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Track Name

Workflow of Medication Administration Process

 

Submitting WG/Project/Implementer Group

IHE Pharmacy, GS1 Netherlands, HL7

 

Justification


This profile is originally described for a home nursing setting, where nurses visit patients residing in their own homes for the daily medication administration rounds, but the workflow is identical in an institutional environment, where the use of mobile apps on tablets and smartphones are quickly replacing the traditional method of administration requests on paper reports.

The main drive of this profile is to replace the error prone paper administration requests with an efficient process to ensure the 5 rights of administration: right patient, right medication, right dosage, right route at the right time. This workflow is described in the IHE Pharmacy profile called Mobile Medication Administration ( MMA).

The combination with the use of barcoding is to  ensure patient and medication safety. Apps with the combination of camera’s on tablets and smartphones are able to decipher barcodes. Patients should have a wristband or a patient card with a barcode and the drugs, provided in strips or blisters should contain a barcode. This workflow is described in the IHE Pharmacy profile called Uniform Barcode Processing ( UBP).

 

 

Related tracks

LIR

 

Proposed Track Lead

Esther Peelen

Michael Tan

Michael van der Zel

 

Expected participants

-        Hospital  Pharmacy systems: Hix, HiSystems, DXC, Nexus

-        Home Nursing, Care systems: Nedap, Medimo, Farmedvisie

-        Medication Administration systems: Medeye, Philips Medido

 

Roles

Please include information here regarding how much advance preparation will be required if creating a client and/or server.

Figure 1 Medication administration process

 

 

Figure 2 Barcode decoding process

Role 1 Hospital / Nursing Pharmacy System NPS

This system is the Medication Administration Request Placer that generates the instructions for the nursing staff (the performers) to do their rounds at certain time slots and administer one or more medication for certain patients. Upon request it will provide a performer with the proper list of patients and their medication for that specific performer.

 

At the end of the workflow the actual administration is reported back to the NPS. The system fulfills the role of the medication administration consumer.

Role 2 Medication Administration System MAS

The MAS system is the administration performer that places the request for the medication administration lists. It receives a collection of administration requests for a group of patients from the medication administration request placer for a certain time slot (round).

 

The MAS also triggers the decoding of the barcodes of patients and drugs. If barcodes are not in use, then the patient ID and drug ID’s should be entered manually.

 

After the round the MAS is the medication administration informer, that informs the NPS about the actual medication consumption.

 

Role 3 Barcode Reader Consumer

The barcode consumer is the system that scans a barcode. This could be a tag from a patient containing a barcode or a data matrix, or a barcode/ data matrix from a pouch from a baxter, or barcode / data matrix from a blister pack or box of medication.

 

Role 2 and role 3 could be the same system.

 

Role 4 Barcode Processor

The Barcode processor receives a  string to decode. This could either be a patient ID or a Product ID.

Specs: http://www.ihe.net/uploadedFiles/Documents/Pharmacy/IHE_Pharm_Suppl_UBP.pdf

https://github.com/mvdzel/ihe-ubp-fhir + demo url[MT1] 


 

 

Scenario’s

Scenario 1 Happy flow administration request handling

 

  1. The NPS provides multiple medication administration instructions for different nurses on different rounds with multiple medication.
    1. Upon request it provides the request placer with the correct performer and round.
    2. If requestor is unknown or not in duty then the request is politely denied.
    3. Upon return after the rounds the administration reports are digested.
  2. The Medication Administration systems is used by the nurse to assist her during her tour to administer medication to a group of patients during a certain round.
    1. Place a request for a round for the particular performer at a certain date/time and load the input into the MAS.
    2. Repeat the administration event with several patients, each consuming at least 2 medications and confirm the consumption of the medication.
    3. When using barcoding read the barcode tags of patient and drugs and send the strings to the barcode processor.
    4. Digest the reply of the processor into the administration data.
    5. Report the medication administration consumption of all patients back to NPS at the end of the workflow
  3. Barcode processor
    1. Receive a string for either a patient or drug from the perfomer ( MAS).
    2. Retrieve the attributes for patient or drug from a server and return the appropriate answers.

 

Preconditions:

1.     The NPS has a list of 5 patients, 2 nurses. Each patient are required to consume at least 4 drugs.

2.     The MAS should have a clean system.

3.     The barcode decoding system should be able to recognize the patients and the medication that will used in the scenario.

 

Success criteria:

1.     The scenario is succesful when the MAS is able to report the medication administration back to the NPS.

 

 

Scenario 2 Administration request handling with exceptions

 

  1. The NPS provides multiple medication administration instructions for different nurses on different rounds with multiple medication.
    1. Upon request it provides the request placer with the correct performer and round.
    2. Upon return after the rounds the administration reports are digested. This includes OTC and conditional medication, that were not mentioned in the administration list.
    3. The NPS also processes the information of medication that were not consumed.
  2. The Medication Administration systems is used by the nurse to assist her during her tour to administer medication to a group of patients during a certain round.
    1. Place a request for a round for the particular performer at a certain date/time and load the input into the MAS.
    2. Repeat the administration event with several patients, each consuming at least 2 medications and confirm the consumption of the medication.
    3. Process medication that were not consumed. ( for example no supply).
    4. When using barcoding read the barcode tags of patient and drugs and send the strings to the barcode processor.
    5. Digest the reply of the barcode processor into the administration data.
    6. Process OTC medication that were not mentioned on the administration list in a similar manner.
    7. Report the medication administration consumption of all patients back to NPS at the end of the workflow
  3. Barcode processor
    1. Receive a string for either a patient or drug from the perfomer (MAS).
    2. Retrieve the attributes for patient or drug from a server and return the appropriate answers.

 

Preconditions:

4.     The NPS has a list of 5 patients, 2 nurses. Each patient are required to consume at least 4 drugs.

5.     The MAS should have a clean system.

6.     The barcode decoding system should be able to recognize the patients and the medication that will used in the scenario.

 

Success criteria:

2.     The scenario is succesful when the MAS is able to report the medication administration including the exceptional status and OTC back to the NPS.

 

 

 

 

 

TestScript(s)

 

Security and Privacy Considerations

Resource must be anonymized/masked when submitted to the Implant Registry.

Identification of hospital through AGB or URA or Client Certificate?


 [MT1]Decoder voor geneesmiddelen nodig.

Decoder voor BSN?

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