Previous Page TOC Index Next Page

4.8.2 RXO - pharmacy/treatment order segment

This is the "master" pharmacy/treatment order segment. It contains order data not specific to components or additives. Unlike the OBR, it does not contain status fields or other data that are results-only.

It can be used for any type of pharmacy order, including inpatient (unit dose and compound unit dose), outpatient, IVs, and hyperalimentation IVs (nutritional IVs), as well as other nonpharmacy treatments, e.g., respiratory therapy, oxygen, and metabolites..

In addition to the pharmaceutical information, this segment contains additional data such as provider and text comments.

A quantity/timing field is not needed in the RXO segment. The ORC segment contains the requested ORC-7-quantity/timing of the original order which does not change as the order is encoded, dispensed, or administered.

Figure 4-13. RXO attributes

SEQ

LEN

DT

OPT

RP/#

TBL#

ITEM #

ELEMENT NAME

1

100

CE

R



00292

Requested Give Code

2

20

NM

R



00293

Requested Give Amount - Minimum

3

20

NM

O



00294

Requested Give Amount - Maximum

4

60

CE

R



00295

Requested Give Units

5

60

CE

O



00296

Requested Dosage Form

6

200

CE

O

Y


00297

Provider's Pharmacy/Treatment Instructions

7

200

CE

O

Y


00298

Provider's Administration Instructions

8

200

CM

O



00299

Deliver-To Location

9

1

ID

O


0161

00300

Allow Substitutions

10

100

CE

O



00301

Requested Dispense Code

11

20

NM

O



00302

Requested Dispense Amount

12

60

CE

O



00303

Requested Dispense Units

13

3

NM

O



00304

Number Of Refills

14

60

XCN

C



00305

Ordering Provider's DEA Number

15

60

XCN

C



00306

Pharmacist/Treatment Provider Verifier ID

16

1

ID

O


0136

00307

Needs Human Review

17

20

ST

C



00308

Requested Give Per (Time Unit)

18

20

NM

O



01121

Requested Give Strength

19

60

CE

O



01122

Requested Give Strength Units

20

200

CE

O

Y


01123

Indication

21

6

ST

O



01218

Requested Give Rate Amount

22

60

CE

O



01219

Requested Give Rate Units

4.8.2.0 RXO field definitions

4.8.2.1 Requested give code (CE) 00292

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>

Definition: This field identifies the medical substance or product ordered to be given to the patient; it is equivalent to OBR-4-universal service ID code in function. The request-to-dispense fields, which define the type and amount of what is to be issued to the patient (see RXO-10 requested dispense code, RXO-11-requested dispense amount, and RXO-12-requested dispense units), do not necessarily correlate with the instructions of what amount is to be "given" or administered with each dose, and may or may not be specified with the order. For example, the "give" part of the order may convey the field-representation of give 15 mg of Librium every 6 hours, while the request to dispense part of the order may convey issue 30 tablets of 10 mg generic equivalent for this outpatient prescription. When the give code does not include the dosage form, use RXO-5-requested dosage form.

4.8.2.2 Requested give amount - minimum (NM) 00293

Definition: This field is the ordered amount. In a variable dose order, this is the minimum ordered amount. In a nonvarying dose order, this is the exact amount of the order.

Note: This field is not a duplication of the first component of the quantity/timing field, since in non-pharmacy/treatment orders, that component can be used to specify multiples of an ordered amount.

Another way to say this is that, for pharmacy/treatment orders, the quantity component of the quantity/timing field refers to what is to be given out at each service interval; thus, in terms of the RX order, that first component always defaults to 1. Hence, in the actual execution of the order, the value of 1 in the first component of the quantity/timing field always refers to one administration of the amount specified in this field (the Requested Give Amount field).

4.8.2.3 Requested give amount - maximum (NM) 00294

Definition: In a variable dose order, this is the maximum ordered amount. In a nonvarying dose order, this field is not used.

4.8.2.4 Requested give units (CE) 00295

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>

Definition: This field indicates the units for the give amount.

Note: These units can be a "compound quantity"; i.e., the units may contain the word "per." For example, micrograms per KG (micg/kg) is an acceptable value, which means that the units are micrograms per KG (of body weight). See Chapter 7 for full definition of ISO+ units.

A table of standard units is needed to define standard abbreviations for compound units. Until such a table is agreed on, a user-defined table is needed for each site. If the interpretation of a compound unit requires knowledge of some observation results (such as body weight or height), these results can be sent in the same order message using the optional OBX segments.

4.8.2.5 Requested dosage form (CE) 00296

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>

Definition: This field indicates the manner in which the medication is aggregated for dispensing, e.g., tablets, capsules, suppositories. In some cases, this information is implied by the dispense/give code in RXO-1-requested give code or RXO-10-requested dispense code. Use when both RXO-1-requested give code and RXO-10-requested dispense code do not specify the drug/treatment form.

4.8.2.6 Provider's pharmacy/treatment instructions (CE) 00297

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>

Definition: This field identifies the ordering providers instructions to the pharmacy or the non-pharmacy treatment provider (e.g., respiratory therapy). If coded, a user defined table must be used. If transmitted as a free text field, place a null in the first component and the text in the second, e.g., |^this is a free text treatment instruction|.

4.8.2.7 Provider's administration instructions (CE) 00298

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>

Definition: This field identifies the ordering providers instructions to the patient or to the provider administering the drug or treatment. If coded, a user defined table must be used. If transmitted as free text, place a null in the first component and the text in the second, e.g., |^this is a free text administration instruction|.

4.8.2.8 Deliver-to location (CM) 00299

Components: <point of care (ST)> & <room (IS)> & <bed (IS)> & <facility (HD)> & <location status (ID)> & <patient location type (IS)> & <building (IS)> & <floor (IS)> ^ <address (AD)>

Definition: The first components, modeled after the PL data type, contain the inpatient or outpatient location to which the pharmacy provider or treatment supplier is to deliver the drug or treatment device (if applicable). The default (null) value is the current census location for the patient. This component has the same form as PV1-3-assigned patient location. The last component can be used to specify an address. This could be used to fill mail orders to a patient or provider, or to account for home health care.

4.8.2.9 Allow substitution (ID) 00300

Definition: Following are the values:

Table 0161 - Allow substitution

Value

Description

N

Substitutions are NOT authorized. (This is the default - null.)

G

Allow generic substitutions.

T

Allow therapeutic substitutions

4.8.2.10 Requested dispense code (CE) 00301

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>

Definition: This field indicates what is to be/was dispensed; it is equivalent to OBR-4-universal service ID in function. It may be present in the order or not, depending on the application. If not present, and values are given for RXO-11-requested dispense amount and RXO-12-requested dispense units, the RXO-1-requested give code is assumed. If the requested dispense code does not include the dosage form, use RXO-5-requested dosage form.

Note on request-to-dispense fields:

Sometimes an order will be written in which the total amount of the drug or treatment requested to be dispensed has no direct relationship with the give amounts and schedule. For example, an outpatient pharmacy/treatment order might be take four pills a day of <drug name, value>, Q6H (every 6 hours) -- dispense 30 tablets. An inpatient order might be NS/D5W (normal saline with 5% dextrose) at 1000cc/hour -- dispense 3 1-liter bottles of NSD5W solution. The request-to-dispense fields support this common style of ordering.

4.8.2.11 Requested dispense amount (NM) 00302

Definition: This field is the amount to be dispensed.

4.8.2.12 Requested dispense units (CE) 00303

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>

Definition: This field identifies the units for the dispense amount. This must be in simple units that reflect the actual quantity of the substance to be dispensed. It does not include compound units.

4.8.2.13 Number of refills (NM) 00304

Definition: This field defines the number of times the requested dispense amount can be given to the patient, subject to local regulation. Refers to outpatient only.

4.8.2.14 Ordering provider's DEA number (XCN) 00305

Components: <ID number (ST)> ^ <family name (ST)> ^ <given name (ST)> ^ <middle initial or name (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (ST)> ^ <source table (IS)> ^ <assigning authority (HD)> ^ <name type code(ID)> ^ <identifier check digit (ST)> ^ <code identifying the check digit scheme employed (ID )> ^ <identifier type code (IS)> ^ <assigning facility (HD)>

Subcomponents of assigning authority: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)

Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)

Definition: This field identifies the providers controlled substance number, if required by site. It is defined as conditional because it is required when the substance being requested is a controlled substance (e.g., a narcotic).

4.8.2.15 Pharmacist/treatment provider verifier ID (XCN) 00306

Components: <ID number (ST)> ^ <family name (ST)> ^ <given name (ST)> ^ <middle initial or name (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (ST)> ^ <source table (IS)> ^ <assigning authority (HD)> ^ <name type code(ID)> ^ <identifier check digit (ST)> ^ <code identifying the check digit scheme employed (ID )> ^ <identifier type code (IS)> ^ <assigning facility (HD)>

Subcomponents of assigning authority: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)

Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)

Definition: This field is the provider ID of the pharmacist/treatment substance supplier verifier. Use if required by the pharmacy or treatment application or site on orders (or some subgroup of orders), in addition to ORC-11-verified by.

Example:

The site requires a "verified by" provider (such as a nurse) and a "verifying pharmacist/treatment supplier" on the order. In this case the first field, ORC-11-verified by, is already present; but the second field, RXO-15-pharmacist/treatment provider verifier ID, is needed.

4.8.2.16 Needs human review (ID) 00307

Definition: This field uses HL7 table 0136 - Yes/no indicator. The values have the following meaning for this field:

Table 0136 - Yes/no indicator

Value

Description

Y

Yes - Indicates that the pharmacist or non-pharmacist treatment supplier filling the order needs to pay special attention to the text in the RXO-6-provider's pharmacy/treatment instructions. A warning is present.



N

No - No warning is present. This is the equivalent default (null) value.

An example of the use of this field is given by the following case:

A smart Order Entry application knows of a possible drug or treatment interaction on a certain order, but the provider issuing the order wants to override the condition. In this case, the pharmacy or treatment application receiving the order will want to have a staff pharmacist or non-pharmacist treatment supplier review the interaction and contact the ordering physician.

4.8.2.17 Requested give per (time unit) (ST) 00308

Definition: This field identifies the time unit to use to calculate the rate at which the pharmaceutical is to be administered.

Format:

S<integer>

=

<integer> seconds

M<integer>

=

<integer> minutes

H<integer>

=

<integer> hours

D<integer>

=

<integer> days

W<integer>

=

<integer> weeks

L<integer>

=

<integer> months

Note: This is the same as the format specified for the DURATION component of the quantity/timing field, excluding the "X" specification.

This field is defined as conditional because it is required when the ordered substance is to be administered continuously at a prescribed rate (e.g., certain IVs). For example, if the "give amount/units" are 300 ml and the "give per" time unit is H1, the rate is 300ml/hr and the duration of this dose is 1 hour. Thus the give amount and give per time unit define the duration of the service.

This field is distinct from the "interval" component of the quantity/timing field, but it could be used in conjunction with it, as in give 300ml of NS per hr for 1 hour, repeat twice a day.

4.8.2.18 Requested strength (NM) 01121

Definition: Use this field when RXO-1-requested give code does not specify the strength. This is the numeric part of the strength, used in combination with Requested Strength Unit.

The need for strength and strength unit fields in addition to the amount and amount units fields included in various RX_ segments requires explanation. Physicians can write a prescription for a drug such as ampicillin in two ways. One way would be: "Ampicillin 250 mg tabs, 2 tabs four times a day." In this case the give amount would be 2, the give units would be tabs, the strength would be 250 and the strength units would milligrams. However, the provider could also write the prescription as "Ampicillin 500 mg four times a day." In this case the give amount would be 500 and the give units would be milligrams. The strength would not be reported in the RXO segment because it is not specified; the drug could be given in two 250 mg caps or one 500 mg cap. But the pharmacist would dispense a specific pill size and would record the strength in the RXE segment as 250 or 500, depending upon which pill size was dispensed.

Some coding systems imply the strength, units, route of administration, and manufacturer of substances within a single instructional code. NDC codes, for example, usually imply not only the medical substance, but the strength, the units, and the form, e.g., 0047-0402-30^Ampicillin 250 MG TABS^NDC. So all of this information can also be completely specified in RXO-1-requested give code and in the analogous CE fields in other pharmacy/treatment segments. In this case, it is not necessary to use the strength and strength units fields to specify this information.

4.8.2.19 Requested strength unit (CE) 01122

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>

Definition: Use when both RXO-1-requested give code and RXO-10-requested dispense code do not specify the strength. This is the unit of the strength, used in combination with RXO-18-requested strength.

Note: These units can be a "compound quantity"; i.e., the units may express a quantity per unit of time. For example, micrograms per hour (ug/h) is an acceptable value. These compound units are contained in the ISO+ table. See Chapter 7 for full definition of ISO+ units.

4.8.2.20 Indication (CE) 01123

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>

Definition: This field identifies the condition or problem for which the drug/treatment was prescribed. May repeat if multiple indications are relevant.

4.8.2.21 Requested give rate amount (ST) 01218

Definition: This field contains the rate at which to administer treatment.

4.8.2.22 Requested give rate units (CE) 01219

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>

Definition: This field contains the units in which RXO-21-requested give rate amount is denominated.

Previous Page TOC Index Next Page