Resource type: medicationdispense

Description

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.

Elements

PathShortDefinitionComments
Dispensing a medication to a named patientIndicates 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.
identifierExternal identifierIdentifiers associated with this Medication Dispense that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server.This is a business identifier, not a resource identifier.
partOfEvent that dispense is part ofThe procedure that trigger the dispense.
statuspreparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | unknownA code specifying the state of the set of dispense events.This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
statusReason[x]Why a dispense was not performedIndicates the reason why a dispense was not performed.
categoryType of medication dispenseIndicates the type of medication dispense (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)).The category can be used to include where the medication is expected to be consumed or other types of dispenses. Invariants can be used to bind to different value sets when profiling to bind.
medication[x]What medication was suppliedIdentifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications.If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended. For example if you require form or lot number, then you must reference the Medication resource.
subjectWho the dispense is forA link to a resource representing the person or the group to whom the medication will be given.SubstanceAdministration->subject->Patient.
contextEncounter / Episode associated with eventThe encounter or episode of care that establishes the context for this event.
supportingInformationInformation that supports the dispensing of the medicationAdditional information that supports the medication being dispensed.
performerWho performed eventIndicates who or what performed the event.
performer.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
performer.extensionAdditional content defined by implementationsMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
performer.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
performer.functionWho performed the dispense and what they didDistinguishes the type of performer in the dispense. For example, date enterer, packager, final checker.
performer.actorIndividual who was performingThe device, practitioner, etc. who performed the action. It should be assumed that the actor is the dispenser of the medication.
locationWhere the dispense occurredThe principal physical location where the dispense was performed.
authorizingPrescriptionMedication order that authorizes the dispenseIndicates the medication order that is being dispensed against.Maps to basedOn in Event logical model.
typeTrial fill, partial fill, emergency fill, etc.Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc.
quantityAmount dispensedThe amount of medication that has been dispensed. Includes unit of measure.
daysSupplyAmount of medication expressed as a timing amountThe amount of medication expressed as a timing amount.
whenPreparedWhen product was packaged and reviewedThe time when the dispensed product was packaged and reviewed.
whenHandedOverWhen product was given outThe time the dispensed product was provided to the patient or their representative.
destinationWhere the medication was sentIdentification of the facility/location where the medication was shipped to, as part of the dispense event.
receiverWho collected the medicationIdentifies the person who picked up the medication. This will usually be a patient or their caregiver, but some cases exist where it can be a healthcare professional.
noteInformation about the dispenseExtra information about the dispense that could not be conveyed in the other attributes.
dosageInstructionHow the medication is to be used by the patient or administered by the caregiverIndicates how the medication is to be used by the patient.When the dose or rate is intended to change over the entire administration period (e.g. Tapering dose prescriptions), multiple instances of dosage instructions will need to be supplied to convey the different doses/rates. The pharmacist reviews the medication order prior to dispense and updates the dosageInstruction based on the actual product being dispensed.
substitutionWhether a substitution was performed on the dispenseIndicates whether or not substitution was made as part of the dispense. In some cases substitution will be expected but does not happen, in other cases substitution is not expected but does happen. This block explains what substitution did or did not happen and why. If nothing is specified, substitution was not done.
substitution.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
substitution.extensionAdditional content defined by implementationsMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
substitution.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
substitution.wasSubstitutedWhether a substitution was or was not performed on the dispenseTrue if the dispenser dispensed a different drug or product from what was prescribed.
substitution.typeCode signifying whether a different drug was dispensed from what was prescribedA code signifying whether a different drug was dispensed from what was prescribed.
substitution.reasonWhy was substitution madeIndicates the reason for the substitution (or lack of substitution) from what was prescribed.
substitution.responsiblePartyWho is responsible for the substitutionThe person or organization that has primary responsibility for the substitution.
detectedIssueClinical issue with actionIndicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a patient; e.g. drug-drug interaction, duplicate therapy, dosage alert etc.This element can include a detected issue that has been identified either by a decision support system or by a clinician and may include information on the steps that were taken to address the issue.
eventHistoryA list of relevant lifecycle eventsA summary of the events of interest that have occurred, such as when the dispense was verified.This might not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the Provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the Provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.).

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

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.

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.

Search Parameters

contextReturns dispenses with a specific context (episode or episode of care)MedicationDispense.context
destinationReturns dispenses that should be sent to a specific destinationMedicationDispense.destination
patientThe identity of a patient to list dispenses forMedicationDispense.subject.where(resolve() is Patient)
performerReturns dispenses performed by a specific individualMedicationDispense.performer.actor
prescriptionMultiple Resources: * [MedicationDispense](medicationdispense.html): The identity of a prescription to list dispenses from MedicationDispense.authorizingPrescription
receiverThe identity of a receiver to list dispenses forMedicationDispense.receiver
responsiblepartyReturns dispenses with the specified responsible partyMedicationDispense.substitution.responsibleParty
subjectThe identity of a patient for whom to list dispensesMedicationDispense.subject
typeReturns dispenses of a specific typeMedicationDispense.type
whenhandedoverReturns dispenses handed over on this dateMedicationDispense.whenHandedOver
whenpreparedReturns dispenses prepared on this dateMedicationDispense.whenPrepared

Extension Definitions

These are extension definitions for this resource defined by the spec