Workflow Intravenous Therapy Kickstart

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1 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 VO37 of 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.

This working method applies to the Kickstart and will be further developed in parallel.

2 Prescribe

The following agreement applies to prescribing infusion therapy in the Kickstart:

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.

If several active substances are prescribed, this usually 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 the clinical situation, the solvent is almost never prescribed separately. One TA with the active substance will suffice.

3.2 Ambulatory situation

In the home situation, both the pharmacy and the administrator can prepare the medicine for administration.

3.2.1 Prepare infusion for administration by pharmacist

The pharmacist creates a TA with a magisterial in which both the medicine and the solvent used are registered as ingredients.

This appears as one line on the administration list.

3.2.2 Prepare infusion for administration by operator

When the operator prepares the infusion for administration, the pharmacy must supply the solvent separately from the medicine. Therefore, two separate, parallel TAs are created under one MBH, one for the solvent and one for the drug. This will result in two lines on the administration list: one for the drug and one for the solvent.

4 Administer

Special agreements have been made regarding infusion administration that only apply during the Kickstart. Not all infusion administrations will be exchanged and are therefore not available in the chain for, for example, an overview of administrations. In addition, not all information about infusion therapy is complete. Below is an explanation:

• MTD's of single products (infusions with one active substance), which may or may not be prepared for administration, are exchanged.

• Two active substances in one infusion bag can be registered in the information system as medication administration, but are not exchanged. The associated MAs and TAs can already be exchanged. The alternative is that this is exchanged as a magistral, then the MTDs can be exchanged.

• An Administration Rate can be stated in the MTD and this can be exchanged. The running speeds included in the MA and TA are also included in the MTD and can be exchanged. If application rates are not included in the MA or TA and an operator makes a change themselves, it will not be exchanged in the MTD. Changes in administration rates cannot be exchanged in the chain.

• Variations in infusion rate cannot be exchanged. For example, when a short-acting insulin is administered where variations in walking speeds apply. Pump levels can be registered in some administration registration systems. Exchange of these is not possible in the Kickstart.

• When a new syringe or infusion bag is attached to the patient and registered, the total volume will always be exchanged in the MTD. If it ultimately turns out that only half of the total volume has been administered, this can be registered by correcting the medication administration. This means that the residual volume of the infusion bag is registered in a new MTD. The relevant residual volume is recorded as a negative number, for example -200ml. This allows the total administration to be calculated. For example, the original volume of 1 l, minus the residual volume of 200 ml, results in a total administration of 1000 -200 = 800ml. See use case 4 for this

• In an admission or discharge situation, a written transfer of MTDs or other infusion data that cannot be exchanged may be necessary. Relevant MTDs from the past 24 hours can be included. The volume of an infusion that will last can also be transferred.