These medicationRequest examples require use of additionalInstruction elements.
Examples use combinations of the following elements of the CareConnect medicationRequest and FHIR Dosage structure;
- dispenseRequest
- additionalInstruction (using a coded concept)
- sequence (sequential and concurrent instructions)
- maxDosePerPeriod
- asNeededCodableConcept
- rateRatio
- rateRange
- duration
- periodMax
Microgynon 30 tablets (Bayer Plc), 63 tablets
This example includes a dispenseRequest instruction so represents the clinical information that could be shared as part of a FHIR-based primary care prescription between a prescribing and dispensing clinical system.
Simvastatin, 40mg, oral, once a day
Aspirin 300mg dispersible tablets, two tablets to be taken four times daily well diluted in water. To be taken with or after food.
Oxygen by inhalation 1 to 2 litres per minute via nasal cannula
Prednisolone 5mg tablets, have 8 tablets a day after food for 7 days then stop
Loperamide 2mg capsules, take two capsules (4 mg) immediately followed by one capsule (2 mg) after each episode of diarrhoea. Daily dose should not exceed eight capsules (16 mg)
Microgynon 30 tablets (Bayer Plc), 1 tablet, ONCE a DAY, oral, for 21 days, subsequent courses repeated after 7-day tablet-free interval
Salbutamol, 100-200mcg to be inhaled when required up to 4 times daily, using the metered dose device
Salbutamol, 5mg to be given via a nebuliser. Repeat every 20-30 minutes as required
Phenoxymethylpenicillin 250mg tablets, 2 tablets every 6 hours an hour before food or on an empty stomach, oral
Complex because “on an empty stomach” is not a coded SNOMED-CT code nor in a FHIR value-set. To avoid confusion with a coded “before food”, the complete instruction “an hour before food or on an empty stomach” is conveyed as free-text within additionalInstruction.
Prednisolone, 7.5-30 mg once daily, adjusted according to response
Complex because the instruction to “adjusted according to response” cannot be coded information so is conveyed as free-text within additionalInstruction.
Migraleve tablets (McNeil Products Ltd), initially 2 pink tablets to be taken at onset of attack followed by 2 yellow tablets every 4 hours if required. maximum 2 pink and 6 yellow tablets in 24 hours
Complex because specific instructions related to combination products is not currently supported within the STU3 Dosage structure.