mp:Kickstart Workflow Intravenous Therapy: verschil tussen versies

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Regel 9: Regel 9:
 
=Introduction=  
 
=Introduction=  
  
The information standard Medication Process 9 (MP9) has not yet been fully developed. Further development is needed, among other things, for the exchange of data regarding infusion therapy. That is why separate agreements have been made for the Kickstart based on decision VO37of the core team decisions. This decision does not make it sufficiently clear what infusion data is and is not exchanged. Further elaboration has been made in consultation with administration sectors, medical specialists and a number of software suppliers. This is explained below for different situations.  
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The Medication Process 9 (MP9) information standard is currently under development and needs further refinement, particularly concerning the exchange of data related to infusion therapy. As a temporary solution, specific agreements for the Kickstart have been established, based on [[mp:Besluiten_kernteams|decision VO37 ]] of the core team. However, this decision lacks clarity on the specifics of what infusion data should be exchanged. Therefore, further elaboration has been conducted in consultation with administrative sectors, medical specialists, and various software suppliers.  
  
This working method applies to the Kickstart and will be further developed in parallel.
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This document outlines the detailed approach for different situations and serves as a provisional working method for the Kickstart, with ongoing development to follow.
  
 
=Prescribe=   
 
=Prescribe=   
The following agreement applies to prescribing infusion therapy in the Kickstart:
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The following agreement applies to prescribing infusion therapy during the Kickstart phase:  
  
The active substance is included in the MA. A reference to a schedule or protocol for preparing the infusion or solvent can be included in the data element 'Explanation'. The same applies to (short-acting) insulins.  
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The active substance must be included in the Medication Agreement (MA). A reference to a schedule or protocol for preparing the infusion or solvent can be included in the 'Explanation' data element. This also applies to (short-acting) insulins.  
  
If several active substances are prescribed, this usually results in the same number of MAs or a magistral.
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If multiple active substances are prescribed, this typically results in the same number of MAs or a magistral. If the infusion preparation listed in the G standard includes multiple active substances, it can be selected as a single product in the medication agreement. This means it will not result in multiple medication agreements.
  
 
=Dispense=
 
=Dispense=
Regel 24: Regel 24:
 
==Clinical situation==  
 
==Clinical situation==  
  
In the clinical situation, the solvent is almost never prescribed separately. One TA with the active substance will suffice.
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In a clinical setting, the solvent is almost never prescribed separately. A single treatment administration (TA) containing the active substance is typically sufficient.
  
==Ambulatory situation==
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==Ambulatory Situation==
  
In the home situation, both the pharmacy and the administrator can prepare the medicine for administration.
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In a home setting, both the pharmacy and the administrator have the capability to prepare the medicine for administration.  
  
===Prepare infusion for administration by pharmacist===
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===Preparation of Infusion by Pharmacist===
  
The pharmacist creates a TA with a magisterial in which both the medicine and the solvent used are registered as ingredients.  
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The pharmacist prepares a TA with a compounded medication, in which both the drug and the solvent are registered as ingredients. This results in a single entry on the administration list.  
  
This appears as one line on the administration list.
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===Preparation of Infusion by Administrator===
  
===Gereedmaken infuus voor toediening door toediener===
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When the administrator prepares the infusion, the pharmacy must provide the solvent separately from the medication. Consequently, two separate, parallel TA's are created under one medication batch history (MBH): one for the solvent and one for the drug. This results in two entries on the administration list: one for the drug and one for the solvent.
  
Wanneer de toediener het infuus voor toediening gereed maakt, moet de apotheek het oplosmiddel apart leveren van het geneesmiddel.  Er worden daarom twee aparte, parallelle TA’s aangemaakt onder één MBH, een voor het oplosmiddel en een voor het geneesmiddel. Dit zal leiden tot twee regels op de toedienlijst: één voor het geneesmiddel en één regel voor het oplosmiddel.
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=Administer=
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==Special Agreements for Infusion Administration During Kickstart==
  
=Toedienen=
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Special agreements have been established for infusion administration that apply only during the Kickstart phase. Not all infusion administrations will be exchanged, meaning some data may not be available for an administration overview. Additionally, some information about infusion therapy may be incomplete. Below are the details:
  
Met name rondom infuustoedieningen zijn aparte afspraken gemaakt die alleen gelden tijdens de Kickstart. Niet alle infuustoedieningen zullen worden uitgewisseld en zijn dan ook niet beschikbaar in de keten voor bijvoorbeeld een overzicht ten behoeve van toedieningen. Daarnaast is niet alle informatie over infuustherapie volledig. Hieronder volgt een toelichting:
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* '''Single Product MTDs''': Medication Treatment Descriptions (MTDs) of single-product infusions (those with one active substance), whether prepared for administration or not, are exchanged.  
 
* MTD’s van enkelvoudige producten (infusen met één werkzame stof), die al dan niet voor toediening gereed worden gemaakt, worden uitgewisseld.
 
  
* Twee werkzame stoffen in één infuuszak kunnen wel in het informatiesysteem als medicatietoediening geregistreerd worden, maar worden niet uitgewisseld. De bijbehorende MA’s en TA’s kunnen al wel voor worden uitgewisseld. Alternatief is dat dit als magistraal wordt uitgewisseld, dan kunnen de MTD’s wèl uitgewisseld worden.  
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* '''Dual Active Substance Infusions''': Infusions containing two active substances in one bag can be recorded in the information system as medication administration but are not exchanged. The associated Medication Administrations (MAs) and Treatment Administrations (TAs) can be exchanged. Alternatively, these can be exchanged as compounded medications, allowing the MTDs to be exchanged.  
  
* In de MTD kan een Toedieningssnelheid vermeld worden en deze kan worden uitgewisseld. De loopsnelheden die zijn opgenomen in de MA en de TA, worden ook opgenomen in de MTD en kunnen worden uitgewisseld. Wanneer toedieningssnelheden niet zijn opgenomen in de MA of de TA en een toediener brengt zelf een wijziging aan, wordt deze niet in de MTD uitgewisseld. Wisselingen in toedieningssnelheden kunnen niet worden uitgewisseld in de keten.  
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* '''Administration Rate''': An Administration Rate can be stated in the MTD and exchanged. The administration rates included in the MA and TA are also included in the MTD and can be exchanged. If rates are not included in the MA or TA and an operator makes a change, it will not be exchanged in the MTD. Changes in administration rates cannot be exchanged.  
  
* Wisselingen in loopsnelheid kunnen niet worden uitgewisseld. Bijvoorbeeld, wanneer een kortwerkende insuline toegediend wordt waarbij wisselingen in loopsnelheden van toepassing zijn. In sommige toedienregistratiesystemen kunnen pompstanden wel geregistreerd worden. Uitwisseling hiervan is in de Kickstart niet mogelijk.  
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* '''Infusion Rate Variations''': Variations in infusion rate, such as those for short-acting insulin, cannot be exchanged. Pump levels can be registered in some administration systems, but their exchange is not possible during the Kickstart.  
  
* Wanneer er een nieuwe spuit of infuuszak wordt aangehangen bij de patiënt en geregistreerd, zal altijd het totale volume worden uitgewisseld in de MTD. Wanneer uiteindelijk blijkt dat maar de helft van het totaal volume is ingelopen, kan dit geregistreerd worden door de medicatietoediening te corrigeren. Dit betekent dat het restvolume van de infuuszak wordt geregistreerd in een nieuwe MTD. Het betreffende restvolume wordt geregistreerd als een negatief getal, bijvoorbeeld -200ml. Hiermee kan de totale toediening berekend worden. Het originele volume van bijvoorbeeld 1 l, min het restvolume van 200 ml, resulteert in een totale toediening van 800ml. Zie hiervoor use case x
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* '''Syringe or Infusion Bag Changes''': When a new syringe or infusion bag is attached and registered, the total volume will always be exchanged in the MTD. If only part of the volume is administered, the remaining volume is registered in a new MTD as a negative number (e.g., -200 ml). This allows the total administration to be calculated (e.g., an original volume of 1 liter minus the residual volume of 200 ml results in a total administration of 1000 – 200 = 800 ml). See use case 4 for details.
  
* In een opname- of ontslagsituatie kan een schriftelijke overdracht nodig zijn van MTD’s  of andere infuusgegevens die niet uitgewisseld kunnen worden. Hierbij kunnen relevante MTD’s van de afgelopen 24 uur meegegeven worden. Ook kan hierbij het volume van een infuus dat meegaat, worden overgedragen.
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* '''Admission or Discharge Situations''': A written transfer of MTDs or other non-exchangeable infusion data may be necessary. Relevant MTDs from the past 24 hours can be included, and the volume of ongoing infusions can also be transferred.

Huidige versie van 11 jun 2024 om 09:02


1 Introduction

The Medication Process 9 (MP9) information standard is currently under development and needs further refinement, particularly concerning the exchange of data related to infusion therapy. As a temporary solution, specific agreements for the Kickstart have been established, based on decision VO37 of the core team. However, this decision lacks clarity on the specifics of what infusion data should be exchanged. Therefore, further elaboration has been conducted in consultation with administrative sectors, medical specialists, and various software suppliers.

This document outlines the detailed approach for different situations and serves as a provisional working method for the Kickstart, with ongoing development to follow.

2 Prescribe

The following agreement applies to prescribing infusion therapy during the Kickstart phase:

The active substance must be included in the Medication Agreement (MA). A reference to a schedule or protocol for preparing the infusion or solvent can be included in the 'Explanation' data element. This also applies to (short-acting) insulins.

If multiple active substances are prescribed, this typically results in the same number of MAs or a magistral. If the infusion preparation listed in the G standard includes multiple active substances, it can be selected as a single product in the medication agreement. This means it will not result in multiple medication agreements.

3 Dispense

3.1 Clinical situation

In a clinical setting, the solvent is almost never prescribed separately. A single treatment administration (TA) containing the active substance is typically sufficient.

3.2 Ambulatory Situation

In a home setting, both the pharmacy and the administrator have the capability to prepare the medicine for administration.

3.2.1 Preparation of Infusion by Pharmacist

The pharmacist prepares a TA with a compounded medication, in which both the drug and the solvent are registered as ingredients. This results in a single entry on the administration list.

3.2.2 Preparation of Infusion by Administrator

When the administrator prepares the infusion, the pharmacy must provide the solvent separately from the medication. Consequently, two separate, parallel TA's are created under one medication batch history (MBH): one for the solvent and one for the drug. This results in two entries on the administration list: one for the drug and one for the solvent.

4 Administer

4.1 Special Agreements for Infusion Administration During Kickstart

Special agreements have been established for infusion administration that apply only during the Kickstart phase. Not all infusion administrations will be exchanged, meaning some data may not be available for an administration overview. Additionally, some information about infusion therapy may be incomplete. Below are the details:

  • Single Product MTDs: Medication Treatment Descriptions (MTDs) of single-product infusions (those with one active substance), whether prepared for administration or not, are exchanged.
  • Dual Active Substance Infusions: Infusions containing two active substances in one bag can be recorded in the information system as medication administration but are not exchanged. The associated Medication Administrations (MAs) and Treatment Administrations (TAs) can be exchanged. Alternatively, these can be exchanged as compounded medications, allowing the MTDs to be exchanged.
  • Administration Rate: An Administration Rate can be stated in the MTD and exchanged. The administration rates included in the MA and TA are also included in the MTD and can be exchanged. If rates are not included in the MA or TA and an operator makes a change, it will not be exchanged in the MTD. Changes in administration rates cannot be exchanged.
  • Infusion Rate Variations: Variations in infusion rate, such as those for short-acting insulin, cannot be exchanged. Pump levels can be registered in some administration systems, but their exchange is not possible during the Kickstart.
  • Syringe or Infusion Bag Changes: When a new syringe or infusion bag is attached and registered, the total volume will always be exchanged in the MTD. If only part of the volume is administered, the remaining volume is registered in a new MTD as a negative number (e.g., -200 ml). This allows the total administration to be calculated (e.g., an original volume of 1 liter minus the residual volume of 200 ml results in a total administration of 1000 – 200 = 800 ml). See use case 4 for details.
  • Admission or Discharge Situations: A written transfer of MTDs or other non-exchangeable infusion data may be necessary. Relevant MTDs from the past 24 hours can be included, and the volume of ongoing infusions can also be transferred.