<status value="active" /> <date value="2023-10-26T09:56:07.4563357+00:00" /> <publisher value="NICE" /> <contact> <name value="NICE" /> <telecom> <system value="email" /> <value value="vragen@stichting-nice.nl" /> </telecom> </contact> <description value="This profile is for submitting data to the NICE related to pain scores. The pain score is a general measurement for pain experience of an ICU patient at rest. It is not a description of specific, localized pain." /> <purpose value="This profile is used to submit pain score related information to the Dutch National Intensive Care Evaluation (NICE). It was derived from the Nictiz Health and Care Information Model (HCIM; Dutch: Zorginformatiebouwsteen or ZIB) PainScore, 2017 release version 3.1" /> <copyright value="CC0" /> <fhirVersion value="3.0.2" /> <mapping> <identity value="NICE-AI" /> <uri value="https://www.stichting-nice.nl/dd/#791" /> <name value="NICE2Improve (Actionable Indicators)" /> </mapping> <kind value="resource" /> <abstract value="false" /> <type value="Observation" /> <baseDefinition value="http://fhir.nl/fhir/StructureDefinition/nl-core-observation" /> <derivation value="constraint" /> <differential> <element id="Observation"> <path value="Observation" /> <short value="PainScore" /> <definition value="The pain score is a general measurement for pain experience, not a description of specific, localized pain. The following are used as an easily reproducible measurement for pain experience: NRS (Numeric Rating Scale) in which the patient gives the pain a number on a scale of 1 (no pain) to 10 (unbearable pain). VAS (Visual Analogue Score), in which the patient points to a bar with a line to indicate the pain they feel. The back of the bar has a scale from 0 (no pain) to 10 (unbearable pain) on it. BPS (Behavioural Pain Scale) in which the care provider scores pain based on three indicators: facial expression, upper limb movement and compliance with ventilation. Each indicator is scored a 1, 2, 3 or 4. High scores indicate more pain. CPOT (Critical-Care Pain Observation Tool) in which the care provider scores pain based on four indicators: facial expression, body movements muscle tension and compliance with the ventilator if intubated, or vocalization if extubated. Each indicator is scored a 0, 1 or 2. High scores indicate more pain. CIA (Critically Ill Assessment scale) in which five items are scored (alertness, facial tension, muscle tone, body movements and respiratory response) with a total score between 5 and 20" /> <alias value="Pijnscore" /> <constraint> <key value="maxValue-for-method" /> <severity value="error" /> <human value="maxValue of 10 if method is VAS10 or NRS, 100 if VAS100, 12 if BPS, 8 if CPTOT, or 20 if CIA" /> <expression value="((method.coding.code = 'VAS10' or method.coding.code = 'NRS') and valueQuantity.value <= 10) or (method.coding.code='VAS100' and valueQuantity.value <= 100) or (method.coding.code = 'BPS' and valueQuantity.value <= 12) or (method.coding.code='CPTOT' and valueQuantity.value <= 8) or (method.coding.code='CIA' and valueQuantity.value <= 20)" /> </constraint> <constraint> <key value="minValue-for-method" /> <severity value="error" /> <human value="minValue of 1 if method is NRS, 0 if VAS or CPTOT, 4 if BPS and 5 if CIA" /> <expression value="((method.coding.code = 'VAS10' or method.coding.code = 'VAS100' or method.coding.code = 'CPTOT') and valueQuantity.value >= 0) or (method.coding.code='NRS' and valueQuantity.value >= 1) or (method.coding.code='BPS' and valueQuantity.value >= 4) or (method.coding.code='CIA' and valueQuantity.value >= 5)" /> </constraint> <mapping> <identity value="NICE-AI" /> <map value="https://www.stichting-nice.nl/dd/#752" /> <comment value="Pain score" /> </mapping> <mapping> <identity value="hcim-painscore-v3.1-2017EN" /> <map value="NL-CM:12.9.1" /> <comment value="Pain score" /> </mapping> </element> <element id="Observation.identifier"> <path value="Observation.identifier" /> <max value="1" /> <mustSupport value="true" /> <mapping> <identity value="NICE-AI" /> <map value="https://www.stichting-nice.nl/dd/#750" /> <comment value="Pijnmeting volgnummer" /> </mapping> </element> <element id="Observation.status"> <path value="Observation.status" /> <constraint> <key value="completed" /> <severity value="error" /> <human value="NICE observations SHALL be completed" /> <expression value="$this = 'final' or $this = 'amended' or $this = 'corrected'" /> </constraint> <mustSupport value="true" /> </element> <element id="Observation.code"> <path value="Observation.code" /> <mustSupport value="true" /> </element> <element id="Observation.code.coding"> <path value="Observation.code.coding" /> <slicing> <discriminator> <type value="value" /> <path value="system" /> </discriminator> <discriminator> <type value="value" /> <path value="code" /> </discriminator> <rules value="open" /> </slicing> <max value="1" /> </element> <element id="Observation.code.coding:PainScoreCode"> <path value="Observation.code.coding" /> <sliceName value="PainScoreCode" /> <max value="1" /> </element> <element id="Observation.code.coding:PainScoreCode.system"> <path value="Observation.code.coding.system" /> <fixedUri value="http://snomed.info/sct" /> </element> <element id="Observation.code.coding:PainScoreCode.code"> <path value="Observation.code.coding.code" /> <fixedCode value="225908003" /> </element> <element id="Observation.code.coding:PainScoreCode.display"> <path value="Observation.code.coding.display" /> <defaultValueString value="Pain score (observable entity)" /> </element> <element id="Observation.subject"> <path value="Observation.subject" /> <type> <code value="Reference" /> <targetProfile value="https://fhir.stichting-nice.nl/STU3/StructureDefinition/NICE-Patient-2022Q1" /> </type> <mustSupport value="true" /> </element> <element id="Observation.context"> <path value="Observation.context" /> <type> <code value="Reference" /> <targetProfile value="https://fhir.stichting-nice.nl/STU3/StructureDefinition/NICE-Encounter-2022Q1" /> </type> <mustSupport value="true" /> </element> <element id="Observation.effective[x]:effectiveDateTime"> <path value="Observation.effectiveDateTime" /> <sliceName value="effectiveDateTime" /> <alias value="PijnscoreDatumTijd" /> <type> <code value="dateTime" /> </type> <mapping> <identity value="hcim-painscore-v3.1-2017EN" /> <map value="NL-CM:12.9.3" /> <comment value="Pain measurement time" /> </mapping> <mapping> <identity value="NICE-AI" /> <map value="https://www.stichting-nice.nl/dd/#751" /> <comment value="Pain measurement time" /> </mapping> </element> <element id="Observation.value[x]:valueQuantity"> <path value="Observation.valueQuantity" /> <sliceName value="valueQuantity" /> <definition value="The score is a general measurement of pain experience, not a description of specific, localized pain. Depending on the measuring method used, it indicates the level of pain experienced by the patient on a scale of 0 to 10: 0 = no pain and 10 = the worst pain imaginable. No descriptions are used for the intermediate values, so that the value is displayed as a number and not as a code. Sometimes a value range of 0-100, 4-12, 0-8 or 5-20 is used instead of 0-10." /> <alias value="PijnscoreWaarde" /> <type> <code value="Quantity" /> </type> <example> <label value="Example of PainScore value" /> <valueQuantity> <value value="7.0" /> <system value="http://unitsofmeasure.org" /> <code value="{score}" /> </valueQuantity> </example> <mapping> <identity value="hcim-painscore-v3.1-2017EN" /> <map value="NL-CM:12.9.2" /> <comment value="PainScoreValue" /> </mapping> </element> <element id="Observation.comment"> <path value="Observation.comment" /> <definition value="Comment on the pain score measurement, including comments on for example the circumstances and/or disruptive factors that may influence the result." /> <alias value="Toelichting" /> <mapping> <identity value="hcim-painscore-v3.1-2017EN" /> <map value="NL-CM:12.9.5" /> <comment value="Comment" /> </mapping> </element> <element id="Observation.bodySite.extension:Laterality"> <path value="Observation.bodySite.extension" /> <sliceName value="Laterality" /> <definition value="Laterality adds information about body side to the anatomic location, e.g. left" /> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." /> <alias value="Lateraliteit" /> <max value="1" /> <type> <code value="Extension" /> <profile value="http://nictiz.nl/fhir/StructureDefinition/BodySite-Qualifier" /> </type> <mapping> <identity value="hcim-painscore-v3.1-2017EN" /> <map value="NL-CM:12.9.7" /> <comment value="Laterality" /> </mapping> </element> <element id="Observation.bodySite.extension:Laterality.valueCodeableConcept:valueCodeableConcept"> <path value="Observation.bodySite.extension.valueCodeableConcept" /> <sliceName value="valueCodeableConcept" /> <binding> <strength value="extensible" /> <description value="Laterality" /> <valueSetReference> <reference value="https://simplifier.net/nictizstu3-zib2017/2.16.840.1.113883.2.4.3.11.60.40.2.12.9.3--20171231000000" /> </valueSetReference> </binding> </element> <element id="Observation.method"> <path value="Observation.method" /> <short value="How it was performed" /> <definition value="The pain score is a general measurement for pain experience, not a description of specific, localized pain. The following are used as an easily reproducible measurement for pain experience: NRS (Numeric Rating Scale) in which the patient gives the pain a number on a scale of 1 (no pain) to 10 (unbearable pain). VAS (Visual Analogue Score), in which the patient points to a bar with a line to indicate the pain they feel. The back of the bar has a scale from 0 (no pain) to 10 (unbearable pain) on it. BPS (Behavioural Pain Scale) in which the care provider scores pain based on three indicators: facial expression, upper limb movement and compliance with ventilation. Each indicator is scored a 1, 2, 3 or 4. High scores indicate more pain. CPOT (Critical-Care Pain Observation Tool) in which the care provider scores pain based on four indicators: facial expression, body movements muscle tension and compliance with the ventilator if intubated, or vocalization if extubated. Each indicator is scored a 0, 1 or 2. High scores indicate more pain. CIA (Critically Ill Assessment scale) in which five items are scored (alertness, facial tension, muscle tone, body movements and respiratory response) with a total score between 5 and 20" /> <min value="1" /> <mustSupport value="true" /> <binding> <strength value="required" /> <description value="NICE-methods for pain measurement" /> <valueSetReference> <reference value="https://fhir.stichting-nice.nl/fhir/ValueSet/NICE-PainMeasurementToolCodeList" /> </valueSetReference> </binding> <mapping> <identity value="NICE-AI" /> <map value="https://www.stichting-nice.nl/dd/#752" /> <comment value="Pain score" /> </mapping> </element> </differential> </StructureDefinition>