Phillip In reviewing the policy of pharmacy in preparing custom admixtures, for a given order_med_id for an admixture, they expand the record to enumerate the ingredients as you describe, each of which points to a unique medication_id. They should never reuse the order record and change the ingredient mapping, that is administratively and clinically unwise. Each medication_id is mapped in our system to the RXNORM CODE at least at the ingredient level.
Very much like you suggested, our medication metadata at Nebraska is hierarchachly arranged with ingredients (RXNORM level = 1) at the low level and combination drug preps all mapped as children of all their ingredients. So I would suggest treating each unique order_med_id for admixtures as a unique branded clinical drug preparation and assign a unique UTSW RXNORM pseudocode for the preparation, creating a metadata node for it in i2b2 which traces it back to all ingredients used in the preparation. This will assure that all folder searches by ingredients will return all the admixtures that contain them, along with all the commercial preps ordered/administered. It sounds to me like some of the data extraction planning will need to proceed in dialogue with your pharmacy department since it sounds like some of their procedures may pose a problem Jim James R. Campbell MD [email protected]<mailto:[email protected]> Office 402-559-7505 Secretary 402-559-7299 Fax 402-559-8396 Cell +001 402 290 5154 From: [email protected] [mailto:[email protected]] On Behalf Of Phillip Reeder Sent: Thursday, November 17, 2016 2:10 PM To: [email protected] Subject: Mapping Medication Mixtures We found that some of our ordered medications are not mapped by GCN to rxnorm using the shared mapping script. It turns out that these medications are actually mixtures of medications that use a mixture template to order them. The data for what is actually in the med order ends up in the order_medmixinfo table. For example: "XXX Chemo Infusion" from the medication order turns out to be "XXX Chemo Solution" + "Overfill Volume for IV Infusions" + "Sodium Chloride 0.9% IV". We have a simple generic code associated with the primary medication but I'm not seeing how to convert get that to an RXNorm Code. The "XXX Chemo Solution" does map to RXNorm. But the ingredients in the template associated with the medicine id also can change over time. In the case above, the template went from 2 to 3 ingredients at some point. I believe the filler was added to the mix. But that indicates that they are not static templates which further complicates the mappings process. I'm considering using the simple generic code to find another similar medication and then taking it's ingredients for my mapping. Another alternative would be to use the medmixinfo to create 3 new observations in i2b2 which represent the 3 components of the mixture. Has anyone else looked at this? Phillip ________________________________ UT Southwestern Medical Center The future of medicine, today. The information in this e-mail may be privileged and confidential, intended only for the use of the addressee(s) above. Any unauthorized use or disclosure of this information is prohibited. If you have received this e-mail by mistake, please delete it and immediately contact the sender.
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