InstructionsForUse-v1.1(2017EN)

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General information

Name: nl.zorg.part.InstructionsForUse
Version: 1.1
HCIM Status:Final
Release: 2017
Release status: Published
Release date: 31-12-2017

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Metadata

DCM::CoderList	Projectgroep Medicatieproces
DCM::ContactInformation.Address
DCM::ContactInformation.Name
DCM::ContactInformation.Telecom
DCM::ContentAuthorList	Projectgroep Medicatieproces
DCM::CreationDate	1-3-2017
DCM::DeprecatedDate
DCM::DescriptionLanguage	nl
DCM::EndorsingAuthority.Address
DCM::EndorsingAuthority.Name
DCM::EndorsingAuthority.Telecom
DCM::Id	2.16.840.1.113883.2.4.3.11.60.40.3.9.12
DCM::KeywordList
DCM::LifecycleStatus	Final
DCM::ModelerList
DCM::Name	nl.zorg.part.GebruiksInstructie
DCM::PublicationDate	31-12-2017
DCM::PublicationStatus	Published
DCM::ReviewerList	Projectgroep Medicatieproces & Architectuurgroep Registratie aan de Bron
DCM::RevisionDate	31-12-2017
DCM::Superseeds	nl.zorg.part.GebruiksInstructie-v1.0
DCM::Version	1.1
HCIM::PublicationLanguage	EN

Revision History

Only available in Dutch

Publicatieversie 1.0 (04-09-2017)

Publicatieversie 1.1 (31-12-2017)

ZIB-617	Toevoeging aan Eenheid van Keerdosis
ZIB-643	Kleine tekstuele verbeteringen

Concept

Instructions for the use or administration of the medication, e.g. dose and route of administration. In the event of medication use, this is the pattern of use established by the patient or which the patient followed.
This is a partial information model

Purpose

InstructionsForUse gives an insight into the manner a drug is to be used.

Information Model

Type	Id	Concept						Card.	Definition	DefinitionCode	Reference
	NL-CM:9.12.22504	InstructionsForUse							Root concept of the InstructionsForUse partial information model. This root concept contains all data elements of the InstructionsForUse partial information model.
	NL-CM:9.12.19944		AdditionalInstructions					0..*	The additional instructions contain extra information on the use of or considerations for the current prescription. This can also include all instructions for use. The text can come from the original “paper" medication prescription, but can also be generated from the coded information. This concept may contain more information than what is structurally coded in the information below, but may not conflict with it. The instructions may not conflict with other components of the request for administration. The instructions can also refer to an existing protocol. The G standard contains many texts that can support this attribute, in for example G standard table 362, which contains texts from the general practitioners’ standard WCIA table 25. If desired, these texts can be used to structure this concept.
	NL-CM:9.12.9581		Description					0..1	Textual description of the complete instructions for use including the period of use.
	NL-CM:9.12.22505		RepeatPeriodCyclicalSchedule					0..1	The repeated period in a cyclical schedule (of one or more dosing instructions). A cyclic schedule is noted in days, the corresponding dosing duration is also in days. Examples of a cyclical schedule: contraceptive pill (21 days, 1 pill 1x a day, then skip for 7 days, repeat), repeat period here is 28 days
	NL-CM:9.12.19941		RouteOfAdministration					0..1	The route through which the medication is administered (oral, nasal, intravenous, etc.).		RouteOfAdministrationCodelist
	NL-CM:9.12.22095		DosingInstructions					0..*	Dosing instructions
	NL-CM:9.12.22506			DoseDuration				0..1	The intended time duration for these dosing instructions, e.g. 5 days or 8 weeks. In the case of medication for an indefinite period, the dosing duration is left empty in the last dosing instruction. Leaving dose duration empty should only be used for medication for an indefinite period.
	NL-CM:9.12.22503			SequenceNumber				0..1	This indicates the sequence of the dosing instructions within the medication agreement.
	NL-CM:9.12.19935			Dosage				0..*	Container of the Dosage concept. This container contains all data elements of the Dosage concept. Instructions for the administrator to administer the medication (the patient themselves, a nurse or other aid). When taking stock of medication use, the dosage describes the pattern of use established by the patient. Once the dose schedule (distribution of doses over time) and the dose have been determined, then there should be one single instruction for use. Multiple parallel instructions for use can be included in the event of a changing dose within one day and in the event of a variable use frequency. Multiple sequential instructions for use can be included in the event of changing doses within one period and/or in the event of a changing dose schedule.
	NL-CM:9.12.19942				AdministeringSpeed::Range			0..1	The administering speed is used in slow administration of liquid. In practice, the measuring unit is almost always ml/hour. Entering an interval (such as 0-10 ml/hour) is also a commonly used option. For example, with an administering speed of 10ml/hour: amount = 10, dose unit = ml, time unit = hour Optionally a translation to NHG table Gebruiksvoorschriften(Table 25) is also allowed.		Range
	NL-CM:9.12.23141				DurationOfAdministration			0..1	The duration of administration defines the length of time during which the drug is administered and is mainly used in the slow parenteral administration of fluids.Optionally a translation to NHG table Gebruiksvoorschriften(Table 25) is also allowed.		Range
	NL-CM:9.12.19940				Dose::Range			0..1	The dose indicates the dose amount per administration. The dosage is described in the unit accompanying the product; usually, this is just a number of units or doses. Liquids and other divisible products will usually include a unit of volume (preferably "ml"). In many cases, the prescriber will want to indicate the dose in units of weight of the active ingredient. If only the ingredient is included and not the product, then the amount of that ingredient will be given. Paracetamol 1000mg is equivalent to 2 Paracetamol 500mg tablets or units. The dosage is sometimes given as a calculation, in which the patient’s body weight or body surface area is used as a parameter. The calculation is however no more than an aid in reaching a decision. In the event of constant administration, sometimes the dose is given in addition to the administration speed (infusion rate) (e.g. 20ml in a syringe or 500ml in a bag), but it is often also omitted. A general dosage recommendation such as ‘Use according to protocol’ or ‘See instructions’ can be sufficient. In that case, no dose is given. Optionally a translation to NHG table Gebruiksvoorschriften(Table 25) is also allowed.		Range
	NL-CM:9.12.22512				AsNeeded			0..1	As needed means that the dose is only to be administered under certain conditions. See also the Instructions section for more information about use of the element.
	NL-CM:9.12.19945					Condition		0..1	The condition for administering medication can be: a physiological measurement value (plasma glucose concentration, body temperature, blood pressure); a symptom or other circumstance (in the event of a headache, or itch). Relevant B codes in Table 25 make up the list of values for coded entering of this concept. Also always include the textual description of that code. Physiological measurement values or other conditions that do not occur in the B codes in Tabel25 do not need to be coded. These can be expressed in free text in the Description concept.		AsNeededCriteriumCodelist
	NL-CM:9.12.19946					MaximumDose		0..1	A maximum dose indicates the maximum duration a product can be used with an ‘as needed’ prescription. Optionally a translation to NHG table Gebruiksvoorschriften(Table 25) is also allowed.
	NL-CM:9.12.19948				AdministeringSchedule			0..1	Specifications of the times at which the medication is to be administered. This is indicated as follows: Time(s) (16:00) or indications (“before meals”) at which the medication is to be taken each day. A specific number of times the medication is to be taken each day ("3x a day"), indicated with the frequency. A time interval between consecutive doses (“Every 2 hours”, “every 3 days”), indicated with the word Interval. Combined periods with an interval and duration (“1 daily for three out of four weeks: the pill schedule”) If a certain medication is not to be taken daily, the aforementioned can be combined with daily indications: One or more week days on which the medication is to be administered (e.g. “Monday, Wednesday, Friday”) ”3x a week”, “2x a month”. The specified administration “infinite” is automatically to be repeated until: The end date and time has been reached The total administration duration has been reached (14 days) A specific amount of administrations has been reached (“20 doses”), to be entered in the Frequency concept.
	NL-CM:9.12.19949					Frequency::Range		0..1	The frequency indicates the number of dose moments per time unit, usually per day. If this frequency is included, then the Interval will not have been included. Usually, frequency comprises both amount and time unit (3 times a day), but it can occur without the time unit (single use). In that case, a reasonable distribution over the day is expected, but exact times are not given. This is left to the patient. It is the most common manner of extramural prescription. In the case of Baxter packs and intramural care, such a prescription is used to draw up a (location-specific) outline for distribution times (logistics). The time unit of the frequency must be the same as how it is indicated in the textual description of the dose. Example: for a '2x a day...' dose: amount = 2 time unit = 'day'. for a '3x a week...' dose: amount = 3 time unit = 'week'. Optionally a translation to NHG table Gebruiksvoorschriften(Table 25) is also allowed.		Range
	NL-CM:9.12.19952					WeekDay		0..*	WeekDay indicates a pattern of doses on fixed week days.		WeekDayCodelist
	NL-CM:9.12.19953					TimeOfDay		0..*	Time of day: morning, afternoon, evening, night.		TimeOfDayCodelist
	NL-CM:9.12.19951					AdministrationTime		0..*	The time of administration is a specific time of day (on the clock). This time usually isn’t (intended to be) exact. There can be multiple administering times in one day. The ideal time of administration can also be entered as a time of day (morning, afternoon, evening, night-time). The administration time is then to be left empty, and the time of day can be entered in the TimeOfDay concept.
	NL-CM:9.12.19950					Interval		0..1	Interval indicates the time between dose times. If this is included, then the Frequency will not have been included. Examples: every 4 hours, every 3 weeks. The times can now be chosen freely, but distribution throughout the day is more precise, and the interval between times is important (e.g. in the case of antibiotics) In the case of Baxter packs and intramural care, such a prescription is used to draw up a (location-specific) outline for distribution times (logistics).

Columns Concept and DefinitionCode: hover over the values for more information
For explanation of the symbols, please see the legend page

Example Instances

Only available in Dutch

Gebruiksinstructie
Omschrijving	Doseerinstructie
	Doseerduur	Dosering|Keerdosis	Toedieningsschema |Frequentie |Interval |Toedientijd |Weekdag |Dagdeel
Van 8-9-2017 tot 18-9-2017 1x per dag 1 stuk. Vanaf 18-9-2017 staken.		1 stuk	1x per dag
Vanaf 6 maart 2016 1x per week op maandag om 14uur 15 mg (=0,6 ml)		15 mg (=0,6 ml)	1x per week op maandag (14u)

Instructions

AsNeeded dosage:
Using the term 'as needed' or a specific reason (eg 'in case of pain') to use medication leads to ambiguity. It is not always clear whether the whole dose is 'as needed' or only part of the dose. For example: 1x daily 1-2 tablets as needed. This can mean: 1 tablet fixed per day and 1 tablet as needed or, as needed, a maximum of 2 tablets.As needed medication is not included in GDS. In the first situation, 1 tablet comes in the GDS (drug dispensing systems) and 1 tablet is delivered separately. In the second situation there is only separate delivery.The system must make sufficiently clear whether the entire instruction or part of the dose is necessary. The ZIB supports both options described above.

Valuesets

AsNeededCriteriumCodelist

Valueset OID: 2.16.840.1.113883.2.4.3.11.60.40.2.9.12.4

Binding:

Conceptname	Conceptcode	Codesystem name	Codesystem OID	Description
Bij een aanval	1022	WCIAv3 Tabel 25 B-codes	2.16.840.1.113883.2.4.4.5	Bij een aanval
Bij benauwdheid	1023	WCIAv3 Tabel 25 B-codes	2.16.840.1.113883.2.4.4.5	Bij benauwdheid
Bij diarree	1024	WCIAv3 Tabel 25 B-codes	2.16.840.1.113883.2.4.4.5	Bij diarree
Bij pijn	1028	WCIAv3 Tabel 25 B-codes	2.16.840.1.113883.2.4.4.5	Bij pijn
Bij jeuk	1121	WCIAv3 Tabel 25 B-codes	2.16.840.1.113883.2.4.4.5	Bij jeuk
Zo nodig	1137	WCIAv3 Tabel 25 B-codes	2.16.840.1.113883.2.4.4.5	Zo nodig
Bij hoofdpijn	1144	WCIAv3 Tabel 25 B-codes	2.16.840.1.113883.2.4.4.5	Bij hoofdpijn
Bij koorts	1145	WCIAv3 Tabel 25 B-codes	2.16.840.1.113883.2.4.4.5	Bij koorts
Bij hoge koorts	1146	WCIAv3 Tabel 25 B-codes	2.16.840.1.113883.2.4.4.5	Bij hoge koorts
Bij koorts en/of pijn	1147	WCIAv3 Tabel 25 B-codes	2.16.840.1.113883.2.4.4.5	Bij koorts en/of pijn
Bij hoest	1387	WCIAv3 Tabel 25 B-codes	2.16.840.1.113883.2.4.4.5	Bij hoest
Overig	OTH	NullFlavor	2.16.840.1.113883.5.1008	Overig
Geen Informatie	NI	NullFlavor	2.16.840.1.113883.5.1008	Geen Informatie

RouteOfAdministrationCodelist

Valueset OID: 2.16.840.1.113883.2.4.3.11.60.40.2.9.12.1

Binding:

Conceptname	Codesystem name	Codesystem OID
Alle waarden	G-Standaard Toedieningswegen	2.16.840.1.113883.2.4.4.9

TimeOfDayCodelist

Valueset OID: 2.16.840.1.113883.2.4.3.11.60.40.2.9.12.3

Binding:

Conceptname	Conceptcode	Codesystem name	Codesystem OID	Description
During the morning	73775008	SNOMED CT	2.16.840.1.113883.6.96	s ochtends
During the afternoon	255213009	SNOMED CT	2.16.840.1.113883.6.96	s middags
During the evening	3157002	SNOMED CT	2.16.840.1.113883.6.96	s avonds
During the night	2546009	SNOMED CT	2.16.840.1.113883.6.96	s nachts

WeekDayCodelist

Valueset OID: 2.16.840.1.113883.2.4.3.11.60.40.2.9.12.2

Binding:

Conceptname	Conceptcode	Codesystem name	Codesystem OID	Description
Monday	307145004	SNOMED CT	2.16.840.1.113883.6.96	maandag
Tuesday	307147007	SNOMED CT	2.16.840.1.113883.6.96	dinsdag
Wednesday	307148002	SNOMED CT	2.16.840.1.113883.6.96	woensdag
Thursday	307149005	SNOMED CT	2.16.840.1.113883.6.96	donderdag
Friday	307150005	SNOMED CT	2.16.840.1.113883.6.96	vrijdag
Saturday	307151009	SNOMED CT	2.16.840.1.113883.6.96	zaterdag
Sunday	307146003	SNOMED CT	2.16.840.1.113883.6.96	zondag

This information model in other releases

• Prerelease 2018-2, (Version 1.1.2)
• Prerelease 2019-2, (Version 1.2)
• Release 2020, (Version 1.2.1)
• Prerelease 2021-2, (Version 1.3)
• Prerelease 2022-1, (Version 2.0)
• Prerelease 2023-1, (Version 2.0.1)
• Prerelease 2024-1, (Version 3.0)

Information model references

This information model refers to

• Range-v1.0

This information model is used in

• AdministrationAgreement-v1.0.1
• MedicationAgreement-v1.0.1
• MedicationUse2-v1.0.1

Technical specifications in HL7v3 CDA and HL7 FHIR

To exchange information based on health and care information models, additional, more technical specifications are required.
Not every environment can handle the same technical specifications. For this reason, there are several types of technical specifications:

• HL7® version 3 CDA compatible specifications, available through the Nictiz ART-DECOR® environment
• HL7® FHIR® compatible specifications, available through the Nictiz environment on the Simplifier FHIR

Downloads

This information model is also available as pdf file or as spreadsheet

About this information

The information in this wikipage is based on Release 2017
Conditions for use are located on the mainpage
This page is generated on 19/12/2018 18:28:00 with ZibExtraction v. 3.0.6927.32850

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