Medications and Parenteral fluids archetypes

Heather Leslie heather.leslie at oceaninformatics.com
Mon Oct 17 01:18:18 EDT 2016


Hi everyone,

Seeking advice from the broader community regarding an important modelling issue...

At present the Medication Order (INSTRUCTION.medication) archetype is undergoing community review.

The primary author has proposed that the scope include IV and other parenteral fluid administration which is regarded as therapeutic item by many as even fluids such as Normal Saline or Glucose infusions need to be prescribed. This was not clearly represented in the metadata in previous review rounds and it appears that the archetype will cater for this, albeit with the very medication-specific data elements alongside.

This is the question posed to reviewers, within the current review:

"A significant question has arisen as to whether this archetype should be used for fluid orders, particularly parenteral (IV, IM, SC) orders. Predecessors of this archetype have been used in production to order fluids, where in some settings is normal practice to consider fluid orders as 'prescribables', and therefore considered a 'therapeutic good'. Others have disagreed and feel that 'fluid intake orders' ( to include oral and parenteral fluids) should be handled by a separate INSTRUCTION archetype. It is quite possible that both approaches may have to be supported, reflecting difference in practice but your views and practical experience would be helpful in resolving the scope of this archetype. A further question is the order of 'blood transfusions' - current thinking appears to be that this should be a separate archetype."

So the options are to create an additional archetype (effectively a more focused subset of the INSTRUCTION.medication) that could cater purely for parenteral fluids or use the Medication Order to cover both, which is not intuitive if ordering IV fluids is regarded as a separate process to ordering medications.

Perhaps having both is also a reasonable answer and allow implementers to make their own choice - atcodes/paths could be closely aligned.

PLEASE DON'T RESPOND IN THIS EMAIL THREAD.

Instead we ask that you participate via the Clinical Knowledge Manager as soon as possible in either of these two ways:


1.       If you have already been invited to the review, please complete it as soon as possible; OR

2.       If you have not been invited so far but would like to participate please ADOPT the archetype by following these instructions - https://openehr.atlassian.net/wiki/display/healthmod/Adopt+an+archetype

The review is due to close in the next few days, so your timely response would be much appreciated.

Regards

Heather Leslie (EDITOR)

Dr Heather Leslie MBBS FRACGP FACHI
CCIO, Ocean Informatics<http://www.oceaninformatics.com/>
Clinical Programme Lead, openEHR Foundation<http://www.openehr.org/>
p: +61 418 966 670   skype: heatherleslie   twitter: @omowizard

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