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Date: September 19, 2022

Quarter: Q3

Agenda Topics

Review of Agenda
Update on Formulary Project
Approval of Minutes of May 2022 WGM Minutes
Review of Pharmacy Projects
Update on Specialty Medication Enrolment Project
Update on Pharmacy UV Templates
Update on Pharmacy Projects
Review of Pharmacy FHIR Resources

Minutes/Conclusions Reached

Review of Agenda - Jean will talk to Patient Care about rep on Thu Q1, not able to send rep to LHS on Thu Q4

Update on Da Vinci Formulary Project - Dave Hill noted that Formulary IG was published as a new STU Update.  Mitre is done working on this project.  It will now be taken over by Lantana.

Approval of Minutes - Giorgio raised that there was a discussion Tue Q2 around MedKnowledge referencing MedicationDefinition resources.  That was not noted in the minutes and we will discuss it at this WGM.

Update on Specialty Medication Enrolment Project - Frank McKinney spoke to the recent ballot and review the dispositions.

Update on Pharmacy UV Templates - reviewed the 24 comments.  3 are actually for Pharmacy Consultation Note project.  For the remaining 21, Giorgio and Jean will review and propose dispositions for future vote on a Pharmacy conference call.

Update on Pharmacy Projects

Scott Robertson will review and present the comments on Pharmacy Consultation Note at a future Pharmacy meeting.
Jean Duteau has sent an email to Nancy Lush who commented on the withdrawal ballot to confirm she meant to vote negative.

Review of Pharmacy FHIR Resources - John Hatem reviewed the FHIR resources.  Giorgio will raise an issue on referencing MedKnowledge from Medication, and we will review on a conference call.  Jean thought there was new use cases that supported this element, eg. cross-border use of medications.

Date: September 22, 2022

Quarter: Q2

Agenda Topics

  • Waste Discussion
    • Copied from Waste document describing the issue: 
      • Project need for medication waste events: 

        There is a need for accurate visibility of medication waste events associated to specific dispense and administration events.  Applications of this would include diversion monitoring for controlled substances, patient safety, more precise inventory control, and reporting to state and DEA agencies as well as third party payers.  This could also have additional applications in the future as medication management moves away from hospitals and into more ambulatory areas as well as the home.

        Although there would be high use of this with controlled substance medications, this could be applied to high cost (e.g. specialty), high alert (e.g. chemo), or any other medication which there is a need to ‘close the loop’ for the medication.

        To close the loop with the data you will need the ‘MedicationWaste’ to be recorded.  During a waste workflow, matching/associating this even to the medication dispense and administration is needed to ensure the medication wasn’t tampered with post-administration.

      • Data/Attributes that needs to be recorded with ‘MedicationWaste’: 

        • Date/Time of Waste Event
        • User performing Waste Event
        • Medication Name/Identifier
        • Concentration or strength
        • Quantity (volume or unit
        • Patient identifier
        • Associated with a specific MedicationDIspense
        • Associated with a specific MedicationAdministration
        • (Optional) Witness to Waste Event
      • Medication Waste Event Use Cases - Below are a couple use cases illustrating where a ‘MedicationWaste’ event could be in the clinical workflow:
        • Workflow (Provider)
          • 2 mL vial hydromorphone 2 mg/mL is pulled for a case/patient by the anesthesiologist.
          • 7 mL fentanyl 2 mcg/mL is administered during case.
          • Remaining 0.3 mL fentanyl 2 mcg/mL is wasted into a waste container (‘MedicationWaste’)
        • Nursing Floor Workflow (Caregiver)
          • 50 mcg/hour fentanyl transdermal patch L pre-filled syringe morphine 4 mg/mL is dispensed based on medication order by a nurse.
          • After 72 hours of administration, 50 mcg/hour fentanyl patch is removed from patient.
          • Used 50 mcg/hour fentanyl patch is waster wasted into waste container (‘MedicationWaste’)
        • Alternate Nursing Use Case (Caregiver)
          • 1 mL pre-filled syringe morphine 4 mg/mL is dispensed from ADC by a nurse based on medication order.
          • Patient is administered 0.8 mL 4 mg/mL morphine.
          • 2 mL 4 mg/mL morphine wasted into waste container (‘MedicationWaste’)

Supporting Documents

  • no supporting documents shared this quarter.

Minutes/Conclusions Reached

  • Waste use cases were discussed and a proposed soltution was voted on re: FHIR-37337.  
    • Motion to accept the resolution was made by:  Tim McNeil / Daniel Zhang: Issue passed with vote: 3-0-1
    • See Jira for details of the tracker item.