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.

Use Case: Supply of Medication using ADCs

This section is currently in DRAFT as is a topic under discussion with the Digital Medicines Community of Interest group.

An automated dispensing cabinet (ADC) is a secure, computer-controlled storage unit used in hospitals and healthcare settings to store, track, and dispense medications at the point of care.

The draft diagram below shows where we see ADCs fitting in with other relevant Trust systems for medicines interoperability.

draft-inpatient-meds-diagram

Use Case: Set-up / Configuration of patient mediciations within the ADC

Sending the ADC details of a patient's current medication. An ADC will typically categorise medication as one of three types; routine, PRN/As Required and STAT (take once, immediately). The display console on an ADC will typically group a patient's medication into these three categories.

Any new, changed or stopped medication recorded within the EPMA system will trigger this interaction to be resent to the ADC.

The FHIR MedicationStatement resource could be used for this use case. This can share the medication and dosage. However the business data is more aligned with the FHIR MedicationRequest resource for the following reasons.

  • STAT doses can be identified using MedicationRequest.priority = stat. If using a MedicationStatement the identification of a STAT dose could be identified in two ways. The first is via date logic; if the date/time expressed within the dosage is before or close to the current time. The second is by adding stat to the dosage.timing.code value set, but note the HL7 community removed stat from the equivilant HL7v2 value set for the FHIR standard.
  • Sometimes an ADC is instructed with a quantity of medication to dispense, e.g. "28 tablets". The MedicationStatement does not directly support this so would need to be extended.
  • The element intent provides a logical separation between the use of the MedicationRequest resource for configuration / set-up (intent=plan) and for orders (intent=order). The FHIR standard states the intent element is labeled as a modifier because the intent alters when and how the resource is applicable.

Use Case: Order for "Click and Collect" medication from the ADC

A user-initiated order for "Click and Collect" medication using the FHIR MedicationRequest resource. Typically an ADC will assign the medication for the requesting clinical user, i.e. when the user next accesses the ADC the order will be visible on the ADC console.

OUT OF SCOPE Use Cases

The following integration use cases with an ADC are out of scope for this version of this guidance.

  • Set-up / Configuration of patient clinical and demographic within the ADC
  • Medication refill request to the pharmacy stock control system
  • Using ADCs to support virtual wards
  • Integration with automated dispensing trolleys
  • Self-Administration
  • One-Stop Supply

Self-Administration

Instructions that a patient will be self-administrating medication is out of scope. This a separate workflow characteristic describing who administers the medicine, i.e. the patient themselves. It does not on its own define a separate ADC set-up request. The medicine may be supplied in unit doses or whole packs. There is no need to flag or indicate self-administration to the ADC. The EMPA system would indicate to the clinical user that the medication is for patient self-administration.

One-Stop Supply

One-stop supply is the provision of an original or whole pack to a patient during their admission, for use while admitted and continuation after discharge. It aims to reduce the need to dispense again at discharge. Some EPMA systems have a one-stop flag. Today, ADCs do not display a one-stop indicator but could do in the future. Using One-stop is a decision at the point of admission so applicable to ADC set-up. Typically, one-stop medication will be dispensed by pharmacy, not the ADC, therefore one-stop does not need to be a flag or indicator within the interactions with an ADC.

Guidance for use of FHIR MedicationRequest resource

Implementation guidance for the use of the UKCore MedicationRequest resource for the use cases of patient set-up / configuration and discharge/TTO medication. Note that none of the UKCore extensions are applicable to these use cases so this guidance is compatible with the international base version of this resource.

idΣ0..1id
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
medicationRepeatInformationC0..1Extension(Complex)
modifierExtension?! C0..*Extension
identifierS0..*Identifier
statusS Σ ?!1..1codeBinding
statusReason0..1CodeableConcept
intentS Σ ?!1..1codeBinding
categoryS0..*CodeableConceptBinding
priorityΣ0..1codeBinding
doNotPerformΣ ?!0..1boolean
reportedBooleanboolean
reportedReferenceReference(Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)
medicationCodeableConceptCodeableConcept
medicationReferenceReference(Medication)
subjectS Σ C1..1Reference(Group | Patient)
encounterC0..1Reference(Encounter)
supportingInformationC0..*Reference(Resource)
authoredOnS Σ0..1dateTime
requesterS Σ C0..1Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)
performerC0..1Reference(CareTeam | Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)
performerTypeΣ0..1CodeableConcept
recorderC0..1Reference(Practitioner | PractitionerRole)
reasonCode0..*CodeableConcept
reasonReferenceC0..*Reference(Condition | Observation)
instantiatesCanonicalΣ0..*canonical
instantiatesUriΣ0..*uri
basedOnΣ C0..*Reference(CarePlan | ImmunizationRecommendation | MedicationRequest | ServiceRequest)
groupIdentifierΣ0..1Identifier
courseOfTherapyType0..1CodeableConceptBinding
insuranceC0..*Reference(ClaimResponse | Coverage)
note0..*Annotation
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
sequenceΣ0..1integer
textS Σ0..1string
additionalInstructionΣ0..*CodeableConcept
patientInstructionΣ0..1string
timingS Σ0..1Timing
asNeededBooleanboolean
asNeededCodeableConceptCodeableConcept
siteΣ0..1CodeableConceptBinding
routeΣ0..1CodeableConceptBinding
methodΣ0..1CodeableConceptBinding
id0..1string
extensionC0..*Extension
typeΣ0..1CodeableConcept
doseQuantitySimpleQuantity
doseRangeRange
rateQuantitySimpleQuantity
rateRangeRange
rateRatioRatio
maxDosePerPeriodΣ C0..1Ratio
maxDosePerAdministrationΣ C0..1SimpleQuantity
maxDosePerLifetimeΣ C0..1SimpleQuantity
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
quantityC0..1SimpleQuantity
durationC0..1Duration
dispenseIntervalC0..1Duration
validityPeriodC0..1Period
numberOfRepeatsAllowed0..1unsignedInt
quantityS C0..1SimpleQuantity
expectedSupplyDurationC0..1Duration
performerC0..1Reference(Organization)
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
allowedBooleanboolean
allowedCodeableConceptCodeableConcept
reason0..1CodeableConcept
priorPrescriptionC0..1Reference(MedicationRequest)
detectedIssueC0..*Reference(DetectedIssue)
eventHistoryC0..*Reference(Provenance)

Use of NHS dm+d

For both use cases the medication will be expressed using the NHS dm+d. ADCs do not like to work with VTMs due to variable drug formulations but it is not impossible. Where a VTM is used a typical ADC may display ALL the available products applicable for the VTM. It is therefore recommended to include a route within the dosageInstruction to help the ward clinician select an appropriate product. Product selection will be a manual process using the ADC console screen.

Relevant resource elements for ADC use cases

Note: Where the cardinality in the table below states "required" this relates to the element being part of the UKCore Minimum Viable Content.

Element Cardinality Guidance
status Mandatory Use active to instruct the ADC to action the medication plan or order.
Use cancelled to instruct the ADC to cancel the medication plan or order.
Use stopped to instruct the ADC to stop the medication plan or order.
Use on-hold as per stopped but expected to continue later (restart with active).
intent Mandatory Use plan to configure a patient's medication plan as a schedule within the ADC.
Use order to instruct the ADC to dispense 'click and collect' medication for a specific clinical user.
category Required Use inpatient for dispensing as part of a ward round.
Use discharge or leave for medication to be prepared and labelled for the patient to take away, often as complete packs, opposed to dispensing a unit dose.
priority Optional Use stat to identify a STAT dose.
medication[x] Mandatory The dm+d concept for the medication required by the patient. Typically with a VMP or AMP concept. See notes above about the use of VTM concepts. Can also be a reference to a Medication resource if the ADC needs to be configured with specific ingredients. There is a multi-ingredient example at the bottom of this page.
subject Mandatory Reference to a Patient resource. Likely that two identifiers will be used; the NHS number (when known) and the local MRN (hospital number).
authoredOn Required To timestamp the event.
encounter Optional Reference to an Encounter resource, which may include a local encounter identifier. An ADC typically operates using a combination of the patient and encounter identifiers to support transfer of care workflows e.g. if the patient is transferred from emergency department to an inpatient ward.
requester Required The clinician via a reference to either a Practitioner or PractitionerRole resource.
Note: Some ADCs have user-based interfaces. For example if nurse A is the requester, then nurse A is expected to be the dispenser (unless dispenseRequest.performer states otherwise).
performer Optional A reference to a Practitioner resource.
Note: Required by the Omnicell ADC when the intent is order.
basedOn Optional When the intent is plan this could reference a CarePlan.
When the intent is order this could reference the plan.
dosageInstruction Required Structured dosage for the medication used to set-up the ADC schedule. Complex dosages (titrations) can be split into separate dosages to send to the ADC. Dose ranges can be supported and the ADC will ask the clinician to select the dose from within the given range.
dispenseRequest.quantity Optional To instruct the ADC that a specific quantity of medication should be dispensed. Applicable where an EPMA knows about pack sizes, to instruct a whole pack to be dispensed by the ADC, e.g. "28 tablets". An ADC will allow flexibility to dispense the required quantity, e.g. 1 x 28 tablet pack or 2 x 14 tablet packs, etc. Where an EPMA does not know about pack sizes, this can be omitted as the ADC console can be used to pick an available whole pack.
substitution Mandatory Should always be set to false until local prescribing guidelines permit substitution.
priorPrescription Optional To reference a previous MedicationRequest. This may be useful when the status is changing, e.g. moving an active medication to an on-hold medication.

Examples

A number of examples have been provided to highlight how the MedicationRequest supports ADC use cases. A summary of the key data differences is provided in this table.

Example status intent category other elements
Medication unit dose active plan inpatient
Medication put on hold on-hold plan inpatient doNotPerform = true
dispenseRequest.validityPeriod
priorPrescription (optional)
Click and collect active order inpatient performer
dispenseRequest.quantity (optional)
TTO discharge/leave pack active plan discharge or leave
Whole pack dispense active plan inpatient dispenseRequest.quantity
STAT dose active plan inpatient priority = stat
Multi-use products active plan inpatient The ADC uses local configuration to identify multi-use products
Multi-dose products active plan inpatient The ADC uses local configuration to identify multi-dose products
Multi-ingredient active plan inpatient References a Medication resource containing multiple ingredient data items

Medication unit dose

Atenolol 50mg tablets, 1 tablet, once day

{
  "fullUrl": "urn:uuid:34eb3c92-76e6-48c2-9691-aa1f0b58369b",
  "resource": {
    "resourceType": "MedicationRequest",
    "id": "34eb3c92-76e6-48c2-9691-aa1f0b58369b",
    "meta": {
      "profile": [
        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
      ]
    },
    "status": "active",
    "intent": "plan",
    "category": "inpatient",
    "medicationCodeableConcept": {
      "coding": [
        {
          "system": "https://dmd.nhs.uk",
          "code": "42370711000001107",
          "display": "Atenolol 50mg tablets"
        }
      ]
    },
    "subject": {
      "reference": "Patient/UKCore-Patient-RichardSmith-Example"
    },
    "dosageInstruction": [
      {
        "text": "1 tablet daily",
        "timing": {
          "repeat": {
            "frequency": 1,
            "period": 1,
            "periodUnit": "d"
          }
        },
        "doseAndRate": [
          {
            "doseQuantity": {
              "value": 1,
              "unit": "tablet",
              "system": "http://snomed.info/sct",
              "code": "428673006"
            }
          }
        ]
      }
    ],
    "substitution": {
      "allowedBoolean": false
    }
  }
}

Medication (VTM) unit dose

Atenolol, 50mg, oral, once a day

{
  "fullUrl": "urn:uuid:34eb3c92-76e6-48c2-9691-aa1f0b58369b",
  "resource": {
    "resourceType": "MedicationRequest",
    "id": "34eb3c92-76e6-48c2-9691-aa1f0b58369b",
    "meta": {
      "profile": [
        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
      ]
    },
    "status": "active",
    "intent": "plan",
    "category": "inpatient",
    "medicationCodeableConcept": {
      "coding": [
        {
          "system": "https://dmd.nhs.uk",
          "code": "774685003",
          "display": "Atenolol"
        }
      ]
    },
    "subject": {
      "reference": "Patient/UKCore-Patient-RichardSmith-Example"
    },
    "dosageInstruction": [
      {
        "text": "50mg daily, oral",
        "timing": {
          "repeat": {
            "frequency": 1,
            "period": 1,
            "periodUnit": "d"
          }
        },
        "route": {
          "coding": [
            {
              "system": "http://snomed.info/sct",
              "code": "26643006",
              "display": "Oral"
            }
          ]
        },
        "doseAndRate": [
          {
            "doseQuantity": {
              "value": 50,
              "unit": "milligram",
              "system": "http://unitsofmeasure.org",
              "code": "mg"
            }
          }
        ]
      }
    ],
    "substitution": {
      "allowedBoolean": false
    }
  }
}

Medication put on hold

Atenolol 50mg tablets - put on hold from 24th Sept to 3rd Oct

{
  "fullUrl": "urn:uuid:643d2f30-f911-4914-bd73-abddea9b9e9f",
  "resource": {
    "resourceType": "MedicationRequest",
    "id": "643d2f30-f911-4914-bd73-abddea9b9e9f",
    "meta": {
      "profile": [
        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
      ]
    },
    "status": "on-hold",
    "intent": "plan",
    "category": "inpatient",
    "doNotPerform": true,
    "medicationCodeableConcept": {
      "coding": [
        {
          "system": "https://dmd.nhs.uk",
          "code": "42370711000001107",
          "display": "Atenolol 50mg tablets"
        }
      ]
    },
    "subject": {
      "reference": "Patient/UKCore-Patient-RichardSmith-Example"
    },
    "dispenseRequest": {
      "validityPeriod": {
        "start": "2026-09-24",
        "end": "2026-10-03"
      }
    },
    "substitution": {
      "allowedBoolean": false
    },
    "priorPrescription": {
      "reference": "MedicationRequest/34eb3c92-76e6-48c2-9691-aa1f0b58369b"
    }
  }
}

Click and Collect order

Paracetamol 500mg tablets, 1 tablet, four times a day, pack of 28 tablets ordered by Chris Boland

{
  "fullUrl": "urn:uuid:34eb3c92-76e6-48c2-9691-aa1f0b58369b",
  "resource": {
    "resourceType": "MedicationRequest",
    "id": "34eb3c92-76e6-48c2-9691-aa1f0b58369b",
    "meta": {
      "profile": [
        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
      ]
    },
    "status": "active",
    "intent": "order",
    "category": "inpatient",
    "medicationCodeableConcept": {
      "coding": [
        {
          "system": "https://dmd.nhs.uk",
          "code": "42109611000001109",
          "display": "Paracetamol 500mg tablets"
        }
      ]
    },
    "subject": {
      "reference": "Patient/UKCore-Patient-RichardSmith-Example"
    },
    "performer": {
        "reference": "Patient/UKCore-Practitioner-ChrisBoland-Example"
        }
    },
    "dosageInstruction": [
      {
        "text": "1 tablet, 4 times a day",
        "timing": {
          "repeat": {
            "frequency": 4,
            "period": 1,
            "periodUnit": "d"
          }
        },
        "doseAndRate": [
          {
            "doseQuantity": {
              "value": 1,
              "unit": "tablet",
              "system": "http://snomed.info/sct",
              "code": "428673006"
            }
          }
        ]
      }
    ],
    "dispenseRequest": {
      "quantity": {
        "value": 28,
        "unit": "tablet",
        "system": "http://snomed.info/sct",
        "code": "428673006"
      }
    },
    "substitution": {
      "allowedBoolean": false
    }
  }
}

TTO pack for Discharge

Paracetamol 500mg tablets, 1 tablet, four times a day, for 7 days. Optionally a dispenseRequest.quantity for 28 tablets could be included.

{
  "fullUrl": "urn:uuid:34eb3c92-76e6-48c2-9691-aa1f0b58369b",
  "resource": {
    "resourceType": "MedicationRequest",
    "id": "34eb3c92-76e6-48c2-9691-aa1f0b58369b",
    "meta": {
      "profile": [
        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
      ]
    },
    "status": "active",
    "intent": "plan",
    "category": "discharge",
    "medicationCodeableConcept": {
      "coding": [
        {
          "system": "https://dmd.nhs.uk",
          "code": "42109611000001109",
          "display": "Paracetamol 500mg tablets"
        }
      ]
    },
    "subject": {
      "reference": "Patient/UKCore-Patient-RichardSmith-Example"
    },
    "dosageInstruction": [
      {
        "text": "1 tablet, 4 times a day, for 7 days",
        "timing": {
          "repeat": {
            "frequency": 4,
            "period": 1,
            "periodUnit": "d",
            "boundsDuration": {
              "value": 7,
              "unit": "day",
              "system": "http://unitsofmeasure.org",
              "code": "d"
            }
          }
        },
        "doseAndRate": [
          {
            "doseQuantity": {
              "value": 1,
              "unit": "tablet",
              "system": "http://snomed.info/sct",
              "code": "428673006"
            }
          }
        ]
      }
    ],
    "substitution": {
      "allowedBoolean": false
    }
  }
}
Whole pack PRN for inpatient use

Paracetamol 500mg tablets, 1 tablet, PRN, maximum 8 tablets in 24 hours. If labelled for the patient, the medication could be kept in a patient bedside locker for either nurse or self administration.

{
  "fullUrl": "urn:uuid:34eb3c92-76e6-48c2-9691-aa1f0b58369b",
  "resource": {
    "resourceType": "MedicationRequest",
    "id": "34eb3c92-76e6-48c2-9691-aa1f0b58369b",
    "meta": {
      "profile": [
        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
      ]
    },
    "status": "active",
    "intent": "order",
    "category": "inpatient",
    "medicationCodeableConcept": {
      "coding": [
        {
          "system": "https://dmd.nhs.uk",
          "code": "42109611000001109",
          "display": "Paracetamol 500mg tablets"
        }
      ]
    },
    "subject": {
      "reference": "Patient/UKCore-Patient-RichardSmith-Example"
    },
    "dosageInstruction": [
      {
        "text": "1 tablet, PRN, maximum 8 tablets in 24 hours",
        "asNeededBoolean": true,
        "doseAndRate": [
          {
            "doseQuantity": {
              "value": 1,
              "unit": "tablet",
              "system": "http://snomed.info/sct",
              "code": "428673006"
            }
          }
        ],
        "maxDosePerPeriod": {
          "numerator": {
            "value": 8,
            "unit": "tablet",
            "system": "http://snomed.info/sct",
            "code": "428673006"
          },
          "denominator": {
            "value": 24,
            "unit": "hour",
            "system": "http://unitsofmeasure.org",
            "code": "h"
          }
        }
      }
    ],
    "dispenseRequest": {
      "quantity": {
        "value": 28,
        "unit": "tablet",
        "system": "http://snomed.info/sct",
        "code": "428673006"
      }
    },
    "substitution": {
      "allowedBoolean": false
    }
  }
}

STAT dose example

Morphine sulfate 1mg/1ml solution for injection ampoules, 1 ampoule, Bolus, Intravenous, stat

{
  "fullUrl": "urn:uuid:34eb3c92-76e6-48c2-9691-aa1f0b58369b",
  "resource": {
    "resourceType": "MedicationRequest",
    "id": "34eb3c92-76e6-48c2-9691-aa1f0b58369b",
    "meta": {
      "profile": [
        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
      ]
    },
    "status": "active",
    "intent": "plan",
    "category": "inpatient",
    "priority": "stat",
    "medicationCodeableConcept": {
      "coding": [
        {
          "system": "https://dmd.nhs.uk",
          "code": "22401911000001100",
          "display": "Morphine sulfate 1mg/1ml solution for injection ampoules"
        }
      ]
    },
    "subject": {
      "reference": "Patient/UKCore-Patient-RichardSmith-Example"
    },
    "dosageInstruction": [
      {
        "text": "Bolus - Intravenous - stat",
        "timing": {
          "repeat": {
            "frequency": 2,
            "period": 1,
            "periodUnit": "d"
          }
        },
        "method": {
          "coding": [
            {
              "system": "http://snomed.info/sct",
              "code": "13283801000001100",
              "display": "Bolus"
            }
          ]
        },
        "route": {
          "coding": [
            {
              "system": "http://snomed.info/sct",
              "code": "47625008",
              "display": "Intravenous"
            }
          ]
        },
        "doseAndRate": [
          {
            "doseQuantity": {
              "value": 1,
              "unit": "ampoule",
              "system": "http://snomed.info/sct",
              "code": "413516001"
            }
          }
        ]
      }
    ],
    "substitution": {
      "allowedBoolean": false
    }
  }
}

Multi-use products

Beclometasone 100micrograms/dose inhaler CFC free, 2 puffs, twice a day. The ADC will have this type of product configured as a "multi-use" product retained for use by this patient, often stored in a bedside locker.

{
  "fullUrl": "urn:uuid:34eb3c92-76e6-48c2-9691-aa1f0b58369b",
  "resource": {
    "resourceType": "MedicationRequest",
    "id": "34eb3c92-76e6-48c2-9691-aa1f0b58369b",
    "meta": {
      "profile": [
        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
      ]
    },
    "status": "active",
    "intent": "plan",
    "category": "inpatient",
    "medicationCodeableConcept": {
      "coding": [
        {
          "system": "https://dmd.nhs.uk",
          "code": "35908111000001105",
          "display": "Beclometasone 100micrograms/dose inhaler CFC free"
        }
      ]
    },
    "subject": {
      "reference": "Patient/UKCore-Patient-RichardSmith-Example"
    },
    "dosageInstruction": [
      {
        "text": "2 puffs, twice a day",
        "timing": {
          "repeat": {
            "frequency": 2,
            "period": 1,
            "periodUnit": "d"
          }
        },
        "doseAndRate": [
          {
            "doseQuantity": {
              "value": 2,
              "unit": "puff",
              "system": "http://snomed.info/sct",
              "code": "415215001"
            }
          }
        ]
      }
    ],
    "substitution": {
      "allowedBoolean": false
    }
  }
}

Multi-dose products

Paracetamol 500mg/5ml oral solution sugar free, 5ml, twice a day. The ADC will have this type of product configured as a "multi-dose" product so that it can be returned to the ADC for another patient use.

{
  "fullUrl": "urn:uuid:34eb3c92-76e6-48c2-9691-aa1f0b58369b",
  "resource": {
    "resourceType": "MedicationRequest",
    "id": "34eb3c92-76e6-48c2-9691-aa1f0b58369b",
    "meta": {
      "profile": [
        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
      ]
    },
    "status": "active",
    "intent": "plan",
    "category": "inpatient",
    "medicationCodeableConcept": {
      "coding": [
        {
          "system": "https://dmd.nhs.uk",
          "code": "24014911000001102",
          "display": "Paracetamol 500mg/5ml oral solution sugar free"
        }
      ]
    },
    "subject": {
      "reference": "Patient/UKCore-Patient-RichardSmith-Example"
    },
    "dosageInstruction": [
      {
        "text": "5 millilitres, twice a day",
        "timing": {
          "repeat": {
            "frequency": 2,
            "period": 1,
            "periodUnit": "d"
          }
        },
        "doseAndRate": [
          {
            "doseQuantity": {
              "value": 5,
              "unit": "millilitre",
              "system": "http://unitsofmeasure.org",
              "code": "ml"
            }
          }
        ]
      }
    ],
    "substitution": {
      "allowedBoolean": false
    }
  }
}

Multi-ingredient

Gentamicin 400mg in 100ml sodium chloride 0.9% infusion bags, for a total quantity of 200ml infusion fluid, for continuous infusion over 60 minutes, 3 times a day, intravenous. The instruction for the ADC is to dispense Gentamicin in a suitable form as the active ingredient along with 2 x 100ml infusion bags.

The MedicationRequest resource.

{
  "fullUrl": "urn:uuid:34eb3c92-76e6-48c2-9691-aa1f0b58369b",
  "resource": {
    "resourceType": "MedicationRequest",
    "id": "34eb3c92-76e6-48c2-9691-aa1f0b58369b",
    "meta": {
      "profile": [
        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
      ]
    },
    "status": "active",
    "intent": "plan",
    "category": "inpatient",
    "medicationReference": {
      "reference": "11dc9519-b6e8-41bb-bce5-f6f724b743bc",
      "type": "Medication"
    },
    "subject": {
      "reference": "Patient/UKCore-Patient-RichardSmith-Example"
    },
    "dosageInstruction": [
      {
        "text": "Continuous infusion 200 millilitre - over 60 minutes - 3 times a day - Intravenous",
        "timing": {
          "repeat": {
            "duration": 60,
            "durationUnit": "min",
            "frequency": 3,
            "period": 1,
            "periodUnit": "d"
          }
        },
        "route": {
          "coding": [
            {
              "system": "http://snomed.info/sct",
              "code": "47625008",
              "display": "Intravenous"
            }
          ]
        },
        "method": {
          "coding": [
            {
              "system": "http://snomed.info/sct",
              "code": "261754007",
              "display": "Continuous infusion"
            }
          ]
        },
        "doseAndRate": [
          {
            "doseQuantity": {
              "value": 200,
              "unit": "millilitre",
              "system": "http://unitsofmeasure.org",
              "code": "ml"
            }
          }
        ]
      }
    ],
    "substitution": {
      "allowedBoolean": false
    }
  }
}

The referenced Medication resource.

{
  "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"
      ]
    },
    "code": {
      "text": "Gentamicin 400 milligram in Sodium chloride 0.9% infusion 100ml bags - Solution for infusion"
    },
    "form": {
      "coding": [
        {
          "system": "http://snomed.info/sct",
          "code": "385229008",
          "display": "Solution for infusion"
        }
      ]
    },
    "ingredient": [
      {
        "itemCodeableConcept": {
          "coding": [
            {
              "system": "https://dmd.nhs.uk",
              "code": "387321007",
              "display": "Gentamicin"
            }
          ]
        },
        "strength": {
          "numerator": {
            "value": 400,
            "unit": "milligram",
            "system": "http://unitsofmeasure.org",
            "code": "mg"
          },
          "denominator": {
            "value": 1
          }
        }
      },
      {
        "itemCodeableConcept": {
          "coding": [
            {
              "system": "https://dmd.nhs.uk",
              "code": "4898311000001108",
              "display": "Sodium chloride 0.9% infusion 100ml bags"
            }
          ]
        }
      }
    ]
  }
}
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