Release 4B

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11.3 Resource MedicationDispense - Content

Pharmacy Work GroupMaturity Level: 2 Trial UseSecurity Category: Patient Compartments: Patient, Practitioner

Indicates that a medication product is to be or has been dispensed for a named person/patient. This includes a description of the medication product (supply) provided and the instructions for administering the medication. The medication dispense is the result of a pharmacy system responding to a medication order.

11.3.1 Scope and Usage

This resource covers the supply of medications to a patient. Examples include dispensing and pick-up from an outpatient or community pharmacy, dispensing patient-specific medications from inpatient pharmacy to ward, as well as issuing a single dose from ward stock to a patient for consumption. The medication dispense is the result of a pharmacy system responding to a medication order.

MedicationDispense is an event resource from a FHIR workflow perspective - see Workflow Event

11.3.2 Boundaries and Relationships

The Medication domain includes a number of related resources

MedicationRequest An order for both supply of the medication and the instructions for administration of the medicine to a patient.
MedicationDispense Provision of a supply of a medication with the intention that it is subsequently consumed by a patient (usually in response to a prescription).
MedicationAdministration When a patient actually consumes a medicine, or the medication is otherwise administered to them
MedicationStatement This is a record of a medication being taken by a patient or that a medication has been given to a patient, where the record is the result of a report from the patient or another clinician. A medication statement is not a part of the prescribe->dispense->administer sequence but is a report that such a sequence (or at least a part of it) did take place, resulting in a belief that the patient has received a particular medication.

This resource does not deal with the supply or transfer of non-medication related items to a patient.

11.3.3 Background and Context

The supply and the associated administration instructions might not exactly follow the original order (prescription), either because some details were left for completion at this point in the process or because the dispenser exercised their clinical judgment to make some appropriate modification.

11.3.4 References

This resource is referenced by ChargeItem, MedicationStatement and Observation.

This resource implements the Event pattern.

11.3.5 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense TUDomainResourceDispensing a medication to a named patient
+ Rule: whenHandedOver cannot be before whenPrepared
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..*IdentifierExternal identifier
... partOf 0..*Reference(Procedure)Event that dispense is part of
... status ?!Σ1..1codepreparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
MedicationDispense Status Codes (Required)
.... statusReasonCodeableConceptCodeableConcept
.... statusReasonReferenceReference(DetectedIssue)
... category 0..1CodeableConceptType of medication dispense
MedicationDispense Category Codes (Preferred)
... medication[x] Σ1..1What medication was supplied
SNOMED CT Medication Codes (Example)
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(Medication)
... subject Σ0..1Reference(Patient | Group)Who the dispense is for
... context 0..1Reference(Encounter | EpisodeOfCare)Encounter / Episode associated with event
... supportingInformation 0..*Reference(Any)Information that supports the dispensing of the medication
... performer 0..*BackboneElementWho performed event
.... function 0..1CodeableConceptWho performed the dispense and what they did
MedicationDispense Performer Function Codes (Example)
.... actor 1..1Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson)Individual who was performing
... location 0..1Reference(Location)Where the dispense occurred
... authorizingPrescription 0..*Reference(MedicationRequest)Medication order that authorizes the dispense
... type 0..1CodeableConceptTrial fill, partial fill, emergency fill, etc.
ActPharmacySupplyType (Example)
... quantity 0..1SimpleQuantityAmount dispensed
... daysSupply 0..1SimpleQuantityAmount of medication expressed as a timing amount
... whenPrepared Σ0..1dateTimeWhen product was packaged and reviewed
... whenHandedOver 0..1dateTimeWhen product was given out
... destination 0..1Reference(Location)Where the medication was sent
... receiver 0..*Reference(Patient | Practitioner)Who collected the medication
... note 0..*AnnotationInformation about the dispense
... dosageInstruction 0..*DosageHow the medication is to be used by the patient or administered by the caregiver
... substitution 0..1BackboneElementWhether a substitution was performed on the dispense
.... wasSubstituted 1..1booleanWhether a substitution was or was not performed on the dispense
.... type 0..1CodeableConceptCode signifying whether a different drug was dispensed from what was prescribed
ActSubstanceAdminSubstitutionCode (Example)
.... reason 0..*CodeableConceptWhy was substitution made
SubstanceAdminSubstitutionReason (Example)
.... responsibleParty 0..*Reference(Practitioner | PractitionerRole)Who is responsible for the substitution
... detectedIssue 0..*Reference(DetectedIssue)Clinical issue with action
... eventHistory 0..*Reference(Provenance)A list of relevant lifecycle events

doco Documentation for this format

 

See the Profiles & Extensions and the alternate definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions & the dependency analysis

11.3.5.1 Terminology Bindings

PathDefinitionTypeReference
MedicationDispense.status RequiredMedicationDispense Status Codes
MedicationDispense.statusReason[x] ExampleMedicationDispense Status Reason Codes
MedicationDispense.category PreferredMedicationDispense Category Codes
MedicationDispense.medication[x] ExampleSNOMEDCTMedicationCodes
MedicationDispense.performer.function ExampleMedicationDispense Performer Function Codes
MedicationDispense.type ExampleActPharmacySupplyType
MedicationDispense.substitution.type ExampleActSubstanceAdminSubstitutionCode
MedicationDispense.substitution.reason ExampleSubstanceAdminSubstitutionReason

11.3.5.2 Constraints

idLevelLocationDescriptionExpression
mdd-1Rule (base)whenHandedOver cannot be before whenPreparedwhenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared

11.3.6 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionExpressionIn Common
codetokenReturns dispenses of this medicine code(MedicationDispense.medication as CodeableConcept)
contextreferenceReturns dispenses with a specific context (episode or episode of care)MedicationDispense.context
(EpisodeOfCare, Encounter)
destinationreferenceReturns dispenses that should be sent to a specific destinationMedicationDispense.destination
(Location)
identifiertokenReturns dispenses with this external identifierMedicationDispense.identifier
medicationreferenceReturns dispenses of this medicine resource(MedicationDispense.medication as Reference)
(Medication)
patientreferenceThe identity of a patient to list dispenses forMedicationDispense.subject.where(resolve() is Patient)
(Patient)
performerreferenceReturns dispenses performed by a specific individualMedicationDispense.performer.actor
(Practitioner, Organization, Device, Patient, PractitionerRole, RelatedPerson)
prescriptionreferenceThe identity of a prescription to list dispenses fromMedicationDispense.authorizingPrescription
(MedicationRequest)
receiverreferenceThe identity of a receiver to list dispenses forMedicationDispense.receiver
(Practitioner, Patient)
responsiblepartyreferenceReturns dispenses with the specified responsible partyMedicationDispense.substitution.responsibleParty
(Practitioner, PractitionerRole)
statustokenReturns dispenses with a specified dispense statusMedicationDispense.status
subjectreferenceThe identity of a patient for whom to list dispensesMedicationDispense.subject
(Group, Patient)
typetokenReturns dispenses of a specific typeMedicationDispense.type
whenhandedoverdateReturns dispenses handed over on this dateMedicationDispense.whenHandedOver
whenprepareddateReturns dispenses prepared on this dateMedicationDispense.whenPrepared