ARCHETYPE Advance intervention decisions (openEHR-EHR-EVALUATION.advance_intervention_decisions.v1)

ARCHETYPE IDopenEHR-EHR-EVALUATION.advance_intervention_decisions.v1
ConceptAdvance intervention decisions
DescriptionAnticipatory decisions about the overall intent of care and possible interventions (including treatments, activities, and diagnostic or therapeutic procedures), asserted by a clinician.
UseUse to record anticipatory decisions about the overall intent of care and possible interventions for an individual. The decisions will support clinicians by providing guidance regarding possible treatments, activities, and diagnostic or therapeutic procedures that may be life-saving, life-prolonging or cause undesirable side effects. This archetype is intended to be used as part of integrated care or end-of-life planning, and not as a reaction to an acute or emergency situation. Each decision should be made in response to the individual's overall health and general circumstances, and usually asserted by a clinician after consideration of the individual's advance care directives or stated preferences. 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. Not to be used to record the orders required as a consequence of the decisions made and recorded using this archetype. Use specific INSTRUCTION or ACTION archetypes for this purpose.
PurposeTo record anticipatory decisions about the overall intent of care and possible interventions, usually asserted by a 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.

ZIB Centrum. [Internet]. Netherlands: Nictiz. BehandelAanwijzing-v3.2(2019NL); 2020 Feb 03. Available from: https://zibs.nl/wiki/BehandelAanwijzing-v3.2(2019NL)
Copyright© openEHR 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 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}
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, decision, direction
Lifecyclepublished
UIDfb7b27e1-b008-4aee-b692-148e81aca05f
Language useden
Citeable Identifier1013.1.4902
Revision Number1.0.0
AllArchetype [runtimeNameConstraintForConceptName=null, archetypeConceptBinding=null, archetypeConceptDescription=Anticipatory decisions about the overall intent of care and possible interventions (including treatments, activities, and diagnostic or therapeutic procedures), asserted by a clinician., archetypeConceptComment=null, otherContributors=Dag Aarhus, Vestre Viken HF, Norway
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, 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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  •  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
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  •  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.]
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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.]
    • 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
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  • 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.]
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