A mixture. They tend to be for dynamic situations where the patient may fluctuate between being able to take orally or not (the common perioperative situation), or have intermittent IV access.
It isn’t commonly done really, but it is done commonly enough that it really should be catered for.
For clinical safety, the absorbed amount of drug is the vital variable. I doubt that any current system takes it into account though (would love to be proven wrong)!
I think the commonest use case for this kind of prescribing via a choice of either Route A OR Route B, but not both, is in pain relief - making sure appropriate analgesics can be given as required. Post op is a common use case and it was routine for all my palliative care patients, back when I was a lass.
yup agree. We do already cover those simple instructions where the same dosage instructions apply every route. Our solution is actually more sympathetic to that scenario than the FHIR models since we allows common instructions for all routes .
THe question is whether there are situations where different dose instructions can be applied to each route without creating multiple orders.I can imagine some use cases for that e.g. Paracetamol Oral / Paracetamol IV - right arm (for someone with lymphoedema). I am also coming across some possible requirements in mental health but so far the professional guidance is somewhat unclear - digging further!!
If we did decide to go down this road it would mean a very significant breaking change to the archetype , so I think we want to be clear that there is a solid and safe reason for doing so, and I that is the case, it might be an opportunity to review the overall design (in terms of supporting Med Statement etc).
This is not my area obviously, but just ruminating on this whole conundrum… is there value in considering alternate routes of the same medications (i.e. the scenario where specialist nurses might decide on the ward) as the same (in IT & modelling terms) as literally alternate medications, which I assume must be dealt with somewhere, i.e. to cover cases of allergy, unavailability (e.g. while travelling) or just ‘finding one that works’ (e.g. mental health)? Then each route version of morphine (say) is actually a separate medication order.
This idea might come undone if these route variations can occur on the same ‘order’, but normally an order = one form of a medication AFAIK. If on the ward morphine can be supplied PO or IV, it implies that it is already generally available in some sense, i.e. each new pack or IV vial is not separately ‘ordered’. I’m guessing a bit here…
Anyway, just an idea…
Hi THomas - that is indeed the de-facto situation i.e the prescriber has to create 2 separate orders for each route/associated dose. In hospital prescribing, the form is normally not defined - just route. The exact form is often left to ward staff/pharmacist to choose
There are clinical safety concerns either way , and the 2 orders approach is often mandated in local guidance.
.If the form or product is prescribed, I would say that should probably be 2 orders but this is where we need good pharmacy colleague advice. Working on it!!
Is there currently a way to associate N ‘alternate’ medications, i.e. ones that are supposed to have the same therapeutic effect? Probably tricky territory I guess, since ACE inhibitors and Beta-blockers are at some level ‘alternatives’ for hypertension, but have totally different physiological mechanisms…
The answer is, for the reasons you gave is no, but here we are definitely in the area of a single medicinal substance only.
We can sort of track what you suggested via Clinical indication e.g Hypertension.