ARCHETYPE Advance intervention decisions (openEHR-EHR-EVALUATION.intervention_decisions.v0)

ARCHETYPE IDopenEHR-EHR-EVALUATION.intervention_decisions.v0
ConceptAdvance intervention decisions
DescriptionAnticipatory decisions about possible treatments or activities, usually asserted by an authorised clinician.
UseUse to record anticipatory decisions about the overall intent of care and possible interventions (including treatments or activities) for an individual. The decisions will support clinicians by providing guidance regarding possible treatments or activities that may be life-saving, life-prolonging or cause undesirable side effects. Each decision should be made in response to the individual's overall health and circumstances, and usually asserted by an authorised clinician after consideration of the individual's advance care directives or stated preferences. Ideally, the directives are established as part of integrated care or end-of-life planning, and not as a reaction to an acute or emergency situation. It may be necessary to record temporary overrides to usual advance intervention decisions in specific circumstances, for example during pregnancy or preoperatively. In this situation it will be necessary to record a separate instance of this archetype, using a combination of relevant validity and review dates.
MisuseNot to be used to record an 'Advance care directive' or the individual's preferences for care - use EVALUATION.advance_care_directive for this purpose.
PurposeTo record anticipatory decisions about the overall intent of care and possible interventions, usually asserted by an authorised clinician.
ReferencesBreault 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.
Copyright© openEHR Foundation, Apperta Foundation
AuthorsAuthor name: Heather Leslie
Organisation: Atomica Informatics, Australia
Email: heather.leslie@atomicainformatics.com
Date originally authored: 2020-07-31
Other Details LanguageAuthor name: Heather Leslie
Organisation: Atomica Informatics, Australia
Email: heather.leslie@atomicainformatics.com
Date originally authored: 2020-07-31
OtherDetails Language Independent{licence=This work is licensed under the Creative Commons Attribution-ShareAlike 4.0 License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/4.0/., custodian_organisation=Apperta UK, 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., original_namespace=uk.org.clinicalmodels, original_publisher=Apperta UK, custodian_namespace=uk.org.clinicalmodels, MD5-CAM-1.0.1=76A12E51B33F0ED327BA44EE0FE04860, build_uid=07908fc7-7e2b-4e07-b8b7-aea20df3eed2, 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=0.0.1-alpha}
KeywordsDNR, DNAR, DNACPR, NFR, resuscitation, resuscitate, EoL, end of life, directive, preference, goal, care, intervention, ceiling, limit, limitation, treatment, scope, escalation, intent, EOLC, life-prolonging, life-saving, palliative
Lifecyclein_development
UID55793c93-57a1-4440-afee-f56a2d9e1e1f
Language useden
Citeable Identifier1051.32.1143
Revision Number0.0.1-alpha
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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
Anne Grimstvedt Kvalvik, Haraldsplass Diakonale sykehus, Norway
Mikkel Johan Gaup Grønmo, Forvaltningssenter EPJ, Helse-Nord, Norway (openEHR Editor)
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
Liv Laugen, ​Oslo University Hospital, Norway, Norway (openEHR Editor)
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
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
Marit Alice Venheim, Helse Vest IKT, Norway (openEHR Editor)
Lin Zhang, Taikang Insurance Group, China, originalLanguage=en, translators=
  • 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
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    • 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 '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. All treatments to be focused on symptom relief and quality of 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.]
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  •  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.]
    • Parenteral fluids [Maintenance of hydration 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 [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.]
    • Needle thoracocentesis [Insertion of a needle into the pleural or pericardial space.]
    • Central venous line or any arterial line [Insertion of a central venous line or any arterial line.]
    • Cardiac pacemaker [Insertion of an artificial pacemaker to control the heart beat.]
    • Dialysis [Process of removing excess water, solutes, and toxins from the blood.]
    • Parenteral or artificial nutrition [Provision of nutrients by means other than eating or drinking.]
    • 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
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  • Recommended [The intervention is recommended.]
  • Conditional recommendation [The intervention is recommended only in specific circumstances, captured using the 'Conditions' data element.]
  • Not recommended [The intervention is not recommended.]
  • Unknown [The intervention decision is not known.]
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