ARCHETYPE Limitation of treatment (openEHR-EHR-EVALUATION.limitation_of_treatment.v0)

ARCHETYPE IDopenEHR-EHR-EVALUATION.limitation_of_treatment.v0
ConceptLimitation of treatment
DescriptionDecision/s about limitation of future treatment, determined by a senior clinician.
UseUse to record the decision/s about limitation of future treatment, determined by a senior clinician. In many clinical situations, there are 'Not For Resuscitation' or 'Do not attempt resuscitation' orders in place, recorded in clinical records. The assumed default is that the patient should be resuscitated as clinically appropriate. This archetype has been designed to explicitly record 'No limitation of treatment' as default. Any alteration to this is also recorded explicitly in the health record. It is also possible to record specific limitations on treatment, for example allowing IV fluids and antibiotics only. In keeping with recent trends, the 'Status' value set comprises 'No limitation of treatment' (for full resuscitation measures), 'Allow natural death' (for no active resuscitation measures, with the exception of treatments providing comfort) and the specification of treatment limitations at a category level. The 'Limitation of treatment' information contained in this archetype should be aligned with an Advanced Care Directive, initiated by the patient or carers, wherever possible.
MisuseNot to be used to record an 'Advanced care directive' - use EVALUATION.advanced_care_directive for this purpose.
PurposeTo record the decision/s about limitation of future treatment, determined by a senior 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
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., original_namespace=org.openehr, original_publisher=openEHR Foundation, custodian_namespace=org.openehr, MD5-CAM-1.0.1=55F22E15A4917334B439C9BF0A40935D, build_uid=5605f8b3-ab33-40aa-ab0a-67d1c12658b0, 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, EoL, directive, preference
Lifecyclein_development
UID4fa2604b-a1c6-4585-8829-ebb1b4669fde
Language useden
Citeable Identifier1013.1.4902
Revision Number0.0.1-alpha
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  • Cardiopulmonary resuscitation [Lifesaving emergency procedure involving chest compressions and artificial ventilation.]
  • Intubation [Placement of a flexible plastic tube into the trachea to maintain an open airway.]
  • Mechanical ventilation [Artificial ventilation where mechanical means are used to assist or replace spontaneous breathing.]
  • Vasopressor therapy [Treatment with an agent that raises blood pressure.]
  • Parenteral or artificial nutrition [Provision of nutrients by means other than eating or drinking.]
  • Dialysis [Process of removing excess water, solutes, and toxins from the blood.]
  • Blood products [Therapeutic substance prepared from human blood including, but not limited to: whole blood; blood components; and plasma derivatives.]
  • Antibiotics, antiviral or antifungal agents [Medications to treat infections.]
  • Parenteral fluids [Maintenance of hydration by means other than eating or drinking.]
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  • Permitted [The treatment is permitted, if clinically appropriate.]
  • Not permitted [The treatment is not permitted.]
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  • Patient not aware of the decision/s [The patient is not aware of the limitation of treatment decision/s.]
  • Patient aware of the decision/s [The patient is aware of the limitation of treatment decision/s.]
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