Medication, “not ordered”

• QDM 5.5 defines Medication, Order as “a request to a pharmacy to provide the medication indicated” Medication, not ordered requires a reason the medication was not ordered, specifying the reason (negation rationale).
• Medication, not ordered means a medication is intentionally not ordered for a valid reason.

Medication "not discharged”

• The QDM 5.5 defines Medication Discharge as “the medications [_that_] should be taken by or given to the patient after being discharged from an inpatient encounter.”
• Medication, Discharge includes only one timing attribute: author dateTime “the time the discharge medication list on the discharge instruction form is authored.”
• Sources for medications on the discharge medication list:
• medication orders written to be dispensed in the community (ambulatory) setting
• medications for which the patient already has a supply at home
• medications the patient may purchase without prescription (i.e., over-the-counter)

Medication, not discharged means a medication is intentionally not recommended (with a reason) at discharge. Therefore, it may not be on the discharge medication list.

Previous QDM User Group discussions determined that most EHRs provide a method for practitioners to indicate the setting in which the prescription should be dispensed and taken (QDM describes this attribute as setting; QI-Core describes the element as category).

A medication order (prescription) written during an inpatient hospitalization with the setting “hospital” represent the QDM concept Medication, not ordered. A medication order (prescription) written during an inpatient hospitalization with the setting “ambulatory, or community” represent QDM Medication, not discharged.  As long as that order with indication of reason not ordered is present in the clinical system, it qualifies for Medication not discharge. Specific evidence in the discharge instructions about medication(s) to be avoided for a specific reason should be acceptable as evidence of Medication not discharge; however, such information may not be included in the discharge medication list.

Questions for the QDM User Group:

• How might a practitioner indicate a medication intentionally not ordered or recommended (with a reason) for the ambulatory setting?
  • Will this information be on the discharge medication list?
  • Do practitioners use the medication order function to indicate medications not ordered with a reason for the ambulatory setting?
• What type of guidance should be provided for implementers and measure developers?