For a patient encounter in an Accident and Emergency cubicle, which Medication archetype would be the most appropriate for use as immediate treatment within the cubicle? We are torn between Medication Management and Medication order.
Hi Candice, I worked with emergency doctors in the past. As a general criteria, when a medication or procedure is recorded after it’s done, I would classify that as an ACTION. But if there is an indication explicitly recorded, it’s an INSTRUCTION. That can give you an idea of which archetype to use.
3 Likes
Thank you! That makes a lot of sense.
Hi Candice,
Yup Pablo is correct.
Formally that would probably be a medication dispense - meds given to take home, or a medication administration, so the ACTION.medication archetype would handle each or both of these steps.
Depending on the exact process and requirement, you might also need the INSTRUCTION to record the details of the original order (which in this case might be implicit) e.g If a nurse gives the patient painkillers to take home, someone somewhere had to authorise that. It is not necessary in openEHR to tie every ACTION to the original INSTRUCTION as it may not be recorded as an explicit order, but there are some advantages.
So ‘properly’ you would use both, but using the ACTION of dispensed/administered could be acceptable as a proxy for an explicit order.
2 Likes
Hey Pablo, clinical indication has just been added to the ACTION in the last week, specifically to support the many situations where only the ACTION is used. It also has the following comment: “If only an ACTION is used to record a medication indication, this data element can be used without additional consideration. However, if a clinical indication is recorded for both the Medication order INSTRUCTION and this Medication management ACTION, be aware that these indications might not be consistent.”
2 Likes
Thanks Heather, that seems reasonable. Even recording these data elements in paper could result on inconsistencies, I guess that is an implementation-related issue more than clinical modeling. Something else could happen in emergency care: the medication administration could be executed without an order, then on the record they put the order and the administration. This could be to follow a local protocol, or because the ‘order’ was verbal, like a doctor to a nurse. It’s difficult in an urgent situation to be too picky 
Here in Uruguay, I worked in an emergency department and talked with the doctors and nurses there. Car accidents (they don’t call these accidents because most could be prevented), gun shots, knife wounds, etc. The ER can get crazy and they only care about keeping the patient alive, recording always comes second, and I guess consistency comes later.
2 Likes
Precisely. In an ideal situation, there would be a matching INSTRUCTION and ACTION with no overlap, perfectly modelled. But real medicine is messy and in a life and death situation we are probably lucky if an accurate record of all drugs administered is captured. In distributed, non-integrated systems the INSTRUCTION maybe recorded in original system, and the receiving system carries out the administration and recording as an ACTION.
So the ACTION models may look messy or may have some overlap for these reasons. Good modelling will hopefully identify these potential duplications/overlaps so it can be managed appropriately at implementation.
2 Likes