Medication ACTION archetype - time to reassess

The current ACTION.medication archetype was first uploaded to CKM in 2008, and already then combined the processes of ordering, prescribing, administering and dispensing. This pattern was retained when the archetype was reviewed and published in 2017, even though there was pushback in the reviews about combining these two into a single archetype.

New requirements to better handle the details around administration, particularly of interval-in-time administrations like infusions, makes the current model difficult to use.

Together with other editors I’ve had a look at how the situation can be improved. Our main suggestion is to pare the current archetype down to an “ACTION.medication_order” and considering only the order management process. This archetype would have one (current) instance per order.

Then we can separate out the care flow steps about administration into a new archetype “ACTION.medication_administration”. This enables us to support suspending administrations, and also support double checking in a much better way. This archetype would have one (current) instance per administration time/dose.

It’s likely it’ll be necessary to specialise the “ACTION.medication_order” into an “ACTION.medication_order-prescription”, to support the specific needs of the prescription/dispensing process.

We’d like to get feedback from the community regarding how these proposed changes would work for known use cases.

For details, see this Xmind workbook outlining the two main “order management” and “administration” archetypes, and the possible specialisation for prescriptions: 2024-05-24 Medication ACTION redesign | Silje Ljosland Bakke - Xmind

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I approve.

Also wonder if this is an opportunity to start to review all of the medication archetypes. I know I have pushed back on this in the past but there is clearly quite a lot of overlap between Statement, Order and Actions that

Specialisation of the order-> community prescribing does make sense but might need some careful investigation to understand the national variations in community prescribing as the split between what is in order vs. prescribing might be tricky to delineate.

Ian

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I agree. Apart from the main ACTION, the INSTRUCTION.medication_order is currently unnecessarily large and unwieldy, and there may be a case for revisiting the therapeutic direction/timing/dosage complex, although I don’t have a clear idea about how the latter could be improved.

Definitely. In some jurisdictions, the base order ACTION can probably be used, while in others there may be a need for several additional care flow steps.