Add ward MAR board plus nursing notes and SBAR handovers.

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>

tests/Feature/CareMarAndNursingTest.php

@@ -0,0 +1,268 @@
+<?php
+
+namespace Tests\Feature;
+
+use App\Http\Middleware\EnsurePlatformSession;
+use App\Models\Bed;
+use App\Models\Branch;
+use App\Models\CareUnit;
+use App\Models\Department;
+use App\Models\MarAdministration;
+use App\Models\MarOrder;
+use App\Models\Member;
+use App\Models\Organization;
+use App\Models\Patient;
+use App\Models\Prescription;
+use App\Models\PrescriptionItem;
+use App\Models\User;
+use App\Models\Visit;
+use App\Models\WardHandover;
+use App\Services\Care\MarService;
+use App\Services\Care\VisitPlacementService;
+use Illuminate\Foundation\Testing\RefreshDatabase;
+use Tests\TestCase;
+
+class CareMarAndNursingTest extends TestCase
+{
+    use RefreshDatabase;
+
+    protected User $owner;
+
+    protected Organization $organization;
+
+    protected Branch $branch;
+
+    protected CareUnit $unit;
+
+    protected Visit $visit;
+
+    protected PrescriptionItem $item;
+
+    protected function setUp(): void
+    {
+        parent::setUp();
+        $this->withoutMiddleware(EnsurePlatformSession::class);
+
+        $this->owner = User::create([
+            'public_id' => 'mar-nursing-owner',
+            'name' => 'Owner',
+            'email' => 'mar-owner@example.com',
+        ]);
+
+        $this->organization = Organization::create([
+            'owner_ref' => $this->owner->public_id,
+            'name' => 'MAR Hospital',
+            'slug' => 'mar-hospital',
+            'settings' => [
+                'onboarded' => true,
+                'facility_type' => 'hospital',
+                'plan' => 'pro',
+                'plan_expires_at' => now()->addMonth()->toIso8601String(),
+            ],
+        ]);
+
+        Member::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'user_ref' => $this->owner->public_id,
+            'role' => 'hospital_admin',
+        ]);
+
+        $this->branch = Branch::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'name' => 'Main',
+            'is_active' => true,
+        ]);
+
+        $department = Department::create([
+            'owner_ref' => $this->owner->public_id,
+            'branch_id' => $this->branch->id,
+            'name' => 'Medicine',
+            'type' => 'general',
+            'is_active' => true,
+        ]);
+
+        $this->unit = CareUnit::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'department_id' => $department->id,
+            'name' => 'Medical Ward',
+            'kind' => 'inpatient',
+            'is_active' => true,
+        ]);
+
+        $bed = Bed::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'care_unit_id' => $this->unit->id,
+            'label' => 'MW-01',
+            'status' => 'available',
+            'is_active' => true,
+        ]);
+
+        $patient = Patient::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_number' => 'P-MAR-1',
+            'first_name' => 'Kofi',
+            'last_name' => 'Asante',
+            'gender' => 'male',
+        ]);
+
+        $this->visit = Visit::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_id' => $patient->id,
+            'status' => Visit::STATUS_IN_PROGRESS,
+            'checked_in_at' => now(),
+        ]);
+
+        app(VisitPlacementService::class)->place(
+            $this->visit,
+            $this->unit,
+            $bed,
+            $this->owner->public_id,
+            $this->owner->public_id,
+        );
+
+        $rx = Prescription::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'visit_id' => $this->visit->id,
+            'patient_id' => $patient->id,
+            'status' => Prescription::STATUS_ACTIVE,
+            'prescribed_by' => $this->owner->public_id,
+        ]);
+
+        $this->item = PrescriptionItem::create([
+            'owner_ref' => $this->owner->public_id,
+            'prescription_id' => $rx->id,
+            'name' => 'Paracetamol',
+            'dosage' => '1g',
+            'frequency' => 'TDS',
+            'route' => 'oral',
+            'sort_order' => 1,
+        ]);
+    }
+
+    public function test_mar_syncs_orders_and_records_given(): void
+    {
+        $mar = app(MarService::class);
+        $orders = $mar->syncOrdersForVisit($this->visit->fresh(), $this->owner->public_id);
+        $this->assertCount(1, $orders);
+        $this->assertSame('tds', $orders->first()->frequency_code);
+
+        $order = $orders->first();
+        $scheduled = now()->startOfDay()->setTime(8, 0);
+
+        $this->actingAs($this->owner)
+            ->post(route('care.mar.administer', $order), [
+                'status' => 'given',
+                'scheduled_for' => $scheduled->toDateTimeString(),
+            ])
+            ->assertRedirect();
+
+        $this->assertDatabaseHas('care_mar_administrations', [
+            'mar_order_id' => $order->id,
+            'status' => MarAdministration::STATUS_GIVEN,
+        ]);
+
+        $this->actingAs($this->owner)
+            ->get(route('care.care-units.mar', $this->unit))
+            ->assertOk()
+            ->assertSee('Paracetamol')
+            ->assertSee('Kofi');
+    }
+
+    public function test_hold_requires_reason(): void
+    {
+        $order = app(MarService::class)
+            ->syncOrdersForVisit($this->visit->fresh(), $this->owner->public_id)
+            ->first();
+
+        $this->actingAs($this->owner)
+            ->from(route('care.visits.mar', $this->visit))
+            ->post(route('care.mar.administer', $order), [
+                'status' => 'held',
+                'scheduled_for' => now()->startOfDay()->setTime(8, 0)->toDateTimeString(),
+            ])
+            ->assertRedirect()
+            ->assertSessionHasErrors('reason');
+    }
+
+    public function test_nursing_note_and_handover(): void
+    {
+        $this->actingAs($this->owner)
+            ->post(route('care.care-units.notes.store', $this->unit), [
+                'visit_id' => $this->visit->id,
+                'note_type' => 'progress',
+                'shift_code' => 'day',
+                'body' => 'Vitals stable; pain controlled.',
+            ])
+            ->assertRedirect(route('care.care-units.notes', $this->unit));
+
+        $this->assertDatabaseHas('care_nursing_notes', [
+            'visit_id' => $this->visit->id,
+            'body' => 'Vitals stable; pain controlled.',
+        ]);
+
+        $this->actingAs($this->owner)
+            ->post(route('care.care-units.handovers.store', $this->unit), [
+                'from_shift' => 'day',
+                'to_shift' => 'night',
+                'situation' => 'Quiet ward',
+                'background' => '4 patients',
+                'assessment' => 'Stable',
+                'recommendation' => 'Continue observations',
+                'complete' => '1',
+            ])
+            ->assertRedirect(route('care.care-units.handovers', $this->unit));
+
+        $this->assertDatabaseHas('care_ward_handovers', [
+            'care_unit_id' => $this->unit->id,
+            'status' => WardHandover::STATUS_COMPLETED,
+            'from_shift' => 'day',
+            'to_shift' => 'night',
+        ]);
+
+        $this->actingAs($this->owner)
+            ->get(route('care.care-units.notes', $this->unit))
+            ->assertOk()
+            ->assertSee('Vitals stable');
+
+        $this->actingAs($this->owner)
+            ->get(route('care.care-units.handovers', $this->unit))
+            ->assertOk()
+            ->assertSee('Completed');
+    }
+
+    public function test_duplicate_scheduled_dose_rejected(): void
+    {
+        $order = app(MarService::class)
+            ->syncOrdersForVisit($this->visit->fresh(), $this->owner->public_id)
+            ->first();
+        $scheduled = now()->startOfDay()->setTime(8, 0)->toDateTimeString();
+
+        $this->actingAs($this->owner)
+            ->post(route('care.mar.administer', $order), [
+                'status' => 'given',
+                'scheduled_for' => $scheduled,
+            ])
+            ->assertRedirect();
+
+        $this->actingAs($this->owner)
+            ->from(route('care.visits.mar', $this->visit))
+            ->post(route('care.mar.administer', $order), [
+                'status' => 'given',
+                'scheduled_for' => $scheduled,
+            ])
+            ->assertRedirect()
+            ->assertSessionHasErrors('scheduled_for');
+
+        $this->assertSame(1, MarAdministration::query()->where('mar_order_id', $order->id)->count());
+        $this->assertSame(1, MarOrder::query()->where('visit_id', $this->visit->id)->count());
+    }
+}