mp:Kickstart Workflow Intravenous Therapy

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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.