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                    "display": "Hypocalcemia"
                }
            ]
        }
    ],
    "dosageInstruction":  [
        {
            "text": "Continuous infusion 2 millilitre per hour - Intravenous central route",
            "method": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "261754007",
                        "display": "Continuous infusion"
                    }
                ]
            },
            "route": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "418114005",
                        "display": "Intravenous central route"
                    }
                ]
            },
            "doseAndRate":  [
                {
                    "rateQuantity": {
                        "value": 2,
                        "unit": "millilitre per hour",
                        "system": "http://unitsofmeasure.org",
                        "code": "ml/h"
                    }
                }
            ]
        }
    ]
}
MedicationRequest.id[0]34eb3c92-76e6-48c2-9691-aa1f0b58369b
MedicationRequest.meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
MedicationRequest.medication[0].coding[0].system[0]https://dmd.nhs.uk
MedicationRequest.medication[0].coding[0].code[0]33456711000001109
MedicationRequest.medication[0].coding[0].display[0]Calcium gluconate 10% solution for injection 50ml vials
MedicationRequest.subject[0].reference[0]Patient/UKCore-Patient-RichardSmith-Example
MedicationRequest.reasonCode[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.reasonCode[0].coding[0].code[0]5291005
MedicationRequest.reasonCode[0].coding[0].display[0]Hypocalcemia
MedicationRequest.dosageInstruction[0].text[0]Continuous infusion 2 millilitre per hour - Intravenous central route
MedicationRequest.dosageInstruction[0].route[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].route[0].coding[0].code[0]418114005
MedicationRequest.dosageInstruction[0].route[0].coding[0].display[0]Intravenous central route
MedicationRequest.dosageInstruction[0].method[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].method[0].coding[0].code[0]261754007
MedicationRequest.dosageInstruction[0].method[0].coding[0].display[0]Continuous infusion
MedicationRequest.dosageInstruction[0].doseAndRate[0].rate[0].value[0]2
MedicationRequest.dosageInstruction[0].doseAndRate[0].rate[0].unit[0]millilitre per hour
MedicationRequest.dosageInstruction[0].doseAndRate[0].rate[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[0].doseAndRate[0].rate[0].code[0]ml/h
MedicationRequest

Co-amoxiclav continuous infusion

To highlight the difference in representing an infusion and an injection using the FHIR standard.

FHIR Data Item Infusion Injection
Medication.ingredient (for the diluent) Sodium chloride 0.9% infusion 100ml bags Water for injections 20ml ampoules
dosageInstruction.timing.duration over 30 minutes over 3-4 minutes
dosageInstruction.method Continous infusion Inject
dosageInstruction.doseAndRate 100 ml 20 ml

Prescribing Event - by Infusion

<Bundle xmlns="http://hl7.org/fhir">
    <id value="co-amoxiclav-infusion-request" />
    <type value="message" />
    <entry>
        <fullUrl value="urn:uuid:682858a9-3942-412d-9ae5-71a2f17f7c5b" />
        <resource>
            <MessageHeader>
                <id value="682858a9-3942-412d-9ae5-71a2f17f7c5b" />
                <eventCoding>
                    <system value="http://snomed.info/sct" />
                    <code value="33633005" />
                    <display value="Prescription of drug" />
                </eventCoding>
                <source>
                    <endpoint value="https://myendpoint.nhs.uk/" />
                </source>
                <focus>
                    <reference value="34eb3c92-76e6-48c2-9691-aa1f0b58369b" />
                    <type value="MedicationRequest" />
                </focus>
            </MessageHeader>
        </resource>
    </entry>
    <entry>
        <fullUrl value="urn:uuid:11dc9519-b6e8-41bb-bce5-f6f724b743bc" />
        <resource>
            <Medication>
                <id value="11dc9519-b6e8-41bb-bce5-f6f724b743bc" />
                <meta>
                    <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Medication" />
                </meta>
                <code>
                    <text value="Co-amoxiclav 1.2 gram in Sodium chloride 0.9% infusion 100ml bags - Solution for infusion" />
                </code>
                <form>
                    <coding>
                        <system value="http://snomed.info/sct" />
                        <code value="385229008" />
                        <display value="Solution for infusion" />
                    </coding>
                </form>
                <ingredient>
                    <itemCodeableConcept>
                        <coding>
                            <system value="https://dmd.nhs.uk" />
                            <code value="39463011000001107" />
                            <display value="Co-amoxiclav" />
                        </coding>
                    </itemCodeableConcept>
                    <strength>
                        <numerator>
                            <value value="1.2" />
                            <unit value="gram" />
                            <system value="http://unitsofmeasure.org" />
                            <code value="g" />
                        </numerator>
                        <denominator>
                            <value value="1" />
                        </denominator>
                    </strength>
                </ingredient>
                <ingredient>
                    <itemCodeableConcept>
                        <coding>
                            <system value="https://dmd.nhs.uk" />
                            <code value="4898311000001108" />
                            <display value="Sodium chloride 0.9% infusion 100ml bags" />
                        </coding>
                    </itemCodeableConcept>
                </ingredient>
            </Medication>
        </resource>
    </entry>
    <entry>
        <fullUrl value="urn:uuid:34eb3c92-76e6-48c2-9691-aa1f0b58369b" />
        <resource>
            <MedicationRequest>
                <id value="34eb3c92-76e6-48c2-9691-aa1f0b58369b" />
                <meta>
                    <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
                </meta>
                <medicationReference>
                    <reference value="11dc9519-b6e8-41bb-bce5-f6f724b743bc" />
                    <type value="Medication" />
                </medicationReference>
                <subject>
                    <reference value="Patient/UKCore-Patient-RichardSmith-Example" />
                </subject>
                <reasonCode>
                    <coding>
                        <system value="http://snomed.info/sct" />
                        <code value="68566005" />
                        <display value="Urinary tract infection" />
                    </coding>
                </reasonCode>
                <dosageInstruction>
                    <text value="Continuous infusion 100 millilitre - over 30 minutes - 3 times a day - Intravenous" />
                    <timing>
                        <repeat>
                            <duration value="30" />
                            <durationUnit value="min" />
                            <frequency value="3" />
                            <period value="1" />
                            <periodUnit value="d" />
                        </repeat>
                    </timing>
                    <route>
                        <coding>
                            <system value="http://snomed.info/sct" />
                            <code value="47625008" />
                            <display value="Intravenous" />
                        </coding>
                    </route>
                    <method>
                        <coding>
                            <system value="http://snomed.info/sct" />
                            <code value="261754007" />
                            <display value="Continuous infusion" />
                        </coding>
                    </method>
                    <doseAndRate>
                        <doseQuantity>
                            <value value="100" />
                            <unit value="millilitre" />
                            <system value="http://unitsofmeasure.org" />
                            <code value="ml" />
                        </doseQuantity>
                    </doseAndRate>
                </dosageInstruction>
            </MedicationRequest>
        </resource>
    </entry>
</Bundle>

{
    "resourceType": "Bundle",
    "id": "co-amoxiclav-infusion-request",
    "type": "message",
    "entry":  [
        {
            "fullUrl": "urn:uuid:682858a9-3942-412d-9ae5-71a2f17f7c5b",
            "resource": {
                "resourceType": "MessageHeader",
                "id": "682858a9-3942-412d-9ae5-71a2f17f7c5b",
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                "source": {
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                    }
                ]
            }
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        {
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                "resourceType": "Medication",
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                },
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                            "system": "http://snomed.info/sct",
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                            "display": "Solution for infusion"
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                    ]
                },
                "code": {
                    "text": "Co-amoxiclav 1.2 gram in Sodium chloride 0.9% infusion 100ml bags - Solution for infusion"
                },
                "ingredient":  [
                    {
                        "itemCodeableConcept": {
                            "coding":  [
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                                    "code": "39463011000001107",
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                                }
                            ]
                        },
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                                "unit": "gram",
                                "system": "http://unitsofmeasure.org",
                                "code": "g"
                            },
                            "denominator": {
                                "value": 1
                            }
                        }
                    },
                    {
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                                    "system": "https://dmd.nhs.uk",
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                "medicationReference": {
                    "reference": "11dc9519-b6e8-41bb-bce5-f6f724b743bc",
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                },
                "reasonCode":  [
                    {
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                                "code": "68566005",
                                "display": "Urinary tract infection"
                            }
                        ]
                    }
                ],
                "dosageInstruction":  [
                    {
                        "text": "Continuous infusion 100 millilitre - over 30 minutes - 3 times a day - Intravenous",
                        "timing": {
                            "repeat": {
                                "duration": 30,
                                "durationUnit": "min",
                                "frequency": 3,
                                "period": 1,
                                "periodUnit": "d"
                            }
                        },
                        "method": {
                            "coding":  [
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                                    "code": "261754007",
                                    "display": "Continuous infusion"
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                        "route": {
                            "coding":  [
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                                    "system": "http://snomed.info/sct",
                                    "code": "47625008",
                                    "display": "Intravenous"
                                }
                            ]
                        },
                        "doseAndRate":  [
                            {
                                "doseQuantity": {
                                    "value": 100,
                                    "unit": "millilitre",
                                    "system": "http://unitsofmeasure.org",
                                    "code": "ml"
                                }
                            }
                        ]
                    }
                ]
            }
        }
    ]
}
Bundle.id[0]co-amoxiclav-infusion-request
Bundle.type[0]message
Bundle.entry[0].fullUrl[0]urn:uuid:682858a9-3942-412d-9ae5-71a2f17f7c5b
Bundle.entry[0].resource[0].id[0]682858a9-3942-412d-9ae5-71a2f17f7c5b
Bundle.entry[0].resource[0].event[0].system[0]http://snomed.info/sct
Bundle.entry[0].resource[0].event[0].code[0]33633005
Bundle.entry[0].resource[0].event[0].display[0]Prescription of drug
Bundle.entry[0].resource[0].source[0].endpoint[0]https://myendpoint.nhs.uk/
Bundle.entry[0].resource[0].focus[0].reference[0]34eb3c92-76e6-48c2-9691-aa1f0b58369b
Bundle.entry[0].resource[0].focus[0].type[0]MedicationRequest
Bundle.entry[1].fullUrl[0]urn:uuid:11dc9519-b6e8-41bb-bce5-f6f724b743bc
Bundle.entry[1].resource[0].id[0]11dc9519-b6e8-41bb-bce5-f6f724b743bc
Bundle.entry[1].resource[0].meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-Medication
Bundle.entry[1].resource[0].code[0].text[0]Co-amoxiclav 1.2 gram in Sodium chloride 0.9% infusion 100ml bags - Solution for infusion
Bundle.entry[1].resource[0].form[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[1].resource[0].form[0].coding[0].code[0]385229008
Bundle.entry[1].resource[0].form[0].coding[0].display[0]Solution for infusion
Bundle.entry[1].resource[0].ingredient[0].item[0].coding[0].system[0]https://dmd.nhs.uk
Bundle.entry[1].resource[0].ingredient[0].item[0].coding[0].code[0]39463011000001107
Bundle.entry[1].resource[0].ingredient[0].item[0].coding[0].display[0]Co-amoxiclav
Bundle.entry[1].resource[0].ingredient[0].strength[0].numerator[0].value[0]1.2
Bundle.entry[1].resource[0].ingredient[0].strength[0].numerator[0].unit[0]gram
Bundle.entry[1].resource[0].ingredient[0].strength[0].numerator[0].system[0]http://unitsofmeasure.org
Bundle.entry[1].resource[0].ingredient[0].strength[0].numerator[0].code[0]g
Bundle.entry[1].resource[0].ingredient[0].strength[0].denominator[0].value[0]1
Bundle.entry[1].resource[0].ingredient[1].item[0].coding[0].system[0]https://dmd.nhs.uk
Bundle.entry[1].resource[0].ingredient[1].item[0].coding[0].code[0]4898311000001108
Bundle.entry[1].resource[0].ingredient[1].item[0].coding[0].display[0]Sodium chloride 0.9% infusion 100ml bags
Bundle.entry[2].fullUrl[0]urn:uuid:34eb3c92-76e6-48c2-9691-aa1f0b58369b
Bundle.entry[2].resource[0].id[0]34eb3c92-76e6-48c2-9691-aa1f0b58369b
Bundle.entry[2].resource[0].meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
Bundle.entry[2].resource[0].medication[0].reference[0]11dc9519-b6e8-41bb-bce5-f6f724b743bc
Bundle.entry[2].resource[0].medication[0].type[0]Medication
Bundle.entry[2].resource[0].subject[0].reference[0]Patient/UKCore-Patient-RichardSmith-Example
Bundle.entry[2].resource[0].reasonCode[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[2].resource[0].reasonCode[0].coding[0].code[0]68566005
Bundle.entry[2].resource[0].reasonCode[0].coding[0].display[0]Urinary tract infection
Bundle.entry[2].resource[0].dosageInstruction[0].text[0]Continuous infusion 100 millilitre - over 30 minutes - 3 times a day - Intravenous
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].duration[0]30
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].durationUnit[0]min
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].frequency[0]3
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].period[0]1
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].periodUnit[0]d
Bundle.entry[2].resource[0].dosageInstruction[0].route[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[2].resource[0].dosageInstruction[0].route[0].coding[0].code[0]47625008
Bundle.entry[2].resource[0].dosageInstruction[0].route[0].coding[0].display[0]Intravenous
Bundle.entry[2].resource[0].dosageInstruction[0].method[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[2].resource[0].dosageInstruction[0].method[0].coding[0].code[0]261754007
Bundle.entry[2].resource[0].dosageInstruction[0].method[0].coding[0].display[0]Continuous infusion
Bundle.entry[2].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].value[0]100
Bundle.entry[2].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].unit[0]millilitre
Bundle.entry[2].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].system[0]http://unitsofmeasure.org
Bundle.entry[2].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].code[0]ml
Bundle

Prescribing Event - by Injection

<Bundle xmlns="http://hl7.org/fhir">
    <id value="co-amoxiclav-injection-request" />
    <type value="message" />
    <entry>
        <fullUrl value="urn:uuid:682858a9-3942-412d-9ae5-71a2f17f7c5b" />
        <resource>
            <MessageHeader>
                <id value="682858a9-3942-412d-9ae5-71a2f17f7c5b" />
                <focus>
                    <reference value="34eb3c92-76e6-48c2-9691-aa1f0b58369b" />
                    <type value="MedicationRequest" />
                </focus>
            </MessageHeader>
        </resource>
    </entry>
    <entry>
        <fullUrl value="urn:uuid:11dc9519-b6e8-41bb-bce5-f6f724b743bc" />
        <resource>
            <Medication>
                <id value="11dc9519-b6e8-41bb-bce5-f6f724b743bc" />
                <meta>
                    <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Medication" />
                </meta>
                <code>
                    <text value="Co-amoxiclav 1.2 gram in Water for injections 20ml ampoules - Solution for injection" />
                </code>
                <form>
                    <coding>
                        <system value="http://snomed.info/sct" />
                        <code value="385219001" />
                        <display value="Solution for injection" />
                    </coding>
                </form>
                <ingredient>
                    <itemCodeableConcept>
                        <coding>
                            <system value="https://dmd.nhs.uk" />
                            <code value="39463011000001107" />
                            <display value="Co-amoxiclav" />
                        </coding>
                    </itemCodeableConcept>
                    <strength>
                        <numerator>
                            <value value="1.2" />
                            <unit value="gram" />
                            <system value="http://unitsofmeasure.org" />
                            <code value="g" />
                        </numerator>
                        <denominator>
                            <value value="1" />
                        </denominator>
                    </strength>
                </ingredient>
                <ingredient>
                    <itemCodeableConcept>
                        <coding>
                            <system value="https://dmd.nhs.uk" />
                            <code value="39720011000001104" />
                            <display value="Water for injections 20ml ampoules" />
                        </coding>
                    </itemCodeableConcept>
                    <strength>
                        <numerator>
                            <value value="1" />
                            <unit value="ampoule" />
                            <system value="http://snomed.info/sct" />
                            <code value="413516001" />
                        </numerator>
                        <denominator>
                            <value value="1" />
                        </denominator>
                    </strength>
                </ingredient>
            </Medication>
        </resource>
    </entry>
    <entry>
        <fullUrl value="urn:uuid:34eb3c92-76e6-48c2-9691-aa1f0b58369b" />
        <resource>
            <MedicationRequest>
                <id value="34eb3c92-76e6-48c2-9691-aa1f0b58369b" />
                <meta>
                    <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
                </meta>
                <medicationReference>
                    <reference value="11dc9519-b6e8-41bb-bce5-f6f724b743bc" />
                    <type value="Medication" />
                </medicationReference>
                <subject>
                    <reference value="Patient/UKCore-Patient-RichardSmith-Example" />
                </subject>
                <reasonCode>
                    <coding>
                        <system value="http://snomed.info/sct" />
                        <code value="68566005" />
                        <display value="Urinary tract infection" />
                    </coding>
                </reasonCode>
                <dosageInstruction>
                    <text value="Inject 20 millilitre - over 3-4 minutes - 3 times a day - Intravenous" />
                    <timing>
                        <repeat>
                            <duration value="3" />
                            <durationMax value="4" />
                            <durationUnit value="min" />
                            <frequency value="3" />
                            <period value="1" />
                            <periodUnit value="d" />
                        </repeat>
                    </timing>
                    <route>
                        <coding>
                            <system value="http://snomed.info/sct" />
                            <code value="47625008" />
                            <display value="Intravenous" />
                        </coding>
                    </route>
                    <method>
                        <coding>
                            <system value="http://snomed.info/sct" />
                            <code value="422145002" />
                            <display value="Inject" />
                        </coding>
                    </method>
                    <doseAndRate>
                        <doseQuantity>
                            <value value="20" />
                            <unit value="millilitre" />
                            <system value="http://unitsofmeasure.org" />
                            <code value="ml" />
                        </doseQuantity>
                    </doseAndRate>
                </dosageInstruction>
            </MedicationRequest>
        </resource>
    </entry>
</Bundle>

{
    "resourceType": "Bundle",
    "id": "co-amoxiclav-injection-request",
    "type": "message",
    "entry":  [
        {
            "fullUrl": "urn:uuid:682858a9-3942-412d-9ae5-71a2f17f7c5b",
            "resource": {
                "resourceType": "MessageHeader",
                "id": "682858a9-3942-412d-9ae5-71a2f17f7c5b",
                "focus":  [
                    {
                        "reference": "34eb3c92-76e6-48c2-9691-aa1f0b58369b",
                        "type": "MedicationRequest"
                    }
                ]
            }
        },
        {
            "fullUrl": "urn:uuid:11dc9519-b6e8-41bb-bce5-f6f724b743bc",
            "resource": {
                "resourceType": "Medication",
                "id": "11dc9519-b6e8-41bb-bce5-f6f724b743bc",
                "meta": {
                    "profile":  [
                        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Medication"
                    ]
                },
                "form": {
                    "coding":  [
                        {
                            "system": "http://snomed.info/sct",
                            "code": "385219001",
                            "display": "Solution for injection"
                        }
                    ]
                },
                "code": {
                    "text": "Co-amoxiclav 1.2 gram in Water for injections 20ml ampoules - Solution for injection"
                },
                "ingredient":  [
                    {
                        "itemCodeableConcept": {
                            "coding":  [
                                {
                                    "system": "https://dmd.nhs.uk",
                                    "code": "39463011000001107",
                                    "display": "Co-amoxiclav"
                                }
                            ]
                        },
                        "strength": {
                            "numerator": {
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                                "unit": "gram",
                                "system": "http://unitsofmeasure.org",
                                "code": "g"
                            },
                            "denominator": {
                                "value": 1
                            }
                        }
                    },
                    {
                        "itemCodeableConcept": {
                            "coding":  [
                                {
                                    "system": "https://dmd.nhs.uk",
                                    "code": "39720011000001104",
                                    "display": "Water for injections 20ml ampoules"
                                }
                            ]
                        },
                        "strength": {
                            "numerator": {
                                "value": 1,
                                "unit": "ampoule",
                                "system": "http://snomed.info/sct",
                                "code": "413516001"
                            },
                            "denominator": {
                                "value": 1
                            }
                        }
                    }
                ]
            }
        },
        {
            "fullUrl": "urn:uuid:34eb3c92-76e6-48c2-9691-aa1f0b58369b",
            "resource": {
                "resourceType": "MedicationRequest",
                "id": "34eb3c92-76e6-48c2-9691-aa1f0b58369b",
                "meta": {
                    "profile":  [
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                    ]
                },
                "subject": {
                    "reference": "Patient/UKCore-Patient-RichardSmith-Example"
                },
                "medicationReference": {
                    "reference": "11dc9519-b6e8-41bb-bce5-f6f724b743bc",
                    "type": "Medication"
                },
                "reasonCode":  [
                    {
                        "coding":  [
                            {
                                "system": "http://snomed.info/sct",
                                "code": "68566005",
                                "display": "Urinary tract infection"
                            }
                        ]
                    }
                ],
                "dosageInstruction":  [
                    {
                        "text": "Inject 20 millilitre - over 3-4 minutes - 3 times a day - Intravenous",
                        "timing": {
                            "repeat": {
                                "duration": 3,
                                "durationMax": 4,
                                "durationUnit": "min",
                                "frequency": 3,
                                "period": 1,
                                "periodUnit": "d"
                            }
                        },
                        "method": {
                            "coding":  [
                                {
                                    "system": "http://snomed.info/sct",
                                    "code": "422145002",
                                    "display": "Inject"
                                }
                            ]
                        },
                        "route": {
                            "coding":  [
                                {
                                    "system": "http://snomed.info/sct",
                                    "code": "47625008",
                                    "display": "Intravenous"
                                }
                            ]
                        },
                        "doseAndRate":  [
                            {
                                "doseQuantity": {
                                    "value": 20,
                                    "unit": "millilitre",
                                    "system": "http://unitsofmeasure.org",
                                    "code": "ml"
                                }
                            }
                        ]
                    }
                ]
            }
        }
    ]
}
Bundle.id[0]co-amoxiclav-injection-request
Bundle.type[0]message
Bundle.entry[0].fullUrl[0]urn:uuid:682858a9-3942-412d-9ae5-71a2f17f7c5b
Bundle.entry[0].resource[0].id[0]682858a9-3942-412d-9ae5-71a2f17f7c5b
Bundle.entry[0].resource[0].focus[0].reference[0]34eb3c92-76e6-48c2-9691-aa1f0b58369b
Bundle.entry[0].resource[0].focus[0].type[0]MedicationRequest
Bundle.entry[1].fullUrl[0]urn:uuid:11dc9519-b6e8-41bb-bce5-f6f724b743bc
Bundle.entry[1].resource[0].id[0]11dc9519-b6e8-41bb-bce5-f6f724b743bc
Bundle.entry[1].resource[0].meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-Medication
Bundle.entry[1].resource[0].code[0].text[0]Co-amoxiclav 1.2 gram in Water for injections 20ml ampoules - Solution for injection
Bundle.entry[1].resource[0].form[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[1].resource[0].form[0].coding[0].code[0]385219001
Bundle.entry[1].resource[0].form[0].coding[0].display[0]Solution for injection
Bundle.entry[1].resource[0].ingredient[0].item[0].coding[0].system[0]https://dmd.nhs.uk
Bundle.entry[1].resource[0].ingredient[0].item[0].coding[0].code[0]39463011000001107
Bundle.entry[1].resource[0].ingredient[0].item[0].coding[0].display[0]Co-amoxiclav
Bundle.entry[1].resource[0].ingredient[0].strength[0].numerator[0].value[0]1.2
Bundle.entry[1].resource[0].ingredient[0].strength[0].numerator[0].unit[0]gram
Bundle.entry[1].resource[0].ingredient[0].strength[0].numerator[0].system[0]http://unitsofmeasure.org
Bundle.entry[1].resource[0].ingredient[0].strength[0].numerator[0].code[0]g
Bundle.entry[1].resource[0].ingredient[0].strength[0].denominator[0].value[0]1
Bundle.entry[1].resource[0].ingredient[1].item[0].coding[0].system[0]https://dmd.nhs.uk
Bundle.entry[1].resource[0].ingredient[1].item[0].coding[0].code[0]39720011000001104
Bundle.entry[1].resource[0].ingredient[1].item[0].coding[0].display[0]Water for injections 20ml ampoules
Bundle.entry[1].resource[0].ingredient[1].strength[0].numerator[0].value[0]1
Bundle.entry[1].resource[0].ingredient[1].strength[0].numerator[0].unit[0]ampoule
Bundle.entry[1].resource[0].ingredient[1].strength[0].numerator[0].system[0]http://snomed.info/sct
Bundle.entry[1].resource[0].ingredient[1].strength[0].numerator[0].code[0]413516001
Bundle.entry[1].resource[0].ingredient[1].strength[0].denominator[0].value[0]1
Bundle.entry[2].fullUrl[0]urn:uuid:34eb3c92-76e6-48c2-9691-aa1f0b58369b
Bundle.entry[2].resource[0].id[0]34eb3c92-76e6-48c2-9691-aa1f0b58369b
Bundle.entry[2].resource[0].meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
Bundle.entry[2].resource[0].medication[0].reference[0]11dc9519-b6e8-41bb-bce5-f6f724b743bc
Bundle.entry[2].resource[0].medication[0].type[0]Medication
Bundle.entry[2].resource[0].subject[0].reference[0]Patient/UKCore-Patient-RichardSmith-Example
Bundle.entry[2].resource[0].reasonCode[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[2].resource[0].reasonCode[0].coding[0].code[0]68566005
Bundle.entry[2].resource[0].reasonCode[0].coding[0].display[0]Urinary tract infection
Bundle.entry[2].resource[0].dosageInstruction[0].text[0]Inject 20 millilitre - over 3-4 minutes - 3 times a day - Intravenous
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].duration[0]3
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].durationMax[0]4
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].durationUnit[0]min
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].frequency[0]3
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].period[0]1
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].periodUnit[0]d
Bundle.entry[2].resource[0].dosageInstruction[0].route[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[2].resource[0].dosageInstruction[0].route[0].coding[0].code[0]47625008
Bundle.entry[2].resource[0].dosageInstruction[0].route[0].coding[0].display[0]Intravenous
Bundle.entry[2].resource[0].dosageInstruction[0].method[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[2].resource[0].dosageInstruction[0].method[0].coding[0].code[0]422145002
Bundle.entry[2].resource[0].dosageInstruction[0].method[0].coding[0].display[0]Inject
Bundle.entry[2].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].value[0]20
Bundle.entry[2].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].unit[0]millilitre
Bundle.entry[2].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].system[0]http://unitsofmeasure.org
Bundle.entry[2].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].code[0]ml
Bundle

Heparin infusion

Heparin medication is a good example of a complex infusion. A typical treatment starts with a single loading dose based on the patient's body weight, followed by a continuous maintenance dose, again based on body weight. The dose, expressed as a number of units per kilogram, would be defined by the Heparin protocol implementation by the Trust.

Two sets of loading dose and maintenance are shown below. The first is where the Trust pharmacy team calculate the actual volume of medication to be infused, based on the units per kilogram calculations.

The second set of examples is where the ward clinicians have performed the calulations and these are recorded on the ePMA system. The FHIR standard allows multiple dosing instructions so the examples include the calculated dose as a volume and as a number of 'units'..

In all cases, the patient's body weight is shared within a referenced Observation resource.

Prescribing Events

Prescribing Event - Loading Dose

<Bundle xmlns="http://hl7.org/fhir">
    <id value="heparin-infusion-request-loading" />
    <type value="message" />
    <entry>
        <fullUrl value="urn:uuid:03791226-ed5d-469c-abb0-0a1c25c74839" />
        <resource>
            <MessageHeader>
                <id value="03791226-ed5d-469c-abb0-0a1c25c74839" />
                <eventCoding>
                    <system value="http://snomed.info/sct" />
                    <code value="33633005" />
                    <display value="Prescription of drug" />
                </eventCoding>
                <source>
                    <endpoint value="https://myendpoint.nhs.uk/" />
                </source>
                <focus>
                    <reference value="2f09481c-a0bb-48aa-b52c-53211984b1bb" />
                    <type value="MedicationRequest" />
                </focus>
            </MessageHeader>
        </resource>
    </entry>
    <entry>
        <fullUrl value="urn:uuid:4a0d9bdc-a583-4390-8983-92e287028b06" />
        <resource>
            <Observation>
                <id value="4a0d9bdc-a583-4390-8983-92e287028b06" />
                <meta>
                    <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Observation" />
                </meta>
                <code>
                    <coding>
                        <system value="http://loinc.org" />
                        <code value="29463-7" />
                        <display value="Body weight" />
                    </coding>
                </code>
                <valueQuantity>
                    <value value="50" />
                    <unit value="kilogram" />
                    <system value="http://unitsofmeasure.org" />
                    <code value="kg" />
                </valueQuantity>
            </Observation>
        </resource>
    </entry>
    <entry>
        <fullUrl value="urn:uuid:2f09481c-a0bb-48aa-b52c-53211984b1bb" />
        <resource>
            <MedicationRequest>
                <id value="2f09481c-a0bb-48aa-b52c-53211984b1bb" />
                <meta>
                    <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
                </meta>
                <medicationCodeableConcept>
                    <coding>
                        <system value="https://dmd.nhs.uk" />
                        <code value="36054511000001107" />
                        <display value="Heparin sodium 20,000units/20ml solution for injection ampoules" />
                    </coding>
                </medicationCodeableConcept>
                <subject>
                    <reference value="Patient/UKCore-Patient-RachelSmith-Example" />
                </subject>
                <supportingInformation>
                    <reference value="Observation/4a0d9bdc-a583-4390-8983-92e287028b06" />
                    <type value="Observation" />
                </supportingInformation>
                <reasonCode>
                    <coding>
                        <system value="http://snomed.info/sct" />
                        <code value="49956009" />
                        <display value="Antenatal deep vein thrombosis" />
                    </coding>
                </reasonCode>
                <dosageInstruction>
                    <text value="Continuous infusion 75 international unit per kilogram - Intravenous - over 5 minutes" />
                    <timing>
                        <repeat>
                            <count value="1" />
                            <duration value="5" />
                            <durationUnit value="min" />
                        </repeat>
                    </timing>
                    <route>
                        <coding>
                            <system value="https://dmd.nhs.uk" />
                            <code value="47625008" />
                            <display value="Intravenous" />
                        </coding>
                    </route>
                    <method>
                        <coding>
                            <system value="http://snomed.info/sct" />
                            <code value="261754007" />
                            <display value="Continuous infusion" />
                        </coding>
                    </method>
                    <doseAndRate>
                        <rateQuantity>
                            <value value="75" />
                            <unit value="international unit per kilogram" />
                            <system value="http://unitsofmeasure.org" />
                            <code value="[iU]/kg" />
                        </rateQuantity>
                    </doseAndRate>
                </dosageInstruction>
            </MedicationRequest>
        </resource>
    </entry>
</Bundle>

{
    "resourceType": "Bundle",
    "type": "message",
    "id": "heparin-infusion-request-loading",
    "entry":  [
        {
            "fullUrl": "urn:uuid:03791226-ed5d-469c-abb0-0a1c25c74839",
            "resource": {
                "resourceType": "MessageHeader",
                "id": "03791226-ed5d-469c-abb0-0a1c25c74839",
                "eventCoding": {
                    "system": "http://snomed.info/sct",
                    "code": "33633005",
                    "display": "Prescription of drug"
                },
                "source": {
                    "endpoint": "https://myendpoint.nhs.uk/"
                },
                "focus":  [
                    {
                        "reference": "2f09481c-a0bb-48aa-b52c-53211984b1bb",
                        "type": "MedicationRequest"
                    }
                ]
            }
        },
        {
            "fullUrl": "urn:uuid:4a0d9bdc-a583-4390-8983-92e287028b06",
            "resource": {
                "resourceType": "Observation",
                "id": "4a0d9bdc-a583-4390-8983-92e287028b06",
                "meta": {
                    "profile":  [
                        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Observation"
                    ]
                },
                "code": {
                    "coding":  [
                        {
                            "system": "http://loinc.org",
                            "code": "29463-7",
                            "display": "Body weight"
                        }
                    ]
                },
                "valueQuantity": {
                    "value": 50,
                    "unit": "kilogram",
                    "system": "http://unitsofmeasure.org",
                    "code": "kg"
                }
            }
        },
        {
            "fullUrl": "urn:uuid:2f09481c-a0bb-48aa-b52c-53211984b1bb",
            "resource": {
                "resourceType": "MedicationRequest",
                "id": "2f09481c-a0bb-48aa-b52c-53211984b1bb",
                "meta": {
                    "profile":  [
                        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
                    ]
                },
                "subject": {
                    "reference": "Patient/UKCore-Patient-RachelSmith-Example"
                },
                "medicationCodeableConcept": {
                    "coding":  [
                        {
                            "system": "https://dmd.nhs.uk",
                            "code": "36054511000001107",
                            "display": "Heparin sodium 20,000units/20ml solution for injection ampoules"
                        }
                    ]
                },
                "reasonCode":  [
                    {
                        "coding":  [
                            {
                                "system": "http://snomed.info/sct",
                                "code": "49956009",
                                "display": "Antenatal deep vein thrombosis"
                            }
                        ]
                    }
                ],
                "supportingInformation":  [
                    {
                        "reference": "Observation/4a0d9bdc-a583-4390-8983-92e287028b06",
                        "type": "Observation"
                    }
                ],
                "dosageInstruction":  [
                    {
                        "text": "Continuous infusion 75 international unit per kilogram - Intravenous - over 5 minutes",
                        "timing": {
                            "repeat": {
                                "duration": 5,
                                "durationUnit": "min",
                                "count": 1
                            }
                        },
                        "method": {
                            "coding":  [
                                {
                                    "system": "http://snomed.info/sct",
                                    "code": "261754007",
                                    "display": "Continuous infusion"
                                }
                            ]
                        },
                        "route": {
                            "coding":  [
                                {
                                    "system": "https://dmd.nhs.uk",
                                    "code": "47625008",
                                    "display": "Intravenous"
                                }
                            ]
                        },
                        "doseAndRate":  [
                            {
                                "rateQuantity": {
                                    "value": 75,
                                    "unit": "international unit per kilogram",
                                    "system": "http://unitsofmeasure.org",
                                    "code": "[iU]/kg"
                                }
                            }
                        ]
                    }
                ]
            }
        }
    ]
}
Bundle.id[0]heparin-infusion-request-loading
Bundle.type[0]message
Bundle.entry[0].fullUrl[0]urn:uuid:03791226-ed5d-469c-abb0-0a1c25c74839
Bundle.entry[0].resource[0].id[0]03791226-ed5d-469c-abb0-0a1c25c74839
Bundle.entry[0].resource[0].event[0].system[0]http://snomed.info/sct
Bundle.entry[0].resource[0].event[0].code[0]33633005
Bundle.entry[0].resource[0].event[0].display[0]Prescription of drug
Bundle.entry[0].resource[0].source[0].endpoint[0]https://myendpoint.nhs.uk/
Bundle.entry[0].resource[0].focus[0].reference[0]2f09481c-a0bb-48aa-b52c-53211984b1bb
Bundle.entry[0].resource[0].focus[0].type[0]MedicationRequest
Bundle.entry[1].fullUrl[0]urn:uuid:4a0d9bdc-a583-4390-8983-92e287028b06
Bundle.entry[1].resource[0].id[0]4a0d9bdc-a583-4390-8983-92e287028b06
Bundle.entry[1].resource[0].meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-Observation
Bundle.entry[1].resource[0].code[0].coding[0].system[0]http://loinc.org
Bundle.entry[1].resource[0].code[0].coding[0].code[0]29463-7
Bundle.entry[1].resource[0].code[0].coding[0].display[0]Body weight
Bundle.entry[1].resource[0].value[0].value[0]50
Bundle.entry[1].resource[0].value[0].unit[0]kilogram
Bundle.entry[1].resource[0].value[0].system[0]http://unitsofmeasure.org
Bundle.entry[1].resource[0].value[0].code[0]kg
Bundle.entry[2].fullUrl[0]urn:uuid:2f09481c-a0bb-48aa-b52c-53211984b1bb
Bundle.entry[2].resource[0].id[0]2f09481c-a0bb-48aa-b52c-53211984b1bb
Bundle.entry[2].resource[0].meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
Bundle.entry[2].resource[0].medication[0].coding[0].system[0]https://dmd.nhs.uk
Bundle.entry[2].resource[0].medication[0].coding[0].code[0]36054511000001107
Bundle.entry[2].resource[0].medication[0].coding[0].display[0]Heparin sodium 20,000units/20ml solution for injection ampoules
Bundle.entry[2].resource[0].subject[0].reference[0]Patient/UKCore-Patient-RachelSmith-Example
Bundle.entry[2].resource[0].supportingInformation[0].reference[0]Observation/4a0d9bdc-a583-4390-8983-92e287028b06
Bundle.entry[2].resource[0].supportingInformation[0].type[0]Observation
Bundle.entry[2].resource[0].reasonCode[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[2].resource[0].reasonCode[0].coding[0].code[0]49956009
Bundle.entry[2].resource[0].reasonCode[0].coding[0].display[0]Antenatal deep vein thrombosis
Bundle.entry[2].resource[0].dosageInstruction[0].text[0]Continuous infusion 75 international unit per kilogram - Intravenous - over 5 minutes
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].count[0]1
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].duration[0]5
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].durationUnit[0]min
Bundle.entry[2].resource[0].dosageInstruction[0].route[0].coding[0].system[0]https://dmd.nhs.uk
Bundle.entry[2].resource[0].dosageInstruction[0].route[0].coding[0].code[0]47625008
Bundle.entry[2].resource[0].dosageInstruction[0].route[0].coding[0].display[0]Intravenous
Bundle.entry[2].resource[0].dosageInstruction[0].method[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[2].resource[0].dosageInstruction[0].method[0].coding[0].code[0]261754007
Bundle.entry[2].resource[0].dosageInstruction[0].method[0].coding[0].display[0]Continuous infusion
Bundle.entry[2].resource[0].dosageInstruction[0].doseAndRate[0].rate[0].value[0]75
Bundle.entry[2].resource[0].dosageInstruction[0].doseAndRate[0].rate[0].unit[0]international unit per kilogram
Bundle.entry[2].resource[0].dosageInstruction[0].doseAndRate[0].rate[0].system[0]http://unitsofmeasure.org
Bundle.entry[2].resource[0].dosageInstruction[0].doseAndRate[0].rate[0].code[0][iU]/kg
Bundle

Prescribing Event - Initial Maintenance Dose

<Bundle xmlns="http://hl7.org/fhir">
    <id value="heparin-infusion-request-maintenance" />
    <type value="message" />
    <entry>
        <fullUrl value="urn:uuid:03791226-ed5d-469c-abb0-0a1c25c74839" />
        <resource>
            <MessageHeader>
                <id value="03791226-ed5d-469c-abb0-0a1c25c74839" />
                <eventCoding>
                    <system value="http://snomed.info/sct" />
                    <code value="33633005" />
                    <display value="Prescription of drug" />
                </eventCoding>
                <source>
                    <endpoint value="https://myendpoint.nhs.uk/" />
                </source>
                <focus>
                    <reference value="2f09481c-a0bb-48aa-b52c-53211984b1bb" />
                    <type value="MedicationRequest" />
                </focus>
            </MessageHeader>
        </resource>
    </entry>
    <entry>
        <fullUrl value="urn:uuid:4a0d9bdc-a583-4390-8983-92e287028b06" />
        <resource>
            <Observation>
                <id value="4a0d9bdc-a583-4390-8983-92e287028b06" />
                <meta>
                    <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Observation" />
                </meta>
                <code>
                    <coding>
                        <system value="http://loinc.org" />
                        <code value="29463-7" />
                        <display value="Body weight" />
                    </coding>
                </code>
                <valueQuantity>
                    <value value="50" />
                    <unit value="kilogram" />
                    <system value="http://unitsofmeasure.org" />
                    <code value="kg" />
                </valueQuantity>
            </Observation>
        </resource>
    </entry>
    <entry>
        <fullUrl value="urn:uuid:203c8dce-aaec-4349-9335-a572ad48c553" />
        <resource>
            <MedicationRequest>
                <id value="203c8dce-aaec-4349-9335-a572ad48c553" />
                <meta>
                    <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
                </meta>
                <medicationCodeableConcept>
                    <coding>
                        <system value="https://dmd.nhs.uk" />
                        <code value="36054511000001107" />
                        <display value="Heparin sodium 20,000units/20ml solution for injection ampoules" />
                    </coding>
                </medicationCodeableConcept>
                <subject>
                    <reference value="Patient/UKCore-Patient-RachelSmith-Example" />
                </subject>
                <supportingInformation>
                    <reference value="Observation/4a0d9bdc-a583-4390-8983-92e287028b06" />
                    <type value="Observation" />
                </supportingInformation>
                <reasonCode>
                    <coding>
                        <system value="http://snomed.info/sct" />
                        <code value="49956009" />
                        <display value="Antenatal deep vein thrombosis" />
                    </coding>
                </reasonCode>
                <dosageInstruction>
                    <text value="Continuous infusion 18 Unit/kilogram/hour - Intravenous" />
                    <route>
                        <coding>
                            <system value="https://dmd.nhs.uk" />
                            <code value="47625008" />
                            <display value="Intravenous" />
                        </coding>
                    </route>
                    <method>
                        <coding>
                            <system value="http://snomed.info/sct" />
                            <code value="261754007" />
                            <display value="Continuous infusion" />
                        </coding>
                    </method>
                    <doseAndRate>
                        <rateQuantity>
                            <value value="18" />
                            <unit value="international unit per kilogram per hour" />
                            <system value="http://unitsofmeasure.org" />
                            <code value="[iU]/kg/h" />
                        </rateQuantity>
                    </doseAndRate>
                </dosageInstruction>
            </MedicationRequest>
        </resource>
    </entry>
</Bundle>

{
    "resourceType": "Bundle",
    "type": "message",
    "id": "heparin-infusion-request-maintenance",
    "entry":  [
        {
            "fullUrl": "urn:uuid:03791226-ed5d-469c-abb0-0a1c25c74839",
            "resource": {
                "resourceType": "MessageHeader",
                "id": "03791226-ed5d-469c-abb0-0a1c25c74839",
                "eventCoding": {
                    "system": "http://snomed.info/sct",
                    "code": "33633005",
                    "display": "Prescription of drug"
                },
                "source": {
                    "endpoint": "https://myendpoint.nhs.uk/"
                },
                "focus":  [
                    {
                        "reference": "2f09481c-a0bb-48aa-b52c-53211984b1bb",
                        "type": "MedicationRequest"
                    }
                ]
            }
        },
        {
            "fullUrl": "urn:uuid:4a0d9bdc-a583-4390-8983-92e287028b06",
            "resource": {
                "resourceType": "Observation",
                "id": "4a0d9bdc-a583-4390-8983-92e287028b06",
                "meta": {
                    "profile":  [
                        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Observation"
                    ]
                },
                "code": {
                    "coding":  [
                        {
                            "system": "http://loinc.org",
                            "code": "29463-7",
                            "display": "Body weight"
                        }
                    ]
                },
                "valueQuantity": {
                    "value": 50,
                    "unit": "kilogram",
                    "system": "http://unitsofmeasure.org",
                    "code": "kg"
                }
            }
        },
        {
            "fullUrl": "urn:uuid:203c8dce-aaec-4349-9335-a572ad48c553",
            "resource": {
                "resourceType": "MedicationRequest",
                "id": "203c8dce-aaec-4349-9335-a572ad48c553",
                "meta": {
                    "profile":  [
                        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
                    ]
                },
                "subject": {
                    "reference": "Patient/UKCore-Patient-RachelSmith-Example"
                },
                "medicationCodeableConcept": {
                    "coding":  [
                        {
                            "system": "https://dmd.nhs.uk",
                            "code": "36054511000001107",
                            "display": "Heparin sodium 20,000units/20ml solution for injection ampoules"
                        }
                    ]
                },
                "reasonCode":  [
                    {
                        "coding":  [
                            {
                                "system": "http://snomed.info/sct",
                                "code": "49956009",
                                "display": "Antenatal deep vein thrombosis"
                            }
                        ]
                    }
                ],
                "supportingInformation":  [
                    {
                        "reference": "Observation/4a0d9bdc-a583-4390-8983-92e287028b06",
                        "type": "Observation"
                    }
                ],
                "dosageInstruction":  [
                    {
                        "text": "Continuous infusion 18 Unit/kilogram/hour - Intravenous",
                        "method": {
                            "coding":  [
                                {
                                    "system": "http://snomed.info/sct",
                                    "code": "261754007",
                                    "display": "Continuous infusion"
                                }
                            ]
                        },
                        "route": {
                            "coding":  [
                                {
                                    "system": "https://dmd.nhs.uk",
                                    "code": "47625008",
                                    "display": "Intravenous"
                                }
                            ]
                        },
                        "doseAndRate":  [
                            {
                                "rateQuantity": {
                                    "value": 18,
                                    "unit": "international unit per kilogram per hour",
                                    "system": "http://unitsofmeasure.org",
                                    "code": "[iU]/kg/h"
                                }
                            }
                        ]
                    }
                ]
            }
        }
    ]
}
Bundle.id[0]heparin-infusion-request-maintenance
Bundle.type[0]message
Bundle.entry[0].fullUrl[0]urn:uuid:03791226-ed5d-469c-abb0-0a1c25c74839
Bundle.entry[0].resource[0].id[0]03791226-ed5d-469c-abb0-0a1c25c74839
Bundle.entry[0].resource[0].event[0].system[0]http://snomed.info/sct
Bundle.entry[0].resource[0].event[0].code[0]33633005
Bundle.entry[0].resource[0].event[0].display[0]Prescription of drug
Bundle.entry[0].resource[0].source[0].endpoint[0]https://myendpoint.nhs.uk/
Bundle.entry[0].resource[0].focus[0].reference[0]2f09481c-a0bb-48aa-b52c-53211984b1bb
Bundle.entry[0].resource[0].focus[0].type[0]MedicationRequest
Bundle.entry[1].fullUrl[0]urn:uuid:4a0d9bdc-a583-4390-8983-92e287028b06
Bundle.entry[1].resource[0].id[0]4a0d9bdc-a583-4390-8983-92e287028b06
Bundle.entry[1].resource[0].meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-Observation
Bundle.entry[1].resource[0].code[0].coding[0].system[0]http://loinc.org
Bundle.entry[1].resource[0].code[0].coding[0].code[0]29463-7
Bundle.entry[1].resource[0].code[0].coding[0].display[0]Body weight
Bundle.entry[1].resource[0].value[0].value[0]50
Bundle.entry[1].resource[0].value[0].unit[0]kilogram
Bundle.entry[1].resource[0].value[0].system[0]http://unitsofmeasure.org
Bundle.entry[1].resource[0].value[0].code[0]kg
Bundle.entry[2].fullUrl[0]urn:uuid:203c8dce-aaec-4349-9335-a572ad48c553
Bundle.entry[2].resource[0].id[0]203c8dce-aaec-4349-9335-a572ad48c553
Bundle.entry[2].resource[0].meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
Bundle.entry[2].resource[0].medication[0].coding[0].system[0]https://dmd.nhs.uk
Bundle.entry[2].resource[0].medication[0].coding[0].code[0]36054511000001107
Bundle.entry[2].resource[0].medication[0].coding[0].display[0]Heparin sodium 20,000units/20ml solution for injection ampoules
Bundle.entry[2].resource[0].subject[0].reference[0]Patient/UKCore-Patient-RachelSmith-Example
Bundle.entry[2].resource[0].supportingInformation[0].reference[0]Observation/4a0d9bdc-a583-4390-8983-92e287028b06
Bundle.entry[2].resource[0].supportingInformation[0].type[0]Observation
Bundle.entry[2].resource[0].reasonCode[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[2].resource[0].reasonCode[0].coding[0].code[0]49956009
Bundle.entry[2].resource[0].reasonCode[0].coding[0].display[0]Antenatal deep vein thrombosis
Bundle.entry[2].resource[0].dosageInstruction[0].text[0]Continuous infusion 18 Unit/kilogram/hour - Intravenous
Bundle.entry[2].resource[0].dosageInstruction[0].route[0].coding[0].system[0]https://dmd.nhs.uk
Bundle.entry[2].resource[0].dosageInstruction[0].route[0].coding[0].code[0]47625008
Bundle.entry[2].resource[0].dosageInstruction[0].route[0].coding[0].display[0]Intravenous
Bundle.entry[2].resource[0].dosageInstruction[0].method[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[2].resource[0].dosageInstruction[0].method[0].coding[0].code[0]261754007
Bundle.entry[2].resource[0].dosageInstruction[0].method[0].coding[0].display[0]Continuous infusion
Bundle.entry[2].resource[0].dosageInstruction[0].doseAndRate[0].rate[0].value[0]18
Bundle.entry[2].resource[0].dosageInstruction[0].doseAndRate[0].rate[0].unit[0]international unit per kilogram per hour
Bundle.entry[2].resource[0].dosageInstruction[0].doseAndRate[0].rate[0].system[0]http://unitsofmeasure.org
Bundle.entry[2].resource[0].dosageInstruction[0].doseAndRate[0].rate[0].code[0][iU]/kg/h
Bundle

Note the unit of measure used in the above example is a UCUM unit of international unit per kilogram per hour. This could also be expressed as a rateRatio. Consumers systems need to be able to handle either type of dosing rate expression.

<doseAndRate>
	<rateRatio>
		<numerator>
			<value value="18" />
			<unit value="international unit per kilogram" />
			<system value="http://unitsofmeasure.org" />
			<code value="[iU]/kg" />
		</numerator>
		<denominator>
			<value value="1" />
			<unit value="hour" />
			<system value="http://unitsofmeasure.org" />
			<code value="h" />
		</denominator>
	</rateQuantity>
</doseAndRate>

Prescribing Event - Loading Dose (Calculated)

Calculation:
75 units per kilogram x 50 Kg = 3,750 units
20,000 units in 20 mL
Total volume to infuse = 3.75 mL

<MedicationRequest xmlns="http://hl7.org/fhir">
    <id value="203c8dce-aaec-4349-9335-a572ad48c553" />
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
    </meta>
    <medicationCodeableConcept>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="36054511000001107" />
            <display value="Heparin sodium 20,000units/20ml solution for injection ampoules" />
        </coding>
    </medicationCodeableConcept>
    <subject>
        <reference value="Patient/UKCore-Patient-RachelSmith-Example" />
    </subject>
    <supportingInformation>
        <reference value="Observation/UKCore-Patient-RachelSmith-Weight-Example" />
        <type value="Observation" />
    </supportingInformation>
    <reasonCode>
        <coding>
            <system value="http://snomed.info/sct" />
            <code value="49956009" />
            <display value="Antenatal deep vein thrombosis" />
        </coding>
    </reasonCode>
    <dosageInstruction>
        <text value="Continuous infusion 3.75 millilitre - Intravenous - over 5 minutes" />
        <timing>
            <repeat>
                <count value="1" />
                <duration value="5" />
                <durationUnit value="min" />
            </repeat>
        </timing>
        <route>
            <coding>
                <system value="https://dmd.nhs.uk" />
                <code value="47625008" />
                <display value="Intravenous" />
            </coding>
        </route>
        <method>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="261754007" />
                <display value="Continuous infusion" />
            </coding>
        </method>
        <doseAndRate>
            <doseQuantity>
                <value value="3.75" />
                <unit value="millilitre" />
                <system value="http://unitsofmeasure.org" />
                <code value="mL" />
            </doseQuantity>
        </doseAndRate>
        <doseAndRate>
            <doseQuantity>
                <value value="3750" />
                <unit value="International Unit" />
                <system value="http://unitsofmeasure.org" />
                <code value="[IU]" />
            </doseQuantity>
        </doseAndRate>
    </dosageInstruction>
</MedicationRequest>

{
    "resourceType": "MedicationRequest",
    "id": "203c8dce-aaec-4349-9335-a572ad48c553",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
        ]
    },
    "subject": {
        "reference": "Patient/UKCore-Patient-RachelSmith-Example"
    },
    "medicationCodeableConcept": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "36054511000001107",
                "display": "Heparin sodium 20,000units/20ml solution for injection ampoules"
            }
        ]
    },
    "reasonCode":  [
        {
            "coding":  [
                {
                    "system": "http://snomed.info/sct",
                    "code": "49956009",
                    "display": "Antenatal deep vein thrombosis"
                }
            ]
        }
    ],
    "supportingInformation":  [
        {
            "reference": "Observation/UKCore-Patient-RachelSmith-Weight-Example",
            "type": "Observation"
        }
    ],
    "dosageInstruction":  [
        {
            "text": "Continuous infusion 3.75 millilitre - Intravenous - over 5 minutes",
            "timing": {
                "repeat": {
                    "duration": 5,
                    "durationUnit": "min",
                    "count": 1
                }
            },
            "method": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "261754007",
                        "display": "Continuous infusion"
                    }
                ]
            },
            "route": {
                "coding":  [
                    {
                        "system": "https://dmd.nhs.uk",
                        "code": "47625008",
                        "display": "Intravenous"
                    }
                ]
            },
            "doseAndRate":  [
                {
                    "doseQuantity": {
                        "value": 3.75,
                        "unit": "millilitre",
                        "system": "http://unitsofmeasure.org",
                        "code": "mL"
                    }
                },
                {
                    "doseQuantity": {
                        "value": 3750,
                        "unit": "International Unit",
                        "system": "http://unitsofmeasure.org",
                        "code": "[IU]"
                    }
                }
            ]
        }
    ]
}
MedicationRequest.id[0]203c8dce-aaec-4349-9335-a572ad48c553
MedicationRequest.meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
MedicationRequest.medication[0].coding[0].system[0]https://dmd.nhs.uk
MedicationRequest.medication[0].coding[0].code[0]36054511000001107
MedicationRequest.medication[0].coding[0].display[0]Heparin sodium 20,000units/20ml solution for injection ampoules
MedicationRequest.subject[0].reference[0]Patient/UKCore-Patient-RachelSmith-Example
MedicationRequest.supportingInformation[0].reference[0]Observation/UKCore-Patient-RachelSmith-Weight-Example
MedicationRequest.supportingInformation[0].type[0]Observation
MedicationRequest.reasonCode[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.reasonCode[0].coding[0].code[0]49956009
MedicationRequest.reasonCode[0].coding[0].display[0]Antenatal deep vein thrombosis
MedicationRequest.dosageInstruction[0].text[0]Continuous infusion 3.75 millilitre - Intravenous - over 5 minutes
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].count[0]1
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].duration[0]5
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].durationUnit[0]min
MedicationRequest.dosageInstruction[0].route[0].coding[0].system[0]https://dmd.nhs.uk
MedicationRequest.dosageInstruction[0].route[0].coding[0].code[0]47625008
MedicationRequest.dosageInstruction[0].route[0].coding[0].display[0]Intravenous
MedicationRequest.dosageInstruction[0].method[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].method[0].coding[0].code[0]261754007
MedicationRequest.dosageInstruction[0].method[0].coding[0].display[0]Continuous infusion
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].value[0]3.75
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].unit[0]millilitre
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].code[0]mL
MedicationRequest.dosageInstruction[0].doseAndRate[1].dose[0].value[0]3750
MedicationRequest.dosageInstruction[0].doseAndRate[1].dose[0].unit[0]International Unit
MedicationRequest.dosageInstruction[0].doseAndRate[1].dose[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[0].doseAndRate[1].dose[0].code[0][IU]
MedicationRequest

Prescribing Event - Initial Maintenance Dose (Calculated)

Calculation:
18 units per kilogram x 50 Kg = 900 units
20,000 units in 20 mL
Total volume to infuse = 0.9 mL

<MedicationRequest xmlns="http://hl7.org/fhir">
    <id value="heparin-infusion-request-maintenance-calculateddose" />
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
    </meta>
    <medicationCodeableConcept>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="36054511000001107" />
            <display value="Heparin sodium 20,000units/20ml solution for injection ampoules" />
        </coding>
    </medicationCodeableConcept>
    <subject>
        <reference value="Patient/UKCore-Patient-RachelSmith-Example" />
    </subject>
    <supportingInformation>
        <reference value="Observation/UKCore-Patient-RachelSmith-Weight-Example" />
        <type value="Observation" />
    </supportingInformation>
    <reasonCode>
        <coding>
            <system value="http://snomed.info/sct" />
            <code value="49956009" />
            <display value="Antenatal deep vein thrombosis" />
        </coding>
    </reasonCode>
    <dosageInstruction>
        <text value="Continuous infusion 0.9 millilitre per hour - Intravenous" />
        <route>
            <coding>
                <system value="https://dmd.nhs.uk" />
                <code value="47625008" />
                <display value="Intravenous" />
            </coding>
        </route>
        <method>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="261754007" />
                <display value="Continuous infusion" />
            </coding>
        </method>
        <doseAndRate>
            <rateQuantity>
                <value value="0.9" />
                <unit value="millilitre per hour" />
                <system value="http://snomed.info/sct" />
                <code value="mL/h" />
            </rateQuantity>
        </doseAndRate>
    </dosageInstruction>
    <priorPrescription>
        <reference value="MedicationRequest/203c8dce-aaec-4349-9335-a572ad48c553" />
        <type value="MedicationRequest" />
    </priorPrescription>
</MedicationRequest>

{
    "resourceType": "MedicationRequest",
    "id": "heparin-infusion-request-maintenance-calculateddose",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
        ]
    },
    "subject": {
        "reference": "Patient/UKCore-Patient-RachelSmith-Example"
    },
    "medicationCodeableConcept": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "36054511000001107",
                "display": "Heparin sodium 20,000units/20ml solution for injection ampoules"
            }
        ]
    },
    "reasonCode":  [
        {
            "coding":  [
                {
                    "system": "http://snomed.info/sct",
                    "code": "49956009",
                    "display": "Antenatal deep vein thrombosis"
                }
            ]
        }
    ],
    "supportingInformation":  [
        {
            "reference": "Observation/UKCore-Patient-RachelSmith-Weight-Example",
            "type": "Observation"
        }
    ],
    "priorPrescription":  [
        {
            "reference": "MedicationRequest/203c8dce-aaec-4349-9335-a572ad48c553",
            "type": "MedicationRequest"
        }
    ],
    "dosageInstruction":  [
        {
            "text": "Continuous infusion 0.9 millilitre per hour - Intravenous",
            "method": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "261754007",
                        "display": "Continuous infusion"
                    }
                ]
            },
            "route": {
                "coding":  [
                    {
                        "system": "https://dmd.nhs.uk",
                        "code": "47625008",
                        "display": "Intravenous"
                    }
                ]
            },
            "doseAndRate":  [
                {
                    "rateQuantity": {
                        "value": 0.9,
                        "unit": "millilitre per hour",
                        "system": "http://snomed.info/sct",
                        "code": "mL/h"
                    }
                }
            ]
        }
    ]
}
MedicationRequest.id[0]heparin-infusion-request-maintenance-calculateddose
MedicationRequest.meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
MedicationRequest.medication[0].coding[0].system[0]https://dmd.nhs.uk
MedicationRequest.medication[0].coding[0].code[0]36054511000001107
MedicationRequest.medication[0].coding[0].display[0]Heparin sodium 20,000units/20ml solution for injection ampoules
MedicationRequest.subject[0].reference[0]Patient/UKCore-Patient-RachelSmith-Example
MedicationRequest.supportingInformation[0].reference[0]Observation/UKCore-Patient-RachelSmith-Weight-Example
MedicationRequest.supportingInformation[0].type[0]Observation
MedicationRequest.reasonCode[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.reasonCode[0].coding[0].code[0]49956009
MedicationRequest.reasonCode[0].coding[0].display[0]Antenatal deep vein thrombosis
MedicationRequest.dosageInstruction[0].text[0]Continuous infusion 0.9 millilitre per hour - Intravenous
MedicationRequest.dosageInstruction[0].route[0].coding[0].system[0]https://dmd.nhs.uk
MedicationRequest.dosageInstruction[0].route[0].coding[0].code[0]47625008
MedicationRequest.dosageInstruction[0].route[0].coding[0].display[0]Intravenous
MedicationRequest.dosageInstruction[0].method[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].method[0].coding[0].code[0]261754007
MedicationRequest.dosageInstruction[0].method[0].coding[0].display[0]Continuous infusion
MedicationRequest.dosageInstruction[0].doseAndRate[0].rate[0].value[0]0.9
MedicationRequest.dosageInstruction[0].doseAndRate[0].rate[0].unit[0]millilitre per hour
MedicationRequest.dosageInstruction[0].doseAndRate[0].rate[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].doseAndRate[0].rate[0].code[0]mL/h
MedicationRequest

Typical treatment using Heparin then involves regular blood tests and the maintenance dose to be adjusted as required. Some Trust protocols may require each adjusted dose to be recorded as a new prescription, authorised by a prescriber. This may or may not result in additional MedicationRequest resources being shared with the Trust pharmacy system.

Other Trust protocols may leave this to the ward team to make changes as per the protocol (without a further prescription) and the changes in rate to be noted in the medication record as a MedicationAdministration event.

Administration Events

Where there is a need to share the administration record of this patient's Heparin medication, a series of MedicationAdministration resources could be generated from the ePMA patient record.

Here we have an example based on the above, but with a series of adjusted doses.

example-heparin-admin-record

Three data attributes would differ for each MedicationAdministration resource. The effectiveDateTime and rateQuantity, plus the reference to the MedicationRequest within request.

Administration effectiveDateTime rateQuantity
Loading dose 2021-03-25T09:00:00+00:00 3.75 mL
Initial maintenance dose 2021-03-25T09:05:00+00:00 0.9 mL/h
Adjusted maintenance dose 2021-03-25T15:05:00+00:00 1 mL/h
Adjusted maintenance dose 2021-03-25T21:05:00+00:00 0.8 mL/h
Administration paused for 1 hour 2021-03-26T16:30:00+00:00 Zero administration
Adjusted maintenance dose 2021-03-26T17:30:00+00:00 0.8 mL/h

The complete MedicationAdministration resource for the first maintenance dose would be as follows;

<MedicationAdministration xmlns="http://hl7.org/fhir">
    <id value="1d7ba0c5-5b05-475d-8aa8-14e2f17b9527" />
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationAdministration" />
    </meta>
    <status value="completed" />
    <medicationCodeableConcept>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="36054511000001107" />
            <display value="Heparin sodium 20,000units/20ml solution for injection ampoules" />
        </coding>
    </medicationCodeableConcept>
    <subject>
        <reference value="Patient/UKCore-Patient-RachelSmith-Example" />
    </subject>
    <effectivePeriod>
        <start value="2021-03-25T09:05:00+00:00" />
        <end value="2021-03-25T15:05:00+00:00" />
    </effectivePeriod>
    <request>
        <reference value="MedicationRequest/203c8dce-aaec-4349-9335-a572ad48c553" />
    </request>
    <dosage>
        <route>
            <coding>
                <system value="https://dmd.nhs.uk" />
                <code value="47625008" />
                <display value="Intravenous" />
            </coding>
        </route>
        <method>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="261754007" />
                <display value="Continuous infusion" />
            </coding>
        </method>
        <rateQuantity>
            <value value="0.9" />
            <unit value="millilitre per hour" />
            <system value="http://unitsofmeasure.org" />
            <code value="mL/h" />
        </rateQuantity>
    </dosage>
</MedicationAdministration>

{
    "resourceType": "MedicationAdministration",
    "id": "1d7ba0c5-5b05-475d-8aa8-14e2f17b9527",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationAdministration"
        ]
    },
    "status": "completed",
    "medicationCodeableConcept": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "36054511000001107",
                "display": "Heparin sodium 20,000units/20ml solution for injection ampoules"
            }
        ]
    },
    "subject": {
        "reference": "Patient/UKCore-Patient-RachelSmith-Example"
    },
    "effectivePeriod": {
        "start": "2021-03-25T09:05:00+00:00",
        "end": "2021-03-25T15:05:00+00:00"
    },
    "request": {
        "reference": "MedicationRequest/203c8dce-aaec-4349-9335-a572ad48c553"
    },
    "dosage": {
        "method": {
            "coding":  [
                {
                    "system": "http://snomed.info/sct",
                    "code": "261754007",
                    "display": "Continuous infusion"
                }
            ]
        },
        "route": {
            "coding":  [
                {
                    "system": "https://dmd.nhs.uk",
                    "code": "47625008",
                    "display": "Intravenous"
                }
            ]
        },
        "rateQuantity": {
            "value": 0.9,
            "unit": "millilitre per hour",
            "system": "http://unitsofmeasure.org",
            "code": "mL/h"
        }
    }
}
MedicationAdministration.id[0]1d7ba0c5-5b05-475d-8aa8-14e2f17b9527
MedicationAdministration.meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationAdministration
MedicationAdministration.status[0]completed
MedicationAdministration.medication[0].coding[0].system[0]https://dmd.nhs.uk
MedicationAdministration.medication[0].coding[0].code[0]36054511000001107
MedicationAdministration.medication[0].coding[0].display[0]Heparin sodium 20,000units/20ml solution for injection ampoules
MedicationAdministration.subject[0].reference[0]Patient/UKCore-Patient-RachelSmith-Example
MedicationAdministration.effective[0].start[0]2021-03-25T09:05:00+00:00
MedicationAdministration.effective[0].end[0]2021-03-25T15:05:00+00:00
MedicationAdministration.request[0].reference[0]MedicationRequest/203c8dce-aaec-4349-9335-a572ad48c553
MedicationAdministration.dosage[0].route[0].coding[0].system[0]https://dmd.nhs.uk
MedicationAdministration.dosage[0].route[0].coding[0].code[0]47625008
MedicationAdministration.dosage[0].route[0].coding[0].display[0]Intravenous
MedicationAdministration.dosage[0].method[0].coding[0].system[0]http://snomed.info/sct
MedicationAdministration.dosage[0].method[0].coding[0].code[0]261754007
MedicationAdministration.dosage[0].method[0].coding[0].display[0]Continuous infusion
MedicationAdministration.dosage[0].rate[0].value[0]0.9
MedicationAdministration.dosage[0].rate[0].unit[0]millilitre per hour
MedicationAdministration.dosage[0].rate[0].system[0]http://unitsofmeasure.org
MedicationAdministration.dosage[0].rate[0].code[0]mL/h
MedicationAdministration

The complete MedicationAdministration resource for the period of zero administration would be as follows;

<MedicationAdministration xmlns="http://hl7.org/fhir">
    <id value="f8fced11-53c3-47c3-92a8-ff49dc1b0e0b" />
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationAdministration" />
    </meta>
    <status value="on-hold" />
    <medicationCodeableConcept>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="36054511000001107" />
            <display value="Heparin sodium 20,000units/20ml solution for injection ampoules" />
        </coding>
    </medicationCodeableConcept>
    <subject>
        <reference value="Patient/UKCore-Patient-RachelSmith-Example" />
    </subject>
    <effectivePeriod>
        <start value="2021-03-26T16:30:00+00:00" />
        <end value="2021-03-26T17:30:00+00:00" />
    </effectivePeriod>
    <request>
        <reference value="MedicationRequest/203c8dce-aaec-4349-9335-a572ad48c553" />
    </request>
    <dosage>
        <route>
            <coding>
                <system value="https://dmd.nhs.uk" />
                <code value="47625008" />
                <display value="Intravenous" />
            </coding>
        </route>
        <method>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="261754007" />
                <display value="Continuous infusion" />
            </coding>
        </method>
        <rateQuantity>
            <value value="0" />
            <unit value="millilitre per hour" />
            <system value="http://unitsofmeasure.org" />
            <code value="mL/h" />
        </rateQuantity>
    </dosage>
</MedicationAdministration>

{
    "resourceType": "MedicationAdministration",
    "id": "f8fced11-53c3-47c3-92a8-ff49dc1b0e0b",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationAdministration"
        ]
    },
    "status": "on-hold",
    "medicationCodeableConcept": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "36054511000001107",
                "display": "Heparin sodium 20,000units/20ml solution for injection ampoules"
            }
        ]
    },
    "subject": {
        "reference": "Patient/UKCore-Patient-RachelSmith-Example"
    },
    "effectivePeriod": {
        "start": "2021-03-26T16:30:00+00:00",
        "end": "2021-03-26T17:30:00+00:00"
    },
    "request": {
        "reference": "MedicationRequest/203c8dce-aaec-4349-9335-a572ad48c553"
    },
    "dosage": {
        "method": {
            "coding":  [
                {
                    "system": "http://snomed.info/sct",
                    "code": "261754007",
                    "display": "Continuous infusion"
                }
            ]
        },
        "route": {
            "coding":  [
                {
                    "system": "https://dmd.nhs.uk",
                    "code": "47625008",
                    "display": "Intravenous"
                }
            ]
        },
        "rateQuantity": {
            "value": 0,
            "unit": "millilitre per hour",
            "system": "http://unitsofmeasure.org",
            "code": "mL/h"
        }
    }
}
MedicationAdministration.id[0]f8fced11-53c3-47c3-92a8-ff49dc1b0e0b
MedicationAdministration.meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationAdministration
MedicationAdministration.status[0]on-hold
MedicationAdministration.medication[0].coding[0].system[0]https://dmd.nhs.uk
MedicationAdministration.medication[0].coding[0].code[0]36054511000001107
MedicationAdministration.medication[0].coding[0].display[0]Heparin sodium 20,000units/20ml solution for injection ampoules
MedicationAdministration.subject[0].reference[0]Patient/UKCore-Patient-RachelSmith-Example
MedicationAdministration.effective[0].start[0]2021-03-26T16:30:00+00:00
MedicationAdministration.effective[0].end[0]2021-03-26T17:30:00+00:00
MedicationAdministration.request[0].reference[0]MedicationRequest/203c8dce-aaec-4349-9335-a572ad48c553
MedicationAdministration.dosage[0].route[0].coding[0].system[0]https://dmd.nhs.uk
MedicationAdministration.dosage[0].route[0].coding[0].code[0]47625008
MedicationAdministration.dosage[0].route[0].coding[0].display[0]Intravenous
MedicationAdministration.dosage[0].method[0].coding[0].system[0]http://snomed.info/sct
MedicationAdministration.dosage[0].method[0].coding[0].code[0]261754007
MedicationAdministration.dosage[0].method[0].coding[0].display[0]Continuous infusion
MedicationAdministration.dosage[0].rate[0].value[0]0
MedicationAdministration.dosage[0].rate[0].unit[0]millilitre per hour
MedicationAdministration.dosage[0].rate[0].system[0]http://unitsofmeasure.org
MedicationAdministration.dosage[0].rate[0].code[0]mL/h
MedicationAdministration
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