Any idea about medication order archetype >> compound drug dispense amount issue

I’m working on POC medication order archetype but got stuck about dispensing quantity.

At first medication archetype look like it can handle most of the medication order complexity.
compound drug( like Ceftriaxone 2 grams + 5%DW 100 ml IV drip in 30 min)
tapering drug( like prednisolon 3 tab twice a day in day 1 and 2 tab twice a day between day 2-5 )

but 1 big issue I can’t solve is when combine this with dispense amount.

such as compound drug
Ceftriaxone 2 grams + 5%DW 100 ml IV drip in 30 min

Ceftriaxone 2 grams is medication_detail sequence 1
5%DW 100 ml is medication_detail sequence 2

the total dispense amount for ceftriaxone is 2 vial (1 gram / vial)
and total dispense amount for 5%DW100 ml is 1 bottle(100ml/bottle)

but since dispense amount has 1 to 1 relationship with medication_item that’s mean it cannot be state amount of it 2 consituent_substance (Ceftriaxone and 5%DW)

I’m not sure i’m missing something but if anyone can give me an example would be appreciated.


Interesting issue.

The situations that the current archetype are designed to handle are

1, Typically community/outpatient orders where the order contains dispense directions since generally a fixed product is dispensed. Where a mixture is dispensed, as in your use case above, this would generally be ‘made-up’ by the pharmacy and dispensed as a combined/mixed product so ‘1 bottle’

2, In hospital inpatient systems , things are generally different in that the medication order is really and order to administer (to the nursing staff), and not an order to dispense per-se. Often the pharmacy will supply the independent ingredients to the ward as part of stock control, which is not directly related to an individual order. There is no explicit dispense order as part of the prescription. There will be occasions where the mixture is made up by the pharmacy but thene we are back to the single product’ being supplied, nad I doubt if this would be specified as part of the order.

What you seem to be suggesting is a mix of these scenarios above - where a mixture is prescribed but where the components of that mixture are also specified to be dispensed. Do you have an example you can share of the current documentation, as I have not seen that described before?

As I live in Thailand, our context is there is a shortage of pharmacist and there are no pharmacist available 24 hr in many small hospitals. And we don’t separate between phamarcy and clinic distinctively like western do(if there is a clinic or hospital either big or small there will be a dispensing unit there).

As a result many HIS design their software so that doctor can order and dispense at the same time and pharmacist just follow dispense amount from doctor order
As time goes by it become norms here.

And my example of ceftriaxone 2 g+5DW 100 ml is part of that norms

This make me wonder how western hospital usually do about other attributes of medication_item like medication safety since those attribute should adhere with medication_detail_name not the medication_item itself because there are so much possibilities for medication item such as cef3 can be mix with 5%dw , nss, 5%dn/2 etc and I don’t think we have to put med safety for each of this mixtures.

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Thanks make more sense now.

However would the pharmacy supply the ‘made-up mixture’ or the individual components, for the clinic to make up?

My first thought would be to perhaps create a local Thai Cluster archetype, like ‘Dispensing component details’ with a multiple occurence slot to carry a Medication archetype for each component and an overall text comment. This could be carried in the Dispense details slot.

That would allow you to define each each component which is to be dispensed, as well as the ‘mixture order’ in the normal medication details slot.

I think it might get very messy/unsafe to try to handle both ‘dispensed component quantities’ and the ‘ordered mixture’ quantities in the same place.

This is quite controversy here.

I would say it depend on hospitals since some hospitals try to adopt separate dispensing unit model(as a safer model for patient) and some hospitals does not.
So in some hospital, the mixture send to nurse station as a whole. but the others will send as a separate components.

So that would also be a common situation in UK hospitals. In some cases the pharmacy would provide the product pre-mixed (especially something like Chemotherapy) but in most cases the nurses/doctors prepare the final product themselves. In neither situation would I expect to give the pharmacy a ‘dispense instruction’.

I suspect the issue for you, is that since an external pharmacy is involved, they need to be given dispense instructions for each component, when they are not expected to prepare the product themselves.

The only other way oif doing this would be to create a completely separate dispense request for the components - essentially a stock order, not a prescription at all, and arguably nothing to do with a specific patient.

So in UK. Prescribing unit and Dispensing unit using two separate UI for each right?
Here in Thailand. Most of HIS I’ve seen so fat use the same UI for Prescribing and Dispensing unit.
Doctor is prescribing medicine with dispense quantity.
when Patient arrive at dispensing unit, pharmacist using same UI as doctor(with limitation of adding any new
or delete medicine) and click dispense the same quantity that doctor ordered.
Not sure if it’s the same as HIS in UK?

It is completely different in UK, and IO think across Europe???

The pharmacy system and prescribing systems are generally separate though may share data via messaging.

I asked a UK pharmacist about hospital practice and we do not know of any cases where a prescriber would be expected to add dispense instructions fir an in-patient setting.
In the UK for community/out-patients e.g. for a complex infusion (very unusual), the prescriber would have to create a prescription for each prescribable component, but only the main item would normally carry the medication order/mixture instructions. I don’t think our electronic prescribing/ pharmacy systems could cope with a mixed dispensing order.

that’s need a lot of work for changing this workflow.
Thanks for your responsive answer.

This is what makes this workspace so fascinating. Every time I think I understand all the variations, a new use-case pops up.

I think the suggestion I have you would work for your use -case. The record of the dispense activity would be interesting as we would use an ACTION.medication archetype for that - arguably 3 instances - one for each component and one for the final product, probably influences by pharmacist billing /reimbursement

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