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.

Morphine bolus

Dose-based VTM prescription using a free text additional instructions to specify patient-administered with a 5 minute lockout. 
<MedicationRequest xmlns="http://hl7.org/fhir">
    <id value="1558295a-9213-44cb-81e1-e1ab8fcc3e81" />
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
    </meta>
    <status value="active" />
    <intent value="order" />
    <category>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/medicationrequest-category" />
            <code value="inpatient" />
            <display value="inpatient" />
        </coding>
    </category>
    <medicationCodeableConcept>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="73572009" />
            <display value="Morphine" />
        </coding>
    </medicationCodeableConcept>
    <subject>
        <identifier>
            <system value="https://fhir.nhs.uk/Id/nhs-number" />
            <value value="9999999999" />
        </identifier>
    </subject>
    <authoredOn value="2020-05-15T15:00:00Z" />
    <requester>
        <reference value="urn:staff-1112" />
        <display value="Dr Maikeu Well" />
    </requester>
    <recorder>
        <reference value="urn:staff-1112" />
        <display value="Dr Maikeu Well" />
    </recorder>
    <dosageInstruction>
        <text value="Intermittent bolus 5 milligram - as required - Intravenous route - Administer via PCA with a 5 minute lockout" />
        <additionalInstruction>
            <text value="Administer via PCA with a 5 minute lockout" />
        </additionalInstruction>
        <asNeededBoolean value="true" />
        <route>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="47625008" />
                <display value="Intravenous route" />
            </coding>
        </route>
        <method>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="397884008" />
                <display value="Intermittent bolus" />
            </coding>
        </method>
        <doseAndRate>
            <doseQuantity>
                <value value="5" />
                <unit value="milligram" />
                <system value="http://unitsofmeasure.org" />
                <code value="mg" />
            </doseQuantity>
        </doseAndRate>
    </dosageInstruction>
    <substitution>
        <allowedBoolean value="false" />
    </substitution>
</MedicationRequest>

{
    "resourceType": "MedicationRequest",
    "id": "1558295a-9213-44cb-81e1-e1ab8fcc3e81",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
        ]
    },
    "status": "active",
    "intent": "order",
    "category":  [
        {
            "coding":  [
                {
                    "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                    "code": "inpatient",
                    "display": "inpatient"
                }
            ]
        }
    ],
    "medicationCodeableConcept": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "73572009",
                "display": "Morphine"
            }
        ]
    },
    "subject": {
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/nhs-number",
            "value": "9999999999"
        }
    },
    "authoredOn": "2020-05-15T15:00:00Z",
    "requester": {
        "reference": "urn:staff-1112",
        "display": "Dr Maikeu Well"
    },
    "recorder": {
        "reference": "urn:staff-1112",
        "display": "Dr Maikeu Well"
    },
    "dosageInstruction":  [
        {
            "text": "Intermittent bolus 5 milligram - as required - Intravenous route - Administer via PCA with a 5 minute lockout",
            "additionalInstruction":  [
                {
                    "text": "Administer via PCA with a 5 minute lockout"
                }
            ],
            "asNeededBoolean": true,
            "route": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "47625008",
                        "display": "Intravenous route"
                    }
                ]
            },
            "method": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "397884008",
                        "display": "Intermittent bolus"
                    }
                ]
            },
            "doseAndRate":  [
                {
                    "doseQuantity": {
                        "value": 5,
                        "unit": "milligram",
                        "system": "http://unitsofmeasure.org",
                        "code": "mg"
                    }
                }
            ]
        }
    ],
    "substitution": {
        "allowedBoolean": false
    }
}
MedicationRequest.id[0]1558295a-9213-44cb-81e1-e1ab8fcc3e81
MedicationRequest.meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
MedicationRequest.status[0]active
MedicationRequest.intent[0]order
MedicationRequest.category[0].coding[0].system[0]http://terminology.hl7.org/CodeSystem/medicationrequest-category
MedicationRequest.category[0].coding[0].code[0]inpatient
MedicationRequest.category[0].coding[0].display[0]inpatient
MedicationRequest.medication[0].coding[0].system[0]https://dmd.nhs.uk
MedicationRequest.medication[0].coding[0].code[0]73572009
MedicationRequest.medication[0].coding[0].display[0]Morphine
MedicationRequest.subject[0].identifier[0].system[0]https://fhir.nhs.uk/Id/nhs-number
MedicationRequest.subject[0].identifier[0].value[0]9999999999
MedicationRequest.authoredOn[0]2020-05-15T15:00:00Z
MedicationRequest.requester[0].reference[0]urn:staff-1112
MedicationRequest.requester[0].display[0]Dr Maikeu Well
MedicationRequest.recorder[0].reference[0]urn:staff-1112
MedicationRequest.recorder[0].display[0]Dr Maikeu Well
MedicationRequest.dosageInstruction[0].text[0]Intermittent bolus 5 milligram - as required - Intravenous route - Administer via PCA with a 5 minute lockout
MedicationRequest.dosageInstruction[0].additionalInstruction[0].text[0]Administer via PCA with a 5 minute lockout
MedicationRequest.dosageInstruction[0].asNeeded[0]True
MedicationRequest.dosageInstruction[0].route[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].route[0].coding[0].code[0]47625008
MedicationRequest.dosageInstruction[0].route[0].coding[0].display[0]Intravenous route
MedicationRequest.dosageInstruction[0].method[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].method[0].coding[0].code[0]397884008
MedicationRequest.dosageInstruction[0].method[0].coding[0].display[0]Intermittent bolus
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].value[0]5
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].unit[0]milligram
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].code[0]mg
MedicationRequest.substitution[0].allowed[0]False
MedicationRequest

Example on-screen presentation:

Morphine
Intermittent bolus 5 milligram - as required - Intravenous route - PCA with a 5 minute lockout
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