Practical examples Administer

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1 Parallel administration agreements, of which one is modified

The GP prescribes pantoprazole for a patient with dyspeptic symptoms:

MA: pantoprazole 20 mg tablet, 1 tablet 2–3 times daily

The fixed dose of 2 tablets is supplied via the GDS system and provided by the GDS supplier as Sandoz. The third tablet is for use ‘as needed’ and is dispensed separately as Teva. This results in two parallel TA’s.
At a certain point, the GDS supplier is temporarily unable to provide pantoprazole. The supplier has Teva in stock and modifies the TA for the fixed dose from dispensing in GDS to dispensing in separate packs. Stopping the GDS TA does not affect the ‘as needed’ TA; this continues unchanged.
This results in two parallel TA’s of the same brand, both dispensed separately. However, one contains the fixed dose and the other the ‘as needed’ dose. This way, they remain visible separately on the medication administration record as the fixed dose and the ‘as needed’ dose.
Once pantoprazole can again be supplied via GDS, the supplier will stop the TA for the fixed dose and create a new TA for supply in GDS.

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2 Increasing the dose of GDS medication in a new MBH

A patient receives 1 tablet of losartan 50 mg daily. This has insufficient effect, and the prescriber decides to increase the dose to 100 mg once daily. This is a change at the PRK level. Consequently, the prescriber stops the original MA and records the new MA in a new MBH. In the data element AdditionalInformation she indicates 'Direct on the administration list or in GDS'.
However, the patient still has a few days’ supply of 50 mg tablets in their GDS roll. The supplier decides to supplement the GDS medication with 1 separate losartan 50 mg tablet until the medication roll change.
The supplier records a stop-TA and 3 new TAs:

• stop-TA to stop the original TA as a result of the stop-MA.
• TA for the original 50 mg losartan dose in GDS.
• TA for bridging with separate losartan 50 mg tablets.
• TA for the new 100 mg losartan dose in GDS.
  

At the next roll change, the increased dose will be supplied in the GDS roll.

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3 Increasing the dose of GDS medication within the same MBH

A patient is administered 1 tablet of furosemide 40 mg every day due to oedema. This has insufficient effect and the prescriber decides to increase the dose to 2 tablets once daily. There is no change at PRK level, so this is a regular modification. The prescriber records a new MA within the same MBH. Along with this, a technical stop-MA is created.
The modification must take effect immediately. However, the medication roll change will not take place until several days later. The supplier therefore decides, until the medication roll change, to supplement the GDS medication with separate furosemide 40 mg tablets.
The supplier records a technical stop-TA and 3 new TA’s:

• technical stop-TA to stop the original TA, as a result of the stop-MA.
• TA for the original dosage of furosemide in GDS.
• TA for the bridging period with separate furosemide 40 mg tablets.
• TA for the new dosage of furosemide 40 mg in GDS.
  

At the next medication roll change, the increased dosage (2 tablets per administration) is supplied in the GDS roll.

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4 Increasing the dose of GDS medication with different administration times

A patient is administered 1 tablet of furosemide 40 mg every day at 08:00, due to oedema. This has insufficient effect and the prescriber decides to increase the dose to 1 tablets twice daily, in the morning at 08:00 and in the afternoon at 17:00. There is no change at PRK level, so the new MA and the technical stop-MA are recorded within the same MBH.
The modification must take effect immediately. However, the medication roll change will not take place until several days later. The supplier therefore decides, until the medication roll change, to supplement the GDS medication with separate furosemide 40 mg tablets. The tablet in the GDS roll is still scheduled for 08:00, while the separate tablet will be administered at 17:00 (in data element AdministrationDateTime).
The supplier records a technical stop-TA and 3 new TA’s:

• technical stop-TA to stop the original TA, as a result of the stop-MA
• TA for the original dosage of furosemide in GDS, with administration time 08:00
• TA for the bridging period with separate furosemide 40 mg tablets, with administration time 17:00
• TA for the new dosage of furosemide 40 mg in GDS, with administration times 08:00 and 17:00

At the next medication roll change, the increased dosage (2 tablets per administration) is supplied in the GDS roll.

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5 Reducing the dose of GDS medication in a new MBH

A patient receives 1 tablet of losartan 100 mg daily. Due to the patient’s deteriorating renal function, the prescriber decides to reduce the dose to 50 mg once daily. This is a change at the PRK level. Consequently, the prescriber stops the original MA and records the new MA in a new MBH.
The patient still has a few days’ supply of 100 mg tablets in their GDS roll. However, an administrator is not allowed to split tablets. The change must take effect immediately and cannot wait until the medication roll change, which will take place a few days later.
The supplier therefore arranges for the remaining GDS bags to be collected the same day and replaced with a new GDS roll containing the 50 mg tablets. She stops the original TA and records a new TA for the reduced dose.

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6 Reducing the dose of GDS medication within the same MBH

A patient is administered 2 tablets of verapamil 240 mg MR every day. The effect is too strong, and the prescriber decides to reduce the dose to 1 tablet once daily. There is no change at PRK level, so the new MA and the associated technical stop-MA are recorded within the same MBH.
The modification must take effect immediately. However, the medication roll change will not occur until several days later. The supplier therefore arranges for the remaining GDS bags to be collected the same day and provide the tablets separately until the next medication roll change.
The supplier records a technical stop-TA and 2 new TA’s:

• technical stop-TA to stop the original TA, as a result of the stop MA
• TA for the bridging period with separate verapamil 240 mg MR tablets
• TA for the new dosage of verapamil 240 mg MR in GDS

At the next medication roll change, the reduced dosage is supplied in the GDS roll.
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7 Changing GDS medication to ‘as needed’ medication

A patient uses temazepam for insomnia. The GP has been trying for some time to persuade the patient to stop this sleep medication. The patient now indicates a willingness to try, but wants to have temazepam available for use as needed. The GP changes the dosage from 10 mg temazepam once daily to 10 mg temazepam 'as needed'.
The patient has just received a new two-week medication roll. The GP wants to act on this momentum and decides that the new MA must take effect immediately. The GDS medication must therefore be collected by the pharmacy on the same day.


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8 Changing GDS medication to partly GDS and partly ‘as needed’ medication

The GP prescribes diazepam 5 mg twice daily to a patient for anxiety. The effect is too strong, and the prescriber decides to reduce the dose to 1 tablet of diazepam 5 mg once daily in GDS plus 1 tablet ‘as needed’. There is no change at PRK level, so the stop-MA and new MA are recorded within the same MBH, as well as the stop-TA and new TAs resulting from the modification.
The modification must take effect immediately. However, the medication roll change will not occur until several days later. The supplier therefore arranges for the remaining GDS bags to be collected the same day and provide the tablets separately until the next medication roll change.
The supplier records a technical stop-TA and 3 new TA’s:

• technical stop-TA to stop the original TA, as a result of the stop-MA
• TA for the bridging period with separate diazepam tablets
• TA for the new dosage of diazepam in GDS
• TA for the new dosage of diazepam as separate tablets

At the next medication roll change, the ‘as needed’ medication is supplied separately, and the reduced regular dose is supplied in the GDS roll.

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9 Administering a changed tablet quantity

The GP prescribes pantoprazole to a patient.

MA: pantoprazole 40 mg tablet, 1 tablet once daily

TA: Sandoz pantoprazole 40 mg tablet, 1 tablet once daily

After some time, there are supply issues with pantoprazole 40 mg. The pharmacy therefore supplies pantoprazole 20 mg.

TA: Sandoz pantoprazole 20 mg tablet, 2 tablets once daily

The home care worker sees the new TA in the eTDR, administers 2 tablets, and records the administration.

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10 Correcting an administration

The GP prescribes calcium 500 mg, 1 tablet twice daily, for a patient with osteoporosis. The patient receives support from home care to take her medication. The calcium tablets are large, and the patient has difficulty taking both tablets. Today, she initially refuses the second tablet. The home care worker records administration of 1 tablet, with the reason ‘medication refused’ in MedicationAdministrationReasonForDeviation. A few minutes later, the patient takes the second tablet. The home care worker corrects the record to 2 tablets, with the reason ‘incorrect registration of medication’.

This can be recorded in the eTDR in two ways:

Correction using a negative administered quantity
In the eTDR, two additional MTDs are recorded: one with a negative AdministeredAmount and one with the correct quantity.
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Correction using an additional MTD
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11 Correcting administration after the patient spits out a tablet

The GP prescribes calcium 1000 mg, 1 tablet once daily, for a patient with osteoporosis. The patient receives support from home care to take her medication. The calcium tablets are large, and the patient has difficulty swallowing a tablet.
The home care worker administers 1 tablet and records this in the eTDR. A short time later, the patient spits out the tablet and it is not possible to administer it again.
The home care worker corrects the previous record by entering a new MTD with a negative quantity.

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12 Medication not administered

A patient is administered 1 tablet of atenolol 50 mg every day. The patient has a lower blood pressure than usual due to fever. The administrator contacts the prescriber. They jointly decide not to administer atenolol on that day. The administrator records an MTD with '0 units' as AdministeredAmount and 'low blood pressure due to fever' in MedicationAdministrationReasonForDeviation.

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13 Postponing an administration

A patient is administered 1 tablet of calcium 1000 mg every day. This morning it is not possible to administer the tablet because the patient is experiencing nausea. The administrator records an MTD with '0 units' as AdministeredAmount and 'patient was nauseous' in MedicationAdministrationReasonForDeviation.

For calcium, a fixed administration time is not required. During the afternoon medication round, the administrator visits the patient again and this time the tablet can be administered successfully.

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14 Recording separate MTDs per InjectionPatchSite

A patient is administered 50 units of long-acting insulin glargine every evening by a home care worker. Due to the high number of units, this must be administered in two doses of 25 units. The supplier records this in the Comment data element in the TA.
The care worker first administers 25U with InjectionPatchSite 'left upper leg' and then 25U with InjectionPatchSite 'right upper leg' and MedicationAdministrationReasonForDeviation '2 administrations due to 50 units'. Because only one InjectionPatchSite can be recorded in an MTD, two MTDs are required.

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15 Document history

Version	Date	Description
9 3.0.0-rc.2	March 2026	for all changes see: *Release notes