Resource type: medicationadministration

Description

Describes the event of a patient consuming or otherwise being administered a medication. This may be as simple as swallowing a tablet or it may be a long running infusion. Related resources tie this event to the authorizing prescription, and the specific encounter between patient and health care practitioner.

Elements

PathShortDefinitionComments
Administration of medication to a patientDescribes the event of a patient consuming or otherwise being administered a medication. This may be as simple as swallowing a tablet or it may be a long running infusion. Related resources tie this event to the authorizing prescription, and the specific encounter between patient and health care practitioner.
identifierExternal identifierIdentifiers associated with this Medication Administration 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.
instantiatesInstantiates protocol or definitionA protocol, guideline, orderset, or other definition that was adhered to in whole or in part by this event.
partOfPart of referenced eventA larger event of which this particular event is a component or step.
statusin-progress | not-done | on-hold | completed | entered-in-error | stopped | unknownWill generally be set to show that the administration has been completed. For some long running administrations such as infusions, it is possible for an administration to be started but not completed or it may be paused while some other process is under way.This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
statusReasonReason administration not performedA code indicating why the administration was not performed.
categoryType of medication usageIndicates where the medication is expected to be consumed or administered.
medication[x]What was administeredIdentifies the medication that was 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 received medicationThe person or animal or group receiving the medication.
contextEncounter or Episode of Care administered as part ofThe visit, admission, or other contact between patient and health care provider during which the medication administration was performed.
supportingInformationAdditional information to support administrationAdditional information (for example, patient height and weight) that supports the administration of the medication.
effective[x]Start and end time of administrationA specific date/time or interval of time during which the administration took place (or did not take place, when the 'notGiven' attribute is true). For many administrations, such as swallowing a tablet the use of dateTime is more appropriate.
performerWho performed the medication administration and what they didIndicates who or what performed the medication administration and how they were involved.
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.functionType of performanceDistinguishes the type of involvement of the performer in the medication administration.
performer.actorWho performed the medication administrationIndicates who or what performed the medication administration.
reasonCodeReason administration performedA code indicating why the medication was given.
reasonReferenceCondition or observation that supports why the medication was administeredCondition or observation that supports why the medication was administered.This is a reference to a condition that is the reason for the medication request. If only a code exists, use reasonCode.
requestRequest administration performed againstThe original request, instruction or authority to perform the administration.This is a reference to the MedicationRequest where the intent is either order or instance-order. It should not reference MedicationRequests where the intent is any other value.
deviceDevice used to administerThe device used in administering the medication to the patient. For example, a particular infusion pump.
noteInformation about the administrationExtra information about the medication administration that is not conveyed by the other attributes.
dosageDetails of how medication was takenDescribes the medication dosage information details e.g. dose, rate, site, route, etc.
dosage.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.
dosage.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.
dosage.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.
dosage.textFree text dosage instructions e.g. SIGFree text dosage can be used for cases where the dosage administered is too complex to code. When coded dosage is present, the free text dosage may still be present for display to humans. The dosage instructions should reflect the dosage of the medication that was administered.
dosage.siteBody site administered toA coded specification of the anatomic site where the medication first entered the body. For example, "left arm".If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension [bodySite](extension-bodysite.html). May be a summary code, or a reference to a very precise definition of the location, or both.
dosage.routePath of substance into bodyA code specifying the route or physiological path of administration of a therapeutic agent into or onto the patient. For example, topical, intravenous, etc.
dosage.methodHow drug was administeredA coded value indicating the method by which the medication is intended to be or was introduced into or on the body. This attribute will most often NOT be populated. It is most commonly used for injections. For example, Slow Push, Deep IV.One of the reasons this attribute is not used often, is that the method is often pre-coordinated with the route and/or form of administration. This means the codes used in route or form may pre-coordinate the method in the route code or the form code. The implementation decision about what coding system to use for route or form code will determine how frequently the method code will be populated e.g. if route or form code pre-coordinate method code, then this attribute will not be populated often; if there is no pre-coordination then method code may be used frequently.
dosage.doseAmount of medication per doseThe amount of the medication given at one administration event. Use this value when the administration is essentially an instantaneous event such as a swallowing a tablet or giving an injection.If the administration is not instantaneous (rate is present), this can be specified to convey the total amount administered over period of time of a single administration.
dosage.rate[x]Dose quantity per unit of timeIdentifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time, e.g. 500 ml per 2 hours. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours.If the rate changes over time, and you want to capture this in MedicationAdministration, then each change should be captured as a distinct MedicationAdministration, with a specific MedicationAdministration.dosage.rate, and the date time when the rate change occurred. Typically, the MedicationAdministration.dosage.rate element is not used to convey an average rate.
eventHistoryA list of events of interest in the lifecycleA summary of the events of interest that have occurred, such as when the administration 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 administration of all medications and vaccines. Please refer to the Immunization Resource/Profile for the treatment of vaccines. It will principally be used within care settings (including inpatient) to record the capture of medication administrations, including self-administrations of oral medications, injections, intra-venous adjustments, etc. It can also be used in outpatient settings to record allergy shots and other non-immunization administrations. In some cases it might be used for home-health reporting, such as recording self-administered or even device-administered insulin.

MedicationAdministration 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 it 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.

MedicationAdministration is intended for tracking the administration of non-vaccine medications. Administration of vaccines is intended to be handled using the Immunization resource. Some systems treat immunizations in the same way as any other medication administration. Such systems SHOULD use an immunization resource to represent these. If systems need to use a MedicationAdministration resource to capture vaccinations for workflow or other reasons, they SHOULD also create and expose an equivalent Immunization instance.

Known Issues

Issue Comments
Medication Resource A medication will typically be referred to by means of a code drawn from a suitable medication terminology. However, on occasion a product will be required for which the "recipe" must be specified. This implies a requirement to deal with a choice of either a code or a much more complete resource.
Currently that resource has not been created.
Contrast Media Is this resource adequate for administering contrast media to a patient?
Author (accountability) Authorship (and any other accountability) is assumed to be dealt with by the standard FHIR methods.

Search Parameters

contextReturn administrations that share this encounter or episode of careMedicationAdministration.context
deviceReturn administrations with this administration device identityMedicationAdministration.device
effective-timeDate administration happened (or did not happen)MedicationAdministration.effective
medicationMultiple Resources: * [MedicationAdministration](medicationadministration.html): Return administrations of this medication resource * [MedicationDispense](medicationdispense.html): Returns dispenses of this medicine resource * [MedicationRequest](medicationrequest.html): Return prescriptions for this medication reference * [MedicationStatement](medicationstatement.html): Return statements of this medication reference (MedicationAdministration.medication as Reference) | (MedicationDispense.medication as Reference) | (MedicationRequest.medication as Reference) | (MedicationStatement.medication as Reference)
patientThe identity of a patient to list administrations forMedicationAdministration.subject.where(resolve() is Patient)
performerThe identity of the individual who administered the medicationMedicationAdministration.performer.actor
reason-givenReasons for administering the medicationMedicationAdministration.reasonCode
reason-not-givenReasons for not administering the medicationMedicationAdministration.statusReason
requestThe identity of a request to list administrations fromMedicationAdministration.request
statusMultiple Resources: * [MedicationAdministration](medicationadministration.html): MedicationAdministration event status (for example one of active/paused/completed/nullified) * [MedicationDispense](medicationdispense.html): Returns dispenses with a specified dispense status * [MedicationRequest](medicationrequest.html): Status of the prescription * [MedicationStatement](medicationstatement.html): Return statements that match the given status MedicationAdministration.status | MedicationDispense.status | MedicationRequest.status | MedicationStatement.status
subjectThe identity of the individual or group to list administrations forMedicationAdministration.subject

Extension Definitions

These are extension definitions for this resource defined by the spec