Prescribing, the medication administration record, medication sets, and sensitive medications.

These guides step system administrators through the set up of the Tamanu Medications Module. If it is your first time implementing the Medications Module or digitising medication workflows in your clinical setting, read the Medications Module Implementation Guide first.

• 15.1 Reference data

  Drug, medication sets, not given reasons, and the hard coded values those columns accept

• 15.2 Settings

  Frequencies, administration schedules, and the automated workflows they drive

• 15.3 Permissions

  Prescribing, administration, pharmacy notes, and sensitive medication access

Warning

The Medications Module is not recommended for the following medications or clinical settings, whose orders and administration should remain on paper:

• IV infusion medications
• Anaesthesia medications
• Complex oncology protocols
• Dialysis
• ICU, PICU and NICU

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Vaccines

All vaccines that appear in the Vaccine Schedule, or are selected when recording vaccine workflows, must also be listed in the Drug reference data. See the Immunisations configuration guides.

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IV medications

IV infusions should remain on paper, however standard IV medications can be prescribed and their administration recorded in Tamanu. The distinction is set out below.

IV medications

IV medications are intermittent intravenous drugs given as bolus doses or short-term infusions, typically over minutes to a few hours at predetermined intervals, and prescribed with standard dosing parameters such as milligrams, units or millilitres.

They are administered either as IV push, given directly into the IV line over seconds to minutes, or as piggyback infusions, mixed in small volume bags of 50 to 250mL and infused over 30 minutes to 2 hours.

Examples:

• Ceftriaxone 1g IV every 24 hours
• Furosemide 40mg IV push twice daily
• Morphine 2 to 4mg IV push every 4 hours as needed for pain

These follow standard pharmacy preparation protocols and can be administered using basic IV techniques, without specialised infusion devices or rate calculations.

IV infusions

IV infusions are continuous intravenous therapies requiring precise rate control. They are measured in units per time, such as mcg/min, units/hour or mg/hour, rather than total dose amounts. They require infusion pumps for accurate delivery and often need frequent titration based on patient response and clinical parameters.

Examples:

• Norepinephrine starting at 0.1 mcg/kg/min, titrated to maintain MAP >65 mmHg
• Insulin infusion beginning at 0.1 units/kg/hour with glucose-based adjustments
• Heparin drip initiated at 18 units/kg/hour with PTT-guided titration

IV infusions require specialised nursing protocols and continuous monitoring, and often a critical care setting, due to their potent effects and the need for rapid dose adjustment based on real-time assessment.

Their documentation requirements are also more complex. An infusion record must capture multiple time-stamped data points including initial rates, all rate changes with clinical rationales, cumulative dosing calculations, concentration calculations and detailed patient response parameters. It must also integrate monitoring parameters, linking blood glucose to insulin adjustments, PTT values to heparin changes, or haemodynamic measurements to vasopressor titrations, and support double-verification workflows, pump programming validation and detailed handover communications.