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.

Salbutamol using the metered dose device

Dose-based VTM prescription using free-text additional instruction for the use of a device.
<MedicationRequest xmlns="http://hl7.org/fhir">
<id value="00d31bbe-72f4-4a29-a880-df1a66075450" />
<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="91143003" />
<display value="Salbutamol" />
</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="100 to 200 microgram - Inhalation - as required - up to a maximum of 8 dose in 1 day - using the metered dose device" />
<additionalInstruction>
<text value="using the metered dose device" />
</additionalInstruction>
<asNeededBoolean value="true" />
<route>
<coding>
<system value="http://snomed.info/sct" />
<code value="18679011000001101" />
<display value="Inhalation" />
</coding>
</route>
<doseAndRate>
<doseRange>
<low>
<value value="100" />
<unit value="microgram" />
<system value="http://unitsofmeasure.org" />
<code value="ug" />
</low>
<high>
<value value="200" />
<unit value="microgram" />
<system value="http://unitsofmeasure.org" />
<code value="ug" />
</high>
</doseRange>
</doseAndRate>
<maxDosePerPeriod>
<numerator>
<value value="8" />
<unit value="dose" />
<system value="http://snomed.info/sct" />
<code value="3317411000001100" />
</numerator>
<denominator>
<value value="1" />
<unit value="day" />
<system value="http://unitsofmeasure.org" />
<code value="d" />
</denominator>
</maxDosePerPeriod>
</dosageInstruction>
<substitution>
<allowedBoolean value="false" />
</substitution>
</MedicationRequest>
{
"resourceType": "MedicationRequest",
"id": "00d31bbe-72f4-4a29-a880-df1a66075450",
"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": "91143003",
"display": "Salbutamol"
}
]
},
"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": "100 to 200 microgram - Inhalation - as required - up to a maximum of 8 dose in 1 day - using the metered dose device",
"additionalInstruction": [
{
"text": "using the metered dose device"
}
],
"asNeededBoolean": true,
"route": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "18679011000001101",
"display": "Inhalation"
}
]
},
"doseAndRate": [
{
"doseRange": {
"low": {
"value": 100,
"unit": "microgram",
"system": "http://unitsofmeasure.org",
"code": "ug"
},
"high": {
"value": 200,
"unit": "microgram",
"system": "http://unitsofmeasure.org",
"code": "ug"
}
}
}
],
"maxDosePerPeriod": {
"numerator": {
"value": 8,
"unit": "dose",
"system": "http://snomed.info/sct",
"code": "3317411000001100"
},
"denominator": {
"value": 1,
"unit": "day",
"system": "http://unitsofmeasure.org",
"code": "d"
}
}
}
],
"substitution": {
"allowedBoolean": false
}
}
MedicationRequest.id[0]00d31bbe-72f4-4a29-a880-df1a66075450
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]91143003
MedicationRequest.medication[0].coding[0].display[0]Salbutamol
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]100 to 200 microgram - Inhalation - as required - up to a maximum of 8 dose in 1 day - using the metered dose device
MedicationRequest.dosageInstruction[0].additionalInstruction[0].text[0]using the metered dose device
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]18679011000001101
MedicationRequest.dosageInstruction[0].route[0].coding[0].display[0]Inhalation
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].low[0].value[0]100
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].low[0].unit[0]microgram
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].low[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].low[0].code[0]ug
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].high[0].value[0]200
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].high[0].unit[0]microgram
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].high[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].high[0].code[0]ug
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].value[0]8
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].unit[0]dose
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].code[0]3317411000001100
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].denominator[0].value[0]1
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].denominator[0].unit[0]day
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].denominator[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].denominator[0].code[0]d
MedicationRequest.substitution[0].allowed[0]False
MedicationRequest

Example on-screen presentation:

Salbutamol
100 to 200 microgram - Inhalation - as required - up to a maximum of 8 dose in 1 day - using the metered dose device
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