nl core FreedomRestrictingIntervention - Nictiz FHIR NL R4 Zib2020 v0.9.0

Nictiz FHIR NL R4 Zib2020
0.9.0 - CI Build

Nictiz FHIR NL R4 Zib2020 - Local Development build (v0.9.0). See the Directory of published versions

Resource Profile: nl core FreedomRestrictingIntervention

Official URL: http://nictiz.nl/fhir/StructureDefinition/nl-core-FreedomRestrictingIntervention				Version: 0.9.0
Draft as of 2023-10-17				Computable Name: NlcoreFreedomRestrictingIntervention
Copyright/Legal: 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.

Freedom restricting interventions are interventions that are used against the will of the person concerned and that consciously restrict the person’s freedom to protect the person or his environment. This definition includes many forms of freedom restriction, such as (not exhaustive)

Forced administration of fluid and nutrition
Forced administration of medication
Performing medical checks or other medical procedures
Restricting freedom of movement
Admitting to an accommodation and secluding when admitted to an accommodation.
Exercising supervision
Searching of clothing or body
Restriction of visitors and the use of communication means

In the hospital, it is usually about restricting the freedom of movement, for example by using bed rails, moving a chair near to the table or using an arm splint for infusion. In combination with freedom-restricting interventions, soothing medication can be administered. In the case of small children, it is often a question of fixing hands, for example, to prevent a stomach tube from being pulled out. For nurses to use it in hospitals, Dutch Nurses Association (V&VN) published a guideline [ref. 3]. In mental health care, care for the disabled and psychogeriatric care, it always concerns care that is used against the will of the patient. The legal framework for using these interventions is (per 1-1-2020) governed by two laws, namely:

The Wet verplichte ggz (Wvggz: Mandatory Care In Mental Health Act) for people with psychiatric disorders
The Wet zorg en dwang (Wzd: Care and Compulsion Act) for people with intellectual disabilities and people with a psychogeriatric disorder, such as dementia.

The Wvggz refers to the term compulsory care, while the Wzd uses the term involuntary care. A national registration system, the Argus registration, is used to register the interventions in the context of the Wvggz.

A derived profile from zib-FreedomRestrictingIntervention to provide a version better suited for implementation purposes. This profile augments the base profile with elements found in the various use cases that have adopted the zib.

Usage:

Examples for this Resource Profile: Procedure/nl-core-FreedomRestrictingIntervention-01

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

Differential Table
Key Elements Table
Snapshot Table
Statistics/References
All

This structure is derived from ZibFreedomRestrictingIntervention

Name	Card.	Type	Description & Constraints
Procedure	0..*	ZibFreedomRestrictingIntervention	FreedomRestrictingIntervention
subject	1..1	Reference(Patient \| Group \| nl core Patient)	Who the procedure was performed on
reasonReference:legalSituation-LegalStatus	0..1	Reference(nl core LegalSituation LegalStatus)	LegalSituation
reasonReference:legalSituation-Representation	0..1	Reference(nl core LegalSituation Representation)	LegalSituation
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Procedure		0..*	ZibFreedomRestrictingIntervention	FreedomRestrictingIntervention
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
legallyCapable	C	0..1	(Complex)	Extension URL: http://nictiz.nl/fhir/StructureDefinition/ext-FreedomRestrictingIntervention.LegallyCapable
assent		0..1	CodeableConcept	Optional Extensions Element URL: http://nictiz.nl/fhir/StructureDefinition/ext-FreedomRestrictingIntervention.Assent
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!Σ	1..1	code	preparation \| in-progress \| not-done \| on-hold \| stopped \| completed \| entered-in-error \| unknown Binding: EventStatus (required): A code specifying the state of the procedure.
category	Σ	1..1	CodeableConcept	Classification of the procedure Binding: ProcedureCategoryCodes(SNOMEDCT) (example): A code that classifies a procedure for searching, sorting and display purposes. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 225317005
subject	Σ	1..1	Reference(Patient \| Group \| nl core Patient)	Who the procedure was performed on
Slices for performed[x]	Σ	0..1		When the procedure was performed Slice: Unordered, Open by type:$this
performedDateTime			dateTime
performedPeriod			Period
performedString			string
performedAge			Age
performedRange			Range
performed[x]:performedPeriod	Σ	0..1	Period	When the procedure was performed
performed[x]:performedDateTime	Σ	0..1	dateTime	Start
reasonCode	Σ	0..1	CodeableConcept	ReasonForUse Binding: http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.20.5.4--20200901000000 (extensible)
Slices for reasonReference	Σ	0..*	Reference(Condition \| Observation \| Procedure \| DiagnosticReport \| DocumentReference)	The justification that the procedure was performed Slice: Unordered, Open by profile:resolve()
reasonReference:legalSituation-LegalStatus	Σ	0..1	Reference(nl core LegalSituation LegalStatus)	LegalSituation
reasonReference:legalSituation-Representation	Σ	0..1	Reference(nl core LegalSituation Representation)	LegalSituation
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Procedure.status	required	EventStatus
Procedure.category	example	Pattern: SNOMED CT code 225317005
Procedure.reasonCode	extensible	http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.20.5.4--20200901000000

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Procedure	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Procedure	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Procedure	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Procedure	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Procedure	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	ALL elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	ALL extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
zib-FreedomRestrictingIntervention-01	warning	Procedure.extension:legallyCapable	If the patient is not legally capable, an explanation must be provided : extension.where(url='legallyCapable').value = false implies extension.where(url='legallyCapableComment').value.exists()