Prescription: Titrated drug dose

care/facility/api/serializers/patient_consultation.py

@@ -16,6 +16,7 @@
     Facility,
     PatientRegistration,
     Prescription,
+    PrescriptionDosageType,
     PrescriptionType,
 )
 from care.facility.models.bed import Bed, ConsultationBed
@@ -109,17 +110,20 @@ class PatientConsultationSerializer(serializers.ModelSerializer):
     medico_legal_case = serializers.BooleanField(default=False, required=False)
 
     def get_discharge_prescription(self, consultation):
-        return Prescription.objects.filter(
-            consultation=consultation,
-            prescription_type=PrescriptionType.DISCHARGE.value,
-            is_prn=False,
-        ).values()
+        return (
+            Prescription.objects.filter(
+                consultation=consultation,
+                prescription_type=PrescriptionType.DISCHARGE.value,
+            )
+            .exclude(dosage_type=PrescriptionDosageType.PRN.value)
+            .values()
+        )
 
     def get_discharge_prn_prescription(self, consultation):
         return Prescription.objects.filter(
             consultation=consultation,
             prescription_type=PrescriptionType.DISCHARGE.value,
-            is_prn=True,
+            dosage_type=PrescriptionDosageType.PRN.value,
         ).values()
 
     def get_icd11_diagnoses_object(self, consultation):
@@ -503,17 +507,20 @@ class PatientConsultationDischargeSerializer(serializers.ModelSerializer):
     )
 
     def get_discharge_prescription(self, consultation):
-        return Prescription.objects.filter(
-            consultation=consultation,
-            prescription_type=PrescriptionType.DISCHARGE.value,
-            is_prn=False,
-        ).values()
+        return (
+            Prescription.objects.filter(
+                consultation=consultation,
+                prescription_type=PrescriptionType.DISCHARGE.value,
+            )
+            .exclude(dosage_type=PrescriptionDosageType.PRN.value)
+            .values()
+        )
 
     def get_discharge_prn_prescription(self, consultation):
         return Prescription.objects.filter(
             consultation=consultation,
             prescription_type=PrescriptionType.DISCHARGE.value,
-            is_prn=True,
+            dosage_type=PrescriptionDosageType.PRN.value,
         ).values()
 
     class Meta:

care/facility/api/serializers/prescription.py

@@ -22,18 +22,18 @@ class Meta:
 class PrescriptionSerializer(serializers.ModelSerializer):
     id = serializers.UUIDField(source="external_id", read_only=True)
     prescribed_by = UserBaseMinimumSerializer(read_only=True)
-    last_administered_on = serializers.SerializerMethodField()
+    last_administration = serializers.SerializerMethodField()
     medicine_object = MedibaseMedicineSerializer(read_only=True, source="medicine")
     medicine = serializers.UUIDField(write_only=True)
 
-    def get_last_administered_on(self, obj):
+    def get_last_administration(self, obj):
         last_administration = (
             MedicineAdministration.objects.filter(prescription=obj)
             .order_by("-administered_date")
             .first()
         )
         if last_administration:
-            return last_administration.administered_date
+            return LastAdministrationSerializer(last_administration).data
         return None
 
     class Meta:
@@ -75,7 +75,21 @@ def validate(self, attrs):
                     }
                 )
 
-        if attrs.get("is_prn"):
+        if attrs.get("dosage_type") == "TITRATED":
+            if not attrs.get("base_dosage"):
+                raise serializers.ValidationError(
+                    {
+                        "base_dosage": "Base dosage should be set for titrated prescriptions."
+                    }
+                )
+            if not attrs.get("target_dosage"):
+                raise serializers.ValidationError(
+                    {
+                        "target_dosage": "Target dosage should be set for titrated prescriptions."
+                    }
+                )
+
+        if attrs.get("dosage_type") == "PRN":
             if not attrs.get("indicator"):
                 raise serializers.ValidationError(
                     {"indicator": "Indicator should be set for PRN prescriptions."}
@@ -119,3 +133,21 @@ class Meta:
             "modified_date",
             "prescription",
         )
+
+
+class LastAdministrationSerializer(serializers.ModelSerializer):
+    id = serializers.UUIDField(source="external_id", read_only=True)
+    administered_by = UserBaseMinimumSerializer(read_only=True)
+
+    class Meta:
+        model = MedicineAdministration
+        exclude = ("deleted",)
+        read_only_fields = (
+            "external_id",
+            "administered_by",
+            "archived_by",
+            "archived_on",
+            "created_date",
+            "modified_date",
+            "prescription",
+        )

care/facility/api/viewsets/prescription.py

@@ -15,6 +15,7 @@
 from care.facility.models import (
     MedicineAdministration,
     Prescription,
+    PrescriptionDosageType,
     PrescriptionType,
     generate_choices,
 )
@@ -30,6 +31,9 @@ def inverse_choices(choices):
 
 
 inverse_prescription_type = inverse_choices(generate_choices(PrescriptionType))
+inverse_prescription_dosage_type = inverse_choices(
+    generate_choices(PrescriptionDosageType)
+)
 
 
 class MedicineAdminstrationFilter(filters.FilterSet):
@@ -79,7 +83,8 @@ def archive(self, request, *args, **kwargs):
 
 
 class ConsultationPrescriptionFilter(filters.FilterSet):
-    is_prn = filters.BooleanFilter()
+    # is_prn = filters.BooleanFilter()
+    dosage_type = CareChoiceFilter(choice_dict=inverse_prescription_dosage_type)
     prescription_type = CareChoiceFilter(choice_dict=inverse_prescription_type)
     discontinued = filters.BooleanFilter()
 

care/facility/migrations/0393_rename_dosage_prescription_base_dosage_and_more.py

@@ -0,0 +1,60 @@
+# Generated by Django 4.2.5 on 2023-10-30 09:52
+
+from django.db import migrations, models
+
+
+class Migration(migrations.Migration):
+    dependencies = [
+        ("facility", "0392_alter_dailyround_consciousness_level"),
+    ]
+
+    def copy_prn_to_dosage_type(apps, schema_editor):
+        Prescription = apps.get_model("facility", "Prescription")
+        Prescription.objects.filter(is_prn=True).update(dosage_type="PRN")
+
+    def reverse_copy_prn_to_dosage_type(apps, schema_editor):
+        Prescription = apps.get_model("facility", "Prescription")
+        Prescription.objects.filter(dosage_type="PRN").update(is_prn=True)
+
+    operations = [
+        migrations.RenameField(
+            model_name="prescription",
+            old_name="dosage",
+            new_name="base_dosage",
+        ),
+        migrations.AddField(
+            model_name="prescription",
+            name="dosage_type",
+            field=models.CharField(
+                choices=[
+                    ("REGULAR", "REGULAR"),
+                    ("TITRATED", "TITRATED"),
+                    ("PRN", "PRN"),
+                ],
+                default="REGULAR",
+                max_length=100,
+            ),
+        ),
+        migrations.RunPython(
+            copy_prn_to_dosage_type, reverse_code=reverse_copy_prn_to_dosage_type
+        ),
+        migrations.RemoveField(
+            model_name="prescription",
+            name="is_prn",
+        ),
+        migrations.AddField(
+            model_name="prescription",
+            name="instruction_on_titration",
+            field=models.TextField(blank=True, null=True),
+        ),
+        migrations.AddField(
+            model_name="prescription",
+            name="target_dosage",
+            field=models.CharField(blank=True, max_length=100, null=True),
+        ),
+        migrations.AddField(
+            model_name="medicineadministration",
+            name="dosage",
+            field=models.CharField(blank=True, max_length=100, null=True),
+        ),
+    ]

care/facility/models/prescription.py

@@ -33,6 +33,12 @@ class PrescriptionType(enum.Enum):
     REGULAR = "REGULAR"
 
 
+class PrescriptionDosageType(enum.Enum):
+    REGULAR = "REGULAR"
+    TITRATED = "TITRATED"
+    PRN = "PRN"
+
+
 def generate_choices(enum_class):
     return [(tag.name, tag.value) for tag in enum_class]
 
@@ -92,9 +98,16 @@ class Prescription(BaseModel):
         blank=True,
         null=True,
     )
-    dosage = models.CharField(max_length=100, blank=True, null=True)
+    base_dosage = models.CharField(max_length=100, blank=True, null=True)
+    dosage_type = models.CharField(
+        max_length=100,
+        choices=generate_choices(PrescriptionDosageType),
+        default=PrescriptionDosageType.REGULAR.value,
+    )
 
-    is_prn = models.BooleanField(default=False)
+    # titrated fields
+    target_dosage = models.CharField(max_length=100, blank=True, null=True)
+    instruction_on_titration = models.TextField(blank=True, null=True)
 
     # non prn fields
     frequency = models.CharField(
@@ -148,6 +161,7 @@ class MedicineAdministration(BaseModel):
         on_delete=models.PROTECT,
         related_name="administrations",
     )
+    dosage = models.CharField(max_length=100, blank=True, null=True)
     notes = models.TextField(default="", blank=True)
     administered_by = models.ForeignKey(
         "users.User",

care/facility/tests/test_medicine_administrations_api.py

@@ -28,9 +28,9 @@ def create_prescription(self, **kwargs):
             "consultation": self.create_consultation(self.patient, self.facility),
             "medicine": MedibaseMedicine.objects.first(),
             "prescription_type": "REGULAR",
-            "dosage": "1 mg",
+            "base_dosage": "1 mg",
             "frequency": "OD",
-            "is_prn": False,
+            "dosage_type": "REGULAR",
         }
         return Prescription.objects.create(
             **{**data, **kwargs, "prescribed_by": self.user}

care/facility/tests/test_prescriptions_api.py

@@ -24,9 +24,9 @@ def setUp(self) -> None:
         self.normal_prescription_data = {
             "medicine": self.medicine.external_id,
             "prescription_type": "REGULAR",
-            "dosage": "1 mg",
+            "base_dosage": "1 mg",
             "frequency": "OD",
-            "is_prn": False,
+            "dosage_type": "REGULAR",
         }
 
     def test_create_normal_prescription(self):

care/facility/utils/reports/discharge_summary.py

@@ -18,6 +18,7 @@
     PatientConsultation,
     PatientSample,
     Prescription,
+    PrescriptionDosageType,
     PrescriptionType,
 )
 from care.facility.models.file_upload import FileUpload
@@ -69,22 +70,21 @@ def get_discharge_summary_data(consultation: PatientConsultation):
     prescriptions = Prescription.objects.filter(
         consultation=consultation,
         prescription_type=PrescriptionType.REGULAR.value,
-        is_prn=False,
-    )
+    ).exclude(dosage_type=PrescriptionDosageType.PRN.value)
     prn_prescriptions = Prescription.objects.filter(
         consultation=consultation,
         prescription_type=PrescriptionType.REGULAR.value,
-        is_prn=True,
+        dosage_type=PrescriptionDosageType.PRN.value,
     )
     discharge_prescriptions = Prescription.objects.filter(
         consultation=consultation,
         prescription_type=PrescriptionType.DISCHARGE.value,
-        is_prn=False,
-    )
+    ).exclude(dosage_type=PrescriptionDosageType.PRN.value)
+
     discharge_prn_prescriptions = Prescription.objects.filter(
         consultation=consultation,
         prescription_type=PrescriptionType.DISCHARGE.value,
-        is_prn=True,
+        dosage_type=PrescriptionDosageType.PRN.value,
     )
     files = FileUpload.objects.filter(
         associating_id=consultation.id,

care/templates/reports/patient_discharge_summary_pdf.html

@@ -409,7 +409,7 @@ <h4 class="mt-6 font-medium text-gray-500">
               {{ prescription.medicine_name }}
             </td>
             <td class="p-1 whitespace-no-wrap text-sm">
-              {{ prescription.dosage }}
+              {{ prescription.base_dosage }}
             </td>
             <td class="p-1 whitespace-no-wrap text-sm">
               {{ prescription.route }}
@@ -466,7 +466,7 @@ <h4 class="mt-6 font-medium text-gray-500">
               {{ prescription.medicine_name }}
             </td>
             <td class="p-1 whitespace-no-wrap text-sm">
-              {{ prescription.dosage }}
+              {{ prescription.base_dosage }}
             </td>
             <td class="p-1 whitespace-no-wrap text-sm">
               {{ prescription.max_dosage }}
@@ -813,7 +813,7 @@ <h4 class="mt-6 font-medium text-gray-500">
               {{ prescription.medicine_name }}
             </td>
             <td class="p-1 whitespace-no-wrap text-sm">
-              {{ prescription.dosage }}
+              {{ prescription.base_dosage }}
             </td>
             <td class="p-1 whitespace-no-wrap text-sm">
               {{ prescription.route }}
@@ -870,7 +870,7 @@ <h4 class="mt-6 font-medium text-gray-500">
               {{ prescription.medicine_name }}
             </td>
             <td class="p-1 whitespace-no-wrap text-sm">
-              {{ prescription.dosage }}
+              {{ prescription.base_dosage }}
             </td>
             <td class="p-1 whitespace-no-wrap text-sm">
               {{ prescription.max_dosage }}