Implementation guide for interoperable medicines

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

type : message

id : heparin-infusion-request-loading

entry

fullUrl : urn:uuid:03791226-ed5d-469c-abb0-0a1c25c74839

resource

id : 03791226-ed5d-469c-abb0-0a1c25c74839

event

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

entry

fullUrl : urn:uuid:4a0d9bdc-a583-4390-8983-92e287028b06

resource

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

value

value : 50

unit : kilogram

system : http://unitsofmeasure.org

code : kg

entry

fullUrl : urn:uuid:2f09481c-a0bb-48aa-b52c-53211984b1bb

resource

id : 2f09481c-a0bb-48aa-b52c-53211984b1bb

meta

profile : https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest

subject

reference : Patient/UKCore-Patient-RachelSmith-Example

medication

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

rate

value : 75

unit : international unit per kilogram

system : http://unitsofmeasure.org

code : [iU]/kg

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

type : message

id : heparin-infusion-request-maintenance

entry

fullUrl : urn:uuid:03791226-ed5d-469c-abb0-0a1c25c74839

resource

id : 03791226-ed5d-469c-abb0-0a1c25c74839

event

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

entry

fullUrl : urn:uuid:4a0d9bdc-a583-4390-8983-92e287028b06

resource

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

value

value : 50

unit : kilogram

system : http://unitsofmeasure.org

code : kg

entry

fullUrl : urn:uuid:203c8dce-aaec-4349-9335-a572ad48c553

resource

id : 203c8dce-aaec-4349-9335-a572ad48c553

meta

profile : https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest

subject

reference : Patient/UKCore-Patient-RachelSmith-Example

medication

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

rate

value : 18

unit : international unit per kilogram per hour

system : http://unitsofmeasure.org

code : [iU]/kg/h

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

id : 203c8dce-aaec-4349-9335-a572ad48c553

meta

profile : https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest

subject

reference : Patient/UKCore-Patient-RachelSmith-Example

medication

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

dose

value : 3.75

unit : millilitre

system : http://unitsofmeasure.org

code : mL

doseAndRate

dose

value : 3750

unit : International Unit

system : http://unitsofmeasure.org

code : [IU]

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

id : heparin-infusion-request-maintenance-calculateddose

meta

profile : https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest

subject

reference : Patient/UKCore-Patient-RachelSmith-Example

medication

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

rate

value : 0.9

unit : millilitre per hour

system : http://snomed.info/sct

code : mL/h

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.

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

id : 1d7ba0c5-5b05-475d-8aa8-14e2f17b9527

meta

profile : https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationAdministration

status : completed

medication

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

effective

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

rate

value : 0.9

unit : millilitre per hour

system : http://unitsofmeasure.org

code : mL/h

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

id : f8fced11-53c3-47c3-92a8-ff49dc1b0e0b

meta

profile : https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationAdministration

status : on-hold

medication

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

effective

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

rate

value : 0

unit : millilitre per hour

system : http://unitsofmeasure.org

code : mL/h