<status value="draft" /> <publisher value="Nictiz" /> <contact> <name value="Nictiz" /> <telecom> <system value="url" /> <value value="https://www.nictiz.nl" /> <use value="work" /> </telecom> </contact> <description value="The Delirium Observation Screening Scale is a tool to determine whether a patient has delirium. The DOSS includes 13 observations of behavior (verbal and non-verbal) which represent the symptoms of a delirium. These observations can be performed during regular contact with the patient." /> <purpose value="This Observation resource represents the Dutch [zib ('Zorginformatiebouwsteen', i.e. Health and Care Information Model) DOSScore v1.0 (2020)](https://zibs.nl/wiki/DOSScore-v1.0(2020EN))." /> <copyright value="Copyright and related rights waived via CC0, https://creativecommons.org/publicdomain/zero/1.0/. This does not apply to information from third parties, for example a medical terminology system. The implementer alone is responsible for identifying and obtaining any necessary licenses or authorizations to utilize third party IP in connection with the specification or otherwise." /> <fhirVersion value="4.0.1" /> <mapping> <identity value="zib-dosscore-v1.0-2020EN" /> <uri value="https://zibs.nl/wiki/DOSScore-v1.0(2020EN)" /> <name value="zib DOSScore-v1.0(2020EN)" /> </mapping> <kind value="resource" /> <abstract value="true" /> <type value="Observation" /> <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Observation" /> <derivation value="constraint" /> <differential> <element id="Observation"> <path value="Observation" /> <short value="DOSScore" /> <alias value="DOSScore" /> <mapping> <identity value="zib-dosscore-v1.0-2020EN" /> <map value="NL-CM:18.7.1" /> <comment value="DOSScore" /> </mapping> </element> <element id="Observation.code"> <path value="Observation.code" /> <comment value="The code to identify this concept (SNOMED 55681000146102) aligns with the next version of the zib, since the current version doesn't provide a code. See [ZIB-1674](https://bits.nictiz.nl/browse/ZIB-1674) for more information." /> <patternCodeableConcept> <coding> <system value="http://snomed.info/sct" /> <code value="55681000146102" /> </coding> </patternCodeableConcept> </element> <element id="Observation.effective[x]"> <path value="Observation.effective[x]" /> <slicing> <discriminator> <type value="type" /> <path value="$this" /> </discriminator> <rules value="open" /> </slicing> </element> <element id="Observation.effective[x]:effectiveDateTime"> <path value="Observation.effective[x]" /> <sliceName value="effectiveDateTime" /> <short value="DOSScoreDateTime" /> <definition value="The date on which the DOS score is registered." /> <alias value="DOSScoreDatumTijd" /> <type> <code value="dateTime" /> </type> <mapping> <identity value="zib-dosscore-v1.0-2020EN" /> <map value="NL-CM:18.7.5" /> <comment value="DOSScoreDateTime" /> </mapping> </element> <element id="Observation.value[x]"> <path value="Observation.value[x]" /> <slicing> <discriminator> <type value="type" /> <path value="$this" /> </discriminator> <rules value="open" /> </slicing> </element> <element id="Observation.value[x]:valueInteger"> <path value="Observation.value[x]" /> <sliceName value="valueInteger" /> <short value="DOSScoreTotal" /> <definition value="Per shift a total score is calculated (minimum 0 and maximum 13). The total scores of three shifts (day, evening and night shifts) are summed to the total score of the day (minimum 0 and maximum 39). The DOS scale final score is calculated by dividing the total score of the day by 3 (minimum 0 and maximum 13). A DOS scale final score < 3 means that the patient is probably not delirious. A DOS scale final score > 3 means that the patient is probably delirious." /> <alias value="DOSScoreTotaal" /> <type> <code value="integer" /> </type> <minValueInteger value="0" /> <maxValueInteger value="13" /> <mapping> <identity value="zib-dosscore-v1.0-2020EN" /> <map value="NL-CM:18.7.3" /> <comment value="DOSScoreTotal" /> </mapping> </element> <element id="Observation.note"> <path value="Observation.note" /> <max value="1" /> </element> <element id="Observation.note.text"> <path value="Observation.note.text" /> <short value="Comment" /> <definition value="Comment on the DOS score." /> <alias value="Toelichting" /> <mapping> <identity value="zib-dosscore-v1.0-2020EN" /> <map value="NL-CM:18.7.2" /> <comment value="Comment" /> </mapping> </element> <element id="Observation.component"> <path value="Observation.component" /> <slicing> <discriminator> <type value="value" /> <path value="code" /> </discriminator> <rules value="open" /> </slicing> </element> <element id="Observation.component:dozesOff"> <path value="Observation.component" /> <sliceName value="dozesOff" /> <max value="1" /> </element> <element id="Observation.component:dozesOff.code"> <path value="Observation.component.code" /> <comment value="The code to identify this concept (18007006 in code system urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0.1) aligns with the next version of the zib, since the current version doesn't provide a code. See [ZIB-1674](https://bits.nictiz.nl/browse/ZIB-1674) for more information." /> <patternCodeableConcept> <coding> <system value="urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0.1" /> <code value="18007006" /> </coding> </patternCodeableConcept> </element> <element id="Observation.component:dozesOff.value[x]"> <path value="Observation.component.value[x]" /> <short value="DozesOff" /> <definition value="DOS observation: patient dozes off during conversation or activities. Score: 0: never 1: sometimes-always (if the answer is "don't know", do not instantiate this concept)" /> <alias value="ZaktWeg" /> <type> <code value="integer" /> </type> <minValueInteger value="0" /> <maxValueInteger value="1" /> <mapping> <identity value="zib-dosscore-v1.0-2020EN" /> <map value="NL-CM:18.7.6" /> <comment value="DozesOff" /> </mapping> </element> <element id="Observation.component:easilyDistracted"> <path value="Observation.component" /> <sliceName value="easilyDistracted" /> <max value="1" /> </element> <element id="Observation.component:easilyDistracted.code"> <path value="Observation.component.code" /> <comment value="The code to identify this concept (18007007 in code system urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0.1) aligns with the next version of the zib, since the current version doesn't provide a code. See [ZIB-1674](https://bits.nictiz.nl/browse/ZIB-1674) for more information." /> <patternCodeableConcept> <coding> <system value="urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0.1" /> <code value="18007007" /> </coding> </patternCodeableConcept> </element> <element id="Observation.component:easilyDistracted.value[x]"> <path value="Observation.component.value[x]" /> <short value="EasilyDistracted" /> <definition value="DOS observation: patient is easily distracted by stimuli from the environment. Someone is easily distracted by stimuli from the environment when he/she responds verbally or non-verbally to sounds or movements that have no relation to him/her and the nature of which does not make you expect a reaction from him/her. Score: 0: never 1: sometimes-always (if the answer is "don't know", do not instantiate this concept)" /> <alias value="SnelAfgeleid" /> <type> <code value="integer" /> </type> <minValueInteger value="0" /> <maxValueInteger value="1" /> <mapping> <identity value="zib-dosscore-v1.0-2020EN" /> <map value="NL-CM:18.7.7" /> <comment value="EasilyDistracted" /> </mapping> </element> <element id="Observation.component:maintainsAttention"> <path value="Observation.component" /> <sliceName value="maintainsAttention" /> <max value="1" /> </element> <element id="Observation.component:maintainsAttention.code"> <path value="Observation.component.code" /> <comment value="The code to identify this concept (18007008 in code system urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0.1) aligns with the next version of the zib, since the current version doesn't provide a code. See [ZIB-1674](https://bits.nictiz.nl/browse/ZIB-1674) for more information." /> <patternCodeableConcept> <coding> <system value="urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0.1" /> <code value="18007008" /> </coding> </patternCodeableConcept> </element> <element id="Observation.component:maintainsAttention.value[x]"> <path value="Observation.component.value[x]" /> <short value="MaintainsAttention" /> <definition value="DOS observation: patient maintains attention to conversation or action. Someone is maintaining attention to a conversation or action if he/she verbally or non-verbally shows that they are following the conversation or action. Score: 1: never 0: sometimes-always (if the answer is "don't know", do not instantiate this concept)" /> <alias value="HeeftAandacht" /> <type> <code value="integer" /> </type> <minValueInteger value="0" /> <maxValueInteger value="1" /> <mapping> <identity value="zib-dosscore-v1.0-2020EN" /> <map value="NL-CM:18.7.8" /> <comment value="MaintainsAttention" /> </mapping> </element> <element id="Observation.component:unfinishedQuestionAnswer"> <path value="Observation.component" /> <sliceName value="unfinishedQuestionAnswer" /> <max value="1" /> </element> <element id="Observation.component:unfinishedQuestionAnswer.code"> <path value="Observation.component.code" /> <comment value="The code to identify this concept (18007009 in code system urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0.1) aligns with the next version of the zib, since the current version doesn't provide a code. See [ZIB-1674](https://bits.nictiz.nl/browse/ZIB-1674) for more information." /> <patternCodeableConcept> <coding> <system value="urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0.1" /> <code value="18007009" /> </coding> </patternCodeableConcept> </element> <element id="Observation.component:unfinishedQuestionAnswer.value[x]"> <path value="Observation.component.value[x]" /> <short value="UnfinishedQuestionAnswer" /> <definition value="DOS observation: patient does not finish question or answer. Score: 0: never 1: sometimes-always (if the answer is "don't know", do not instantiate this concept)" /> <alias value="VraagAntwoordNietAf" /> <type> <code value="integer" /> </type> <minValueInteger value="0" /> <maxValueInteger value="1" /> <mapping> <identity value="zib-dosscore-v1.0-2020EN" /> <map value="NL-CM:18.7.9" /> <comment value="UnfinishedQuestionAnswer" /> </mapping> </element> <element id="Observation.component:answersNoFit"> <path value="Observation.component" /> <sliceName value="answersNoFit" /> <max value="1" /> </element> <element id="Observation.component:answersNoFit.code"> <path value="Observation.component.code" /> <comment value="The code to identify this concept (18007010 in code system urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0.1) aligns with the next version of the zib, since the current version doesn't provide a code. See [ZIB-1674](https://bits.nictiz.nl/browse/ZIB-1674) for more information." /> <patternCodeableConcept> <coding> <system value="urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0.1" /> <code value="18007010" /> </coding> </patternCodeableConcept> </element> <element id="Observation.component:answersNoFit.value[x]"> <path value="Observation.component.value[x]" /> <short value="AnswersNoFit" /> <definition value="DOS observation: patient gives answers that do not fit the question. Score: 0: never 1: sometimes-always (if the answer is "don't know", do not instantiate this concept)" /> <alias value="AntwoordenNietPassend" /> <type> <code value="integer" /> </type> <minValueInteger value="0" /> <maxValueInteger value="1" /> <mapping> <identity value="zib-dosscore-v1.0-2020EN" /> <map value="NL-CM:18.7.10" /> <comment value="AnswersNoFit" /> </mapping> </element> <element id="Observation.component:reactsSlowly"> <path value="Observation.component" /> <sliceName value="reactsSlowly" /> <max value="1" /> </element> <element id="Observation.component:reactsSlowly.code"> <path value="Observation.component.code" /> <comment value="The code to identify this concept (18007011 in code system urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0.1) aligns with the next version of the zib, since the current version doesn't provide a code. See [ZIB-1674](https://bits.nictiz.nl/browse/ZIB-1674) for more information." /> <patternCodeableConcept> <coding> <system value="urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0.1" /> <code value="18007011" /> </coding> </patternCodeableConcept> </element> <element id="Observation.component:reactsSlowly.value[x]"> <path value="Observation.component.value[x]" /> <short value="ReactsSlowly" /> <definition value="DOS observation: patient reacts slowly to instructions. Someone reacts slowly to instructions when acting is delayed and/or there are moments of stillness/inactivity before moving into action. Score: 0: never 1: sometimes-always (if the answer is "don't know", do not instantiate this concept)" /> <alias value="ReageertTraag" /> <type> <code value="integer" /> </type> <minValueInteger value="0" /> <maxValueInteger value="1" /> <mapping> <identity value="zib-dosscore-v1.0-2020EN" /> <map value="NL-CM:18.7.11" /> <comment value="ReactsSlowly" /> </mapping> </element> <element id="Observation.component:thinksSomewhereElse"> <path value="Observation.component" /> <sliceName value="thinksSomewhereElse" /> <max value="1" /> </element> <element id="Observation.component:thinksSomewhereElse.code"> <path value="Observation.component.code" /> <comment value="The code to identify this concept (18007012 in code system urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0.1) aligns with the next version of the zib, since the current version doesn't provide a code. See [ZIB-1674](https://bits.nictiz.nl/browse/ZIB-1674) for more information." /> <patternCodeableConcept> <coding> <system value="urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0.1" /> <code value="18007012" /> </coding> </patternCodeableConcept> </element> <element id="Observation.component:thinksSomewhereElse.value[x]"> <path value="Observation.component.value[x]" /> <short value="ThinksSomewhereElse" /> <definition value="DOS observation: patient thinks they are somewhere else. Someone thinks they are somewhere else when he/she shows this in words or actions. Score: 0: never 1: sometimes-always (if the answer is "don't know", do not instantiate this concept)" /> <alias value="DenktErgensAnders" /> <type> <code value="integer" /> </type> <minValueInteger value="0" /> <maxValueInteger value="1" /> <mapping> <identity value="zib-dosscore-v1.0-2020EN" /> <map value="NL-CM:18.7.12" /> <comment value="ThinksSomewhereElse" /> </mapping> </element> <element id="Observation.component:knowsPartDay"> <path value="Observation.component" /> <sliceName value="knowsPartDay" /> <max value="1" /> </element> <element id="Observation.component:knowsPartDay.code"> <path value="Observation.component.code" /> <comment value="The code to identify this concept (18007013 in code system urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0.1) aligns with the next version of the zib, since the current version doesn't provide a code. See [ZIB-1674](https://bits.nictiz.nl/browse/ZIB-1674) for more information." /> <patternCodeableConcept> <coding> <system value="urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0.1" /> <code value="18007013" /> </coding> </patternCodeableConcept> </element> <element id="Observation.component:knowsPartDay.value[x]"> <path value="Observation.component.value[x]" /> <short value="KnowsPartDay" /> <definition value="DOS observation: patient knows which part of the day it is. Someone knows what part of the day it is when he/she shows such in words or actions. Score: 1: never 0: sometimes-always (if the answer is "don't know", do not instantiate this concept)" /> <alias value="BeseftDagdeel" /> <type> <code value="integer" /> </type> <minValueInteger value="0" /> <maxValueInteger value="1" /> <mapping> <identity value="zib-dosscore-v1.0-2020EN" /> <map value="NL-CM:18.7.13" /> <comment value="KnowsPartDay" /> </mapping> </element> <element id="Observation.component:remembersRecent"> <path value="Observation.component" /> <sliceName value="remembersRecent" /> <max value="1" /> </element> <element id="Observation.component:remembersRecent.code"> <path value="Observation.component.code" /> <comment value="The code to identify this concept (18007014 in code system urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0.1) aligns with the next version of the zib, since the current version doesn't provide a code. See [ZIB-1674](https://bits.nictiz.nl/browse/ZIB-1674) for more information." /> <patternCodeableConcept> <coding> <system value="urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0.1" /> <code value="18007014" /> </coding> </patternCodeableConcept> </element> <element id="Observation.component:remembersRecent.value[x]"> <path value="Observation.component.value[x]" /> <short value="RemembersRecent" /> <definition value="DOS observation: patient remembers recent events. Someone remembers recent events when he/she can for example tell whether they had visitors or what he/she ate. Score: 1: never 0: sometimes-always (if the answer is "don't know", do not instantiate this concept)" /> <alias value="HerinnertRecent" /> <type> <code value="integer" /> </type> <minValueInteger value="0" /> <maxValueInteger value="1" /> <mapping> <identity value="zib-dosscore-v1.0-2020EN" /> <map value="NL-CM:18.7.14" /> <comment value="RemembersRecent" /> </mapping> </element> <element id="Observation.component:restless"> <path value="Observation.component" /> <sliceName value="restless" /> <max value="1" /> </element> <element id="Observation.component:restless.code"> <path value="Observation.component.code" /> <comment value="The code to identify this concept (18007015 in code system urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0.1) aligns with the next version of the zib, since the current version doesn't provide a code. See [ZIB-1674](https://bits.nictiz.nl/browse/ZIB-1674) for more information." /> <patternCodeableConcept> <coding> <system value="urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0.1" /> <code value="18007015" /> </coding> </patternCodeableConcept> </element> <element id="Observation.component:restless.value[x]"> <path value="Observation.component.value[x]" /> <short value="Restless" /> <definition value="DOS observation: patient is picking, disorderly, restless. Score: 0: never 1: sometimes-always (if the answer is "don't know", do not instantiate this concept)" /> <alias value="Rusteloos" /> <type> <code value="integer" /> </type> <minValueInteger value="0" /> <maxValueInteger value="1" /> <mapping> <identity value="zib-dosscore-v1.0-2020EN" /> <map value="NL-CM:18.7.15" /> <comment value="Restless" /> </mapping> </element> <element id="Observation.component:pullsWires"> <path value="Observation.component" /> <sliceName value="pullsWires" /> <max value="1" /> </element> <element id="Observation.component:pullsWires.code"> <path value="Observation.component.code" /> <comment value="The code to identify this concept (18007016 in code system urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0.1) aligns with the next version of the zib, since the current version doesn't provide a code. See [ZIB-1674](https://bits.nictiz.nl/browse/ZIB-1674) for more information." /> <patternCodeableConcept> <coding> <system value="urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0.1" /> <code value="18007016" /> </coding> </patternCodeableConcept> </element> <element id="Observation.component:pullsWires.value[x]"> <path value="Observation.component.value[x]" /> <short value="PullsWires" /> <definition value="DOS observation: patient pulls IV tubing, feeding tubes, catheters, etc. Score: 0: never 1: sometimes-always (if the answer is "don't know", do not instantiate this concept)" /> <alias value="TrektDraden" /> <type> <code value="integer" /> </type> <minValueInteger value="0" /> <maxValueInteger value="1" /> <mapping> <identity value="zib-dosscore-v1.0-2020EN" /> <map value="NL-CM:18.7.16" /> <comment value="PullsWires" /> </mapping> </element> <element id="Observation.component:easilyEmotional"> <path value="Observation.component" /> <sliceName value="easilyEmotional" /> <max value="1" /> </element> <element id="Observation.component:easilyEmotional.code"> <path value="Observation.component.code" /> <comment value="The code to identify this concept (18007017 in code system urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0.1) aligns with the next version of the zib, since the current version doesn't provide a code. See [ZIB-1674](https://bits.nictiz.nl/browse/ZIB-1674) for more information." /> <patternCodeableConcept> <coding> <system value="urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0.1" /> <code value="18007017" /> </coding> </patternCodeableConcept> </element> <element id="Observation.component:easilyEmotional.value[x]"> <path value="Observation.component.value[x]" /> <short value="EasilyEmotional" /> <definition value="DOS observation: patient is easily or suddenly emotional. Someone is easily or suddenly emotional when he/she responds with a fierce emotion without provocation or when the fierceness of the emotion does not seem to match the provocation. Score: 0: never 1: sometimes-always (if the answer is "don't know", do not instantiate this concept)" /> <alias value="SnelGeemotioneerd" /> <type> <code value="integer" /> </type> <minValueInteger value="0" /> <maxValueInteger value="1" /> <mapping> <identity value="zib-dosscore-v1.0-2020EN" /> <map value="NL-CM:18.7.17" /> <comment value="EasilyEmotional" /> </mapping> </element> <element id="Observation.component:hallucinations"> <path value="Observation.component" /> <sliceName value="hallucinations" /> <max value="1" /> </element> <element id="Observation.component:hallucinations.code"> <path value="Observation.component.code" /> <comment value="The code to identify this concept (18007018 in code system urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0.1) aligns with the next version of the zib, since the current version doesn't provide a code. See [ZIB-1674](https://bits.nictiz.nl/browse/ZIB-1674) for more information." /> <patternCodeableConcept> <coding> <system value="urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0.1" /> <code value="18007018" /> </coding> </patternCodeableConcept> </element> <element id="Observation.component:hallucinations.value[x]"> <path value="Observation.component.value[x]" /> <short value="Hallucinations" /> <definition value="DOS observation: patient sees/hears things which are not there. Someone sees/hears things which are not there when he/she shows this verbally (ask!) or non-verbally. Score: 0: never 1: sometimes-always (if the answer is "don't know", do not instantiate this concept)" /> <alias value="Hallucinaties" /> <type> <code value="integer" /> </type> <minValueInteger value="0" /> <maxValueInteger value="1" /> <mapping> <identity value="zib-dosscore-v1.0-2020EN" /> <map value="NL-CM:18.7.18" /> <comment value="Hallucinations" /> </mapping> </element> </differential> </StructureDefinition>

No narrative is provided for definitional resources. A human-readable rendering can be found in the implementation guide(s) where this resource is used.