There is a need for accurate visibility of medication waste events associated to specific dispense and administration events. Applications of this would include diversion monitoring for controlled substances, patient safety, more precise inventory control, and reporting to state and DEA agencies as well as third party payers. This could also have additional applications in the future as medication management moves away from hospitals and into more ambulatory areas as well as the home. Although there would be high use of this with controlled substance medications, this could be applied to high cost (e.g. specialty), high alert (e.g. chemo), or any other medication which there is a need to ‘close the loop’ for the medication. To close the loop with the data you will need the ‘MedicationWaste’ to be recorded. During a waste workflow, matching/associating this even to the medication dispense and administration is needed to ensure the medication wasn’t tampered with post-administration. Proposed ‘Closed Loop’ Accounting of the medication within FHIR:       MedicationDispense = MedicationAdminstation + ‘MedicationWaste’ Data/Attributes that needs to be recorded with ‘MedicationWaste’: • Date/Time of Waste Event • User performing Waste Event • Medication Name/Identifier • Concentration or strength • Quantity (volume or unit • Patient identifier • Associated with a specific MedicationDIspense • Associated with a specific MedicationAdministration • (Optional) Witness to Waste Event Medication Waste Event Use Cases: Below are a couple use cases illustrating where a ‘MedicationWaste’ event could be in the clinical workflows. Workflow (Provider) 1. 2 mL vial hydromorphone 2 mg/mL is pulled for a case/patient by the anesthesiologist 2. 1.7 mL fentanyl 2 mcg/mL is administered during case 3. Remaining 0.3 mL fentanyl 2 mcg/mL is wasted into a waste container (‘MedicationWaste’) Nursing Floor Workflow (Caregiver) 1. 50 mcg/hour fentanyl transdermal patch L pre-filled syringe morphine 4 mg/mL is dispensed based on medication order by a nurse 2. After 72 hours of administration, 50 mcg/hour fentanyl patch is removed from patient. 4. Used 50 mcg/hour fentanyl patch is waster wasted into waste container (‘MedicationWaste’) Alternate Nursing Use Case (Caregiver) 1. 1 mL pre-filled syringe morphine 4 mg/mL is dispensed from ADC by a nurse based on medication order 2. Patient is administered 0.8 mL 4 mg/mL morphine 3. 0.2 mL 4 mg/mL morphine wasted into waste container (‘MedicationWaste’)