Salins N, Gursahani R, Mathur R, Iyer S, Macaden S, Simha N, Mani RK, Rajagopal MR. Definition of Terms Used in Limitation of Treatment and Providing Palliative Care at the End of Life: The Indian Council of Medical Research Commission Report. Indian J Crit Care Med. 2018 Apr;22(4):249-262. doi: 10.4103/ijccm.IJCCM_165_18. PMID: 29743764; PMCID: PMC5930529.
Thomas RL, Zubair MY, Hayes B, Ashby MA. Goals of care: a clinical framework for limitation of medical treatment. Med J Aust. 2014 Oct 20;201(8):452-5. doi: 10.5694/mja14.00623. PMID: 25332031.
ZIB Centrum. [Internet]. Netherlands: Nictiz. BehandelAanwijzing-v3.2(2019NL); 2020 Feb 03. Available from: https://zibs.nl/wiki/BehandelAanwijzing-v3.2(2019NL)
Organisation: Atomica Informatics, Australia
Email: heather.leslie@atomicainformatics.com
Date originally authored: 2020-07-31
Organisation: Atomica Informatics, Australia
Email: heather.leslie@atomicainformatics.com
Date originally authored: 2020-07-31
- Licence: This work is licensed under the Creative Commons Attribution-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/4.0/.
- Custodian Organisation: openEHR Foundation
- References: Breault JL. DNR, DNAR, or AND? Is Language Important? Ochsner J. 2011 Winter;11(4):302-6. PMID: 22190879; PMCID: PMC3241061. Salins N, Gursahani R, Mathur R, Iyer S, Macaden S, Simha N, Mani RK, Rajagopal MR. Definition of Terms Used in Limitation of Treatment and Providing Palliative Care at the End of Life: The Indian Council of Medical Research Commission Report. Indian J Crit Care Med. 2018 Apr;22(4):249-262. doi: 10.4103/ijccm.IJCCM_165_18. PMID: 29743764; PMCID: PMC5930529. Thomas RL, Zubair MY, Hayes B, Ashby MA. Goals of care: a clinical framework for limitation of medical treatment. Med J Aust. 2014 Oct 20;201(8):452-5. doi: 10.5694/mja14.00623. PMID: 25332031. ZIB Centrum. [Internet]. Netherlands: Nictiz. BehandelAanwijzing-v3.2(2019NL); 2020 Feb 03. Available from: https://zibs.nl/wiki/BehandelAanwijzing-v3.2(2019NL)
- Original Namespace: org.openehr
- Original Publisher: openEHR Foundation
- Custodian Namespace: org.openehr
- MD5-CAM-1.0.1: FEF12ACA9033560751C7E28A75C5EF54
- Build Uid: 3d99df16-8886-4c9a-b00d-7e1cbc9bd825
- Ip Acknowledgements: This artefact includes content from SNOMED Clinical Terms® (SNOMED CT®) which is copyrighted material of the International Health Terminology Standards Development Organisation (IHTSDO). Where an implementation of this artefact makes use of SNOMED CT content, the implementer must have the appropriate SNOMED CT Affiliate license - for more information contact http://www.snomed.org/snomed-ct/get-snomedct or info@snomed.org.
- Revision: 1.0.0
'Valid period end' may often overlap with 'Review due date'. However, they may need to be recorded separately in circumstances where a document has an extended period of validity but requires an interim review. That may be due to changed personal circumstances/events or local policy.
For example: an advance care directive.
Choice of:
Text
URI
Include:
openEHR-EHR-CLUSTER.multimedia_
Choice of:
- Text
- URI
Comment: For example, 'John Smith, Lawyer'.
Include:
All not explicitly excluded archetypes
For example: local information requirements; or additional metadata to align with FHIR.
Include:
All not explicitly excluded archetypes
The proposed value set is based on the MJA reference. Coding the intent of care with an external terminology is preferred, where possible.
Choice of:
Coded Text- Curative [The condition is curable; all appropriate life-prolonging treatment will be offered.]
- Restorative [The condition is treatable with potential for restoration to the previous state of health or a prolonged remission; all appropriate life-prolonging treatment will be offered.]
- Supportive [The condition is incurable and progressive; active treatment of the underlying disease may be appropriate for specific symptom relief and/or short term life expectancy gains; focused on comfort, quality of life and dignity. Also referred to as 'Palliative'.]
- Terminal [Life expectancy is short (hours or days); no active treatment of the underlying disease or treatment-related harm; focus on comfort, quality of life and dignity.]
- Unknown [The intent of care decision is not known.]
- Text
May be used to record a narrative overview of the advance intervention decision that reflect the specific circumstances for the individual. This includes any limitations, or conditional circumstances applicable, to interventions. This description may or may not be supported by structured data, recorded using the ‘Per intervention’ cluster. If both this narrative description and ‘Per intervention’ structured data is recorded, caution is required as there is a potential risk of divergence. This data element may be used to capture legacy data that is not available in a structured format.
Choice of:
- Text
- Coded Text
- Full CPR [All appropriate cardiopulmonary resuscitation treatments should be attempted to save or prolong life.]
- Limited CPR [Cardiopulmonary resuscitation treatments should be attempted, as specified in the 'Decisions description' narrative or as structured data in the 'Per intervention' cluster.]
- No CPR [No cardiopulmonary resuscitation treatments should be attempted to save or prolong life. Also known as 'Do not resuscitate (DNR)'; 'Do not attempt resuscitation (DNAR)'; 'Not for resuscitation (NFR)' or similar.]
[SNOMED-CT::450476008 | Not for cardiopulmonary resuscitation] - Unknown [The CPR decision is not known.]
While this archetype is intended for all clinical decisions about possible future interventions, the proposed DV_CODED_TEXT value set for the 'Intervention' data element is deliberately not intended to be exhaustive. Instead it has been designed to be inclusive of most of the common life-saving treatments within an emergency context. The alternate choice of the DV_TEXT option can be used to add a local value set or bind to an alternative external value set within a template.
Choice of:
- Coded Text
- Chest compressions [Technique used to manually pump blood around the body during a cardiac arrest.]
- Defibrillation [Use of electric shock to reset the electrical state of the heart.]
- Intubation [Placement of a tube into the trachea to maintain an open airway, including a tracheostomy.]
- Invasive ventilation [Artificial ventilation where invasive means are used to assist or replace spontaneous breathing.]
- Non-invasive ventilation [Artificial ventilation where non-invasive means are used to assist or replace spontaneous breathing.]
- Peripheral intravenous line [Insertion of a peripheral intravenous line.]
- Central venous line or any arterial line [Insertion of a central venous line or any arterial line.]
- Parenteral fluids [Maintenance of hydration by means other than eating or drinking.]
- Parenteral or artificial nutrition [Provision of nutrients by means other than eating or drinking.]
- Arrest medications [Medications used during an emergency resuscitation to prolong life. For example: adrenaline, atropine, sodium bicarbonate, calcium, other vasoactive medications.]
- Circulatory regulation medications [Medication that supports heart function, including but not limited to: vasopressors, inotropes and chronotropes.]
- Antibiotics, antiviral or antifungal agents [Medications to treat infections.]
- Blood products [Therapeutic substance prepared from human blood including, but not limited to: whole blood; blood components; and plasma derivatives.]
- Chest tube insertion [Insertion of a tube into the pleural space.]
- Cardiac pacemaker [Insertion of an artificial pacemaker to control the heart beat.]
- Dialysis [Process of removing excess water, solutes, and toxins from the blood.]
- Transfer to hospital [Transfer to hospital for assessment or admission.]
- Transfer to Intensive Care [Transfer and admission to an intensive care or high dependency unit.]
- Text
- Recommended [The intervention is recommended.]
- Conditional recommendation [The intervention is recommended only in specific circumstances, captured using the 'Preconditions' data element.]
- Not recommended [The intervention is not recommended.]
- Unknown [The intervention decision is not known.]
This data element is only relevant if the 'Conditional recommendation' option is selected in the 'Decision' data element. For example:' "Transfer to hospital is only applicable in the circumstances where the individual suffers a fracture and requires immobilization for pain relief.#
For example: the justification or rationale for the intervention decision.
For example: people involved in the decision-making process, if it is not possible to use the reference model participations; or additional locally relevant considerations.
Include:
All not explicitly excluded archetypes
For example: the capacity of the patient to understand the decisions.
For example: the individual has no family.
Nuno Abreu, Oporto Hospital Center, Portugal
Tor Aksel Aasmundstad, Oslo University Hospital, Norway
Tomas Alme, Norway
Vebjørn Arntzen, Oslo University Hospital, Norway (openEHR Editor)
Kari-Ann Baarlid, Nasjonalforeningen for folkehelsen, Norway
Silje Ljosland Bakke, Helse Vest IKT AS, Norway (openEHR Editor)
Terje Bektesevic Holmlund, UiT Norges arktiske universitet, Norway
SB Bhattacharyya, Sudisa Consultancy Services, India
Colin Brown, NHS Scotland SCIMP, United Kingdom
Greg Burch, Tiny Medical Apps, United Kingdom
Gry Caroline Aarnes, Nasjonalforeningen for folkehelsen, Norway
Fatemeh Chalabianloo, Helse Bergen, Norway
Bjørn Christensen, Helse Bergen HF, Norway
Oona Dunlop, Oslo University Hospital, Norway
Vibeche Fashing, Norwegian Cancer Society, Norway
Arild Faxvaag, NTNU, Norway
Grant Forrest, Lunaria Ltd, United Kingdom
Reidun Førde, Prof emirata, University of Oslo, Norway
Maria G, Norway
Heather Grain, Llewelyn Grain Informatics, Australia
Anne Grimstvedt Kvalvik, Haraldsplass Diakonale sykehus, Norway
Joost Holslag, Nedap, Netherlands
Evelyn Hovenga, EJSH Consulting, Australia
Keltie Jamieson, NSHA, Canada
Lars Morgan Karlsen, DIPS ASA, Norway
Heidi Koikkalainen, United Kingdom
Nils Kolstrup, Skansen Legekontor og Nasjonalt Senter for samhandling og telemedisin, Norway
Tomi Laptoš, Marand, Slovenia
Heather Leslie, Atomica Informatics, Australia (openEHR Editor)
Manisha Mantri, C-DAC, India
Ian McNicoll, freshEHR Clinical Informatics, United Kingdom
Per Meinich, Helse Sør-Øst RHF, Norway
Paul Miller, NES Digital Service, NHS Scotland, United Kingdom
Bjoern Naess, DIPS ASA, Norway
Arunakiry Natarajan, management4health, Germany
Svenne Naumann, Finnmarkssykehuset, Norway
Andrej Orel, Marand d.o.o., Slovenia
Vanessa Pereira, Better - Pathfinder, Portugal
Anne Rita Øksengård, Nasjonalforeningen for folkehelsen, Norway
Jussara Rotzsch, Hospital Alemão Oswaldo Cruz, Brazil
Nina Saastad, Norwegian Cancer Society, Norway
Joran Slaaen, Norwegian Cancer Society, Norway
Norwegian Review Summary, Nasjonal IKT HF, Norway
Nyree Taylor, Ocean Informatics, Australia
Rowan Thomas, St. Vincent's Hospital Melbourne, Australia
John Tore Valand, Helse Bergen, Norway (openEHR Editor)
Marc Vali Ahmed, Oslo University Hospital, Norway
Lin Zhang, Taikang Insurance Group, China
- German: Alina Rehberg, Medizinische Hochschule Hannover, rehberg.alina@mh-hannover.de
- Norwegian Bokmål: Vebjørn Arntzen, John Tore Valand, Oslo University Hospital, Helse Bergen, varntzen@ous-hf.no, john.tore.valand@helse-bergen.no