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Add ward MAR board plus nursing notes and SBAR handovers.
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Nurses can chart given/held/refused doses from active prescriptions on placed patients, and document chronologic notes and unit shift handovers.

Co-authored-by: Cursor <cursoragent@cursor.com>
This commit is contained in:
isaacclad
2026-07-20 10:15:58 +00:00
co-authored by Cursor
parent 45a1a95142
commit cb6e59e5ed
20 changed files with 2021 additions and 1 deletions
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database/migrations/2026_07_20_140000_create_mar_and_nursing_tables.php
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<?php
use Illuminate\Database\Migrations\Migration;
use Illuminate\Database\Schema\Blueprint;
use Illuminate\Support\Facades\Schema;
/**
* Full MAR + nursing documentation on care units.
*/
return new class extends Migration
{
public function up(): void
{
Schema::create('care_mar_orders', function (Blueprint $table) {
$table->id();
$table->string('owner_ref')->index();
$table->foreignId('organization_id')->constrained('care_organizations')->cascadeOnDelete();
$table->foreignId('visit_id')->constrained('care_visits')->cascadeOnDelete();
$table->foreignId('patient_id')->constrained('care_patients')->cascadeOnDelete();
$table->foreignId('prescription_id')->constrained('care_prescriptions')->cascadeOnDelete();
$table->foreignId('prescription_item_id')->constrained('care_prescription_items')->cascadeOnDelete();
$table->string('drug_name');
$table->string('dosage')->nullable();
$table->string('route')->nullable();
/** od|bd|tds|qds|q4h|q6h|q8h|prn|stat|custom */
$table->string('frequency_code')->default('od');
$table->json('times_of_day')->nullable();
$table->boolean('is_prn')->default(false);
/** active|paused|stopped */
$table->string('status')->default('active');
$table->timestamp('starts_at')->nullable();
$table->timestamp('ends_at')->nullable();
$table->text('instructions')->nullable();
$table->timestamps();
$table->softDeletes();
$table->unique(['prescription_item_id']);
$table->index(['visit_id', 'status']);
$table->index(['organization_id', 'status']);
});
Schema::create('care_mar_administrations', function (Blueprint $table) {
$table->id();
$table->string('owner_ref')->index();
$table->foreignId('organization_id')->constrained('care_organizations')->cascadeOnDelete();
$table->foreignId('mar_order_id')->constrained('care_mar_orders')->cascadeOnDelete();
$table->foreignId('visit_id')->constrained('care_visits')->cascadeOnDelete();
$table->foreignId('patient_id')->constrained('care_patients')->cascadeOnDelete();
$table->foreignId('care_unit_id')->nullable()->constrained('care_care_units')->nullOnDelete();
$table->timestamp('scheduled_for')->nullable();
$table->timestamp('recorded_at');
/** given|held|refused|missed */
$table->string('status');
$table->string('dose_given')->nullable();
$table->string('route')->nullable();
$table->string('administered_by')->nullable();
$table->string('witness_by')->nullable();
$table->string('reason')->nullable();
$table->text('notes')->nullable();
$table->timestamps();
$table->index(['visit_id', 'recorded_at']);
$table->index(['care_unit_id', 'scheduled_for']);
$table->index(['mar_order_id', 'status']);
});
Schema::create('care_nursing_notes', function (Blueprint $table) {
$table->id();
$table->string('owner_ref')->index();
$table->foreignId('organization_id')->constrained('care_organizations')->cascadeOnDelete();
$table->foreignId('visit_id')->constrained('care_visits')->cascadeOnDelete();
$table->foreignId('patient_id')->constrained('care_patients')->cascadeOnDelete();
$table->foreignId('care_unit_id')->nullable()->constrained('care_care_units')->nullOnDelete();
/** progress|assessment|intervention|observation|other */
$table->string('note_type')->default('progress');
$table->string('shift_code')->nullable();
$table->text('body');
$table->string('recorded_by')->nullable();
$table->timestamp('recorded_at');
$table->timestamps();
$table->softDeletes();
$table->index(['visit_id', 'recorded_at']);
$table->index(['care_unit_id', 'recorded_at']);
});
Schema::create('care_ward_handovers', function (Blueprint $table) {
$table->id();
$table->string('owner_ref')->index();
$table->foreignId('organization_id')->constrained('care_organizations')->cascadeOnDelete();
$table->foreignId('care_unit_id')->constrained('care_care_units')->cascadeOnDelete();
$table->string('from_shift')->nullable();
$table->string('to_shift')->nullable();
$table->timestamp('handed_over_at')->nullable();
$table->string('handed_over_by')->nullable();
$table->string('received_by')->nullable();
$table->text('situation')->nullable();
$table->text('background')->nullable();
$table->text('assessment')->nullable();
$table->text('recommendation')->nullable();
$table->json('patient_summaries')->nullable();
/** draft|completed */
$table->string('status')->default('draft');
$table->timestamps();
$table->softDeletes();
$table->index(['care_unit_id', 'status']);
$table->index(['care_unit_id', 'handed_over_at']);
});
}
public function down(): void
{
Schema::dropIfExists('care_ward_handovers');
Schema::dropIfExists('care_nursing_notes');
Schema::dropIfExists('care_mar_administrations');
Schema::dropIfExists('care_mar_orders');
}
};