archetype (adl_version=1.4; uid=32381533-91bf-45ce-b2f9-49645f4b5cb4)
	openEHR-EHR-OBSERVATION.critical_pain_observation_tool.v0

concept
	[at0000]	-- Critical care pain observation tool (CPOT)
language
	original_language = <[ISO_639-1::en]>
	translations = <
		["es-ar"] = <
			language = <[ISO_639-1::es-ar]>
			author = <
				["name"] = <"Alan D. March">
				["organisation"] = <"Hospital Universitario Austral, Pilar, Buenos Aires, Argentina">
				["email"] = <"alandmarch@gmail.com">
			>
		>
	>
description
	original_author = <
		["name"] = <"Alan D. March">
		["organisation"] = <"Hospital Universitario Austral, Pilar, Buenos Aires, Argentina">
		["email"] = <"alandmarch@gmail.com">
		["date"] = <"2016-07-21">
	>
	details = <
		["es-ar"] = <
			language = <[ISO_639-1::es-ar]>
			purpose = <"Una escala de dolor para pacientes no comunicativos y sedados en una unidad de cuidados intesivos (UCI), basada en observaciones clínicas.">
			use = <"La escala consiste de cuatro parametros de comportamiento: expresión facial, movimientos corporales, tensión muscular, y adattación al ventilador (para pacientes intubados) o vocalización (para pacientes extubados). Se asigna un puntaje entre 0 y 2 según el comportamiento de cada paciente para cada uno de los parametros. El rango del puntaje total va de 0 (ausencia de dolor) a 8 (máximo dolor).">
			keywords = <"dolor", "puntaje", "escala", "expresión facial", "movimientos corporales", "tensión muscular", "ventilación", "asistencia respiratoria", "intubación", "vocalización">
			misuse = <"No utilizar en pacientes fuera del alcance (no comunicativos y sedados en unidada de cuidados intensivos).">
			copyright = <"© openEHR Foundation">
		>
		["en"] = <
			language = <[ISO_639-1::en]>
			purpose = <"A pain assessment scale for uncommunicative and sedated intensive care unit (ICU) patients based on clinical observation.">
			use = <"The scale consists of four behavioral parameters: facial expression, body movements, muscle tension and compliance with the ventilation for intubated patients or vocalization for extubated patients. Patient’s behavior for each of the parameters is scored between 0 and 2. Possible total score ranges from 0 (no pain) to 8 (maximum pain).">
			keywords = <"pain", "score", "facial expression", "body movements", "muscle tension", "ventilation", "intubation", "vocalization">
			misuse = <"Not to be used outside the scope of uncommunicative or sedated intesive care patients.">
			copyright = <"© openEHR Foundation">
		>
	>
	lifecycle_state = <"in_development">
	other_contributors = <>
	other_details = <
		["licence"] = <"This work is licensed under the Creative Commons Attribution-ShareAlike 3.0 License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/3.0/.">
		["custodian_organisation"] = <"openEHR Foundation">
		["references"] = <"Payen JF, Bru O, Bosson JL, Lagrasta A, Novel E, Deschaux I, Lavagne P, Jacquot C. Assessing pain in critically ill sedated patients by using a behavioral pain scale. Crit Care Med 2001;29:2258-63. 

Gélinas C, Fillion L, Puntillo KA, Viens C, Fortier M. Validation of the critical-care pain observation tool in adult patients. Am J Crit Care 2006;15:420-7.

Pudas-Tähkä SM, Axelin A, Aantaa R, Lund V, Salanterä S. Pain assessment tools for unconscious or sedated intensive care patients: a systematic review. J Adv Nurs. 2009 May;65(5):946-56.">
		["current_contact"] = <"Alan D. March <alandmarch@gmail.com>">
		["original_namespace"] = <"org.openehr">
		["original_publisher"] = <"openEHR Foundation">
		["custodian_namespace"] = <"org.openehr">
		["MD5-CAM-1.0.1"] = <"6FF6C80EF4B60576C5BF3D828E94AC7A">
		["build_uid"] = <"5b54332a-f9e1-4325-94f5-541c7f2a9736">
		["revision"] = <"0.0.1-alpha">
	>

definition
	OBSERVATION[at0000] matches {	-- Critical care pain observation tool (CPOT)
		data matches {
			HISTORY[at0001] matches {	-- Event Series
				events cardinality matches {1..*; unordered} matches {
					POINT_EVENT[at0002] occurrences matches {0..1} matches {	-- Any event
						data matches {
							ITEM_TREE[at0003] matches {	-- Tree
								items cardinality matches {4..*; ordered} matches {
									ELEMENT[at0004] occurrences matches {0..1} matches {	-- Ventilator compliance
										value matches {
											0|[local::at0005], 	-- Tolerating ventilator or movement
											1|[local::at0006], 	-- Coughing but tolerating
											2|[local::at0007]  	-- Fighting ventilator
										}
									}
									ELEMENT[at0008] occurrences matches {0..1} matches {	-- Vocalization
										value matches {
											0|[local::at0009], 	-- Talking in normal tone or no sound
											1|[local::at0010], 	-- Sighing, moaning
											2|[local::at0011]  	-- Crying out, sobbing
										}
									}
									ELEMENT[at0012] matches {	-- Facial expression
										value matches {
											0|[local::at0013], 	-- Relaxed, neutral
											1|[local::at0014], 	-- Tense
											2|[local::at0015]  	-- Grimacing
										}
									}
									ELEMENT[at0016] matches {	-- Body movements
										value matches {
											0|[local::at0017], 	-- Absence of movements
											1|[local::at0018], 	-- Protection
											2|[local::at0019]  	-- Restlessness
										}
									}
									ELEMENT[at0020] matches {	-- Muscle tension
										value matches {
											0|[local::at0021], 	-- Relaxed
											1|[local::at0022], 	-- Tense, rigid
											2|[local::at0023]  	-- Very tense or rigid
										}
									}
									ELEMENT[at0025] matches {	-- Total score
										value matches {
											DV_COUNT matches {
												magnitude matches {|0..8|}
											}
										}
									}
									ELEMENT[at0026] occurrences matches {0..1} matches {	-- Comment
										value matches {
											DV_TEXT matches {*}
										}
									}
								}
							}
						}
						state matches {
							ITEM_TREE[at0032] matches {	-- Tree
								items cardinality matches {1..*; unordered} matches {
									ELEMENT[at0024] matches {	-- Intubated?
										value matches {
											DV_BOOLEAN matches {
												value matches {True, False}
											}
										}
									}
									ELEMENT[at0033] occurrences matches {0..1} matches {	-- Confounding factors
										value matches {
											DV_TEXT matches {*}
										}
									}
								}
							}
						}
					}
				}
			}
		}
		protocol matches {
			ITEM_TREE[at0027] matches {	-- Tree
				items cardinality matches {0..*; unordered} matches {
					allow_archetype CLUSTER[at0034] occurrences matches {0..*} matches {	-- Extension
						include
							archetype_id/value matches {/.*/}
					}
				}
			}
		}
	}


ontology
	term_definitions = <
		["en"] = <
			items = <
				["at0000"] = <
					text = <"Critical care pain observation tool (CPOT)">
					description = <"A pain scale for uncommunicative and sedated intensive care unit (ICU) patients based on clinical observation.">
				>
				["at0001"] = <
					text = <"Event Series">
					description = <"@ internal @">
				>
				["at0002"] = <
					text = <"Any event">
					description = <"Default, unspecified point in time or interval event which may be explicitly defined in a template or at run-time.">
				>
				["at0003"] = <
					text = <"Tree">
					description = <"@ internal @">
				>
				["at0004"] = <
					text = <"Ventilator compliance">
					description = <"Used in mechanically ventilated patients.">
					comment = <"Please note: for non-ventilated patients, the Vocalization parameter must be used.">
				>
				["at0005"] = <
					text = <"Tolerating ventilator or movement">
					description = <"Alarms not activated, easy ventilation.">
				>
				["at0006"] = <
					text = <"Coughing but tolerating">
					description = <"Alarms stop spontaneously.">
				>
				["at0007"] = <
					text = <"Fighting ventilator">
					description = <"Asynchrony: blocking ventilation, alarms frequently activated.">
				>
				["at0008"] = <
					text = <"Vocalization">
					description = <"Used in non-ventilated patients.">
					comment = <"Please note: for mechanically ventilated patients, the Ventilator compliance parameter must be used.">
				>
				["at0009"] = <
					text = <"Talking in normal tone or no sound">
					description = <"Talking in normal tone or no sound.">
				>
				["at0010"] = <
					text = <"Sighing, moaning">
					description = <"Sighing, moaning.">
				>
				["at0011"] = <
					text = <"Crying out, sobbing">
					description = <"Crying out, sobbing.">
				>
				["at0012"] = <
					text = <"Facial expression">
					description = <"The state and changes in the patient's facial gestures.">
					comment = <"Facial expression is one of the best behavioral indicators for pain
assessment.">
				>
				["at0013"] = <
					text = <"Relaxed, neutral">
					description = <"No muscular tension observed.">
				>
				["at0014"] = <
					text = <"Tense">
					description = <"Presence of frowning, brow lowering, orbit tightening, and levator contraction.">
				>
				["at0015"] = <
					text = <"Grimacing">
					description = <"All of the above facial movements plus eyelid tightly closed.">
				>
				["at0016"] = <
					text = <"Body movements">
					description = <"The patient's pattern of movements.">
					comment = <"Body movements are the less specific behaviors in relation with pain but may convey important insight.">
				>
				["at0017"] = <
					text = <"Absence of movements">
					description = <"Does not move at all (does not necessarily mean absence of pain).">
				>
				["at0018"] = <
					text = <"Protection">
					description = <"Slow, cautious movements, touching or rubbing the pain site, seeking attention through movements.">
				>
				["at0019"] = <
					text = <"Restlessness">
					description = <"Pulling tube, attempting to sit up, moving limbs/thrashing, not following commands, striking at staff, trying to climb out of bed.">
				>
				["at0020"] = <
					text = <"Muscle tension">
					description = <"Generally evaluated by performing a passive flexion and extension of the patient’s arm.">
				>
				["at0021"] = <
					text = <"Relaxed">
					description = <"No resistance to passive movements.">
				>
				["at0022"] = <
					text = <"Tense, rigid">
					description = <"Resistance to passive movements.">
				>
				["at0023"] = <
					text = <"Very tense or rigid">
					description = <"Strong resistance to passive movements, inability to complete them.">
				>
				["at0024"] = <
					text = <"Intubated?">
					description = <"True if the patient is intubated.">
				>
				["at0025"] = <
					text = <"Total score">
					description = <"The value which results from adding up the four variables measured.">
					comment = <"While there are five ordinal data elements represented in this archetype, only one result from either 'Ventilator compliance' or 'Vocalization' may be used to calculate the total score.">
				>
				["at0026"] = <
					text = <"Comment">
					description = <"Additional information regarding pain which were not captured by the structured variables but which might be of interest in the individual patient's assessment.">
				>
				["at0027"] = <
					text = <"Tree">
					description = <"@ internal @">
				>
				["at0032"] = <
					text = <"Tree">
					description = <"@ internal @">
				>
				["at0033"] = <
					text = <"Confounding factors">
					description = <"Any incidental factors related to the state of the subject which may affect clinical interpretation of the measurement.">
					comment = <"For example, delirium is a common complication in ICU and may affect measurement values.">
				>
				["at0034"] = <
					text = <"Extension">
					description = <"Additional information required to capture local context or to align with other reference models/formalisms.">
					comment = <"For example: Local hospital departmental infomation or additional metadata to align with FHIR or CIMI equivalents.">
				>
			>
		>
		["es-ar"] = <
			items = <
				["at0000"] = <
					text = <"Escala de valoración del dolor mediante la observación del paciente crítico(CPOT)">
					description = <"Escala de dolor para pacientes no comunicativos y sedados en una unidad de cuidados intesivos (UCI), basada en observaciones clínicas.">
				>
				["at0001"] = <
					text = <"Event Series">
					description = <"@ internal @">
				>
				["at0002"] = <
					text = <"*Any event(en)">
					description = <"*Default, unspecified point in time or interval event which may be explicitly defined in a template or at run-time.(en)">
				>
				["at0003"] = <
					text = <"Tree">
					description = <"@ internal @">
				>
				["at0004"] = <
					text = <"Adaptación al respirador">
					description = <"Utilizado en pacientes bajo asistencia resporatoria mecánica. Para pacientes no ventilados debe utilizarse el parametro Vocalización.">
				>
				["at0005"] = <
					text = <"Bien adaptado al respirador">
					description = <"No se activan las alarmas. Facil ventilación.">
				>
				["at0006"] = <
					text = <"Tose pero tolera">
					description = <"Las alarmas de detienen en forma espontanea.">
				>
				["at0007"] = <
					text = <"Lucha con el respirador">
					description = <"La ventilación de detiene. Las alarmas se activan con frecuencia.">
				>
				["at0008"] = <
					text = <"Vocalización">
					description = <"Utilizado en pacientes no ventilados. Para pacientes bajo asistencia resporatoria mecánica debe utilizarse el parametro Adaptación al respirador.">
				>
				["at0009"] = <
					text = <"Habla en tono normal o en silencio">
					description = <"Habla en tono normal o esta en silencio.">
				>
				["at0010"] = <
					text = <"Suspiros, gemidos">
					description = <"Suspiros y/o gemidos.">
				>
				["at0011"] = <
					text = <"Gritos, sollozos">
					description = <"Gritos y/o sollozos.">
				>
				["at0012"] = <
					text = <"Expresión facial">
					description = <"El estado y los cambios en las gestos faciales del paciente. La expresión facial es uno de los mejores indicadores conductuales para la evaluación del dolor.">
				>
				["at0013"] = <
					text = <"Relajado, neutro">
					description = <"No se observa tensión muscular.">
				>
				["at0014"] = <
					text = <"Tenso">
					description = <"Presencia de ceño fruncido, cejas bajas, ojos entrecerrados.">
				>
				["at0015"] = <
					text = <"Muecas">
					description = <"Todos los movimientos faciales anteriores, con los párpados fuertemente cerrados.">
				>
				["at0016"] = <
					text = <"Movimientos corporales">
					description = <"El patrón de movimientos del paciente. Los movimientos corporales son comportamientos menos específicos en relación al dolor pero pueden proveer información relevante.">
				>
				["at0017"] = <
					text = <"Ausencia de movimientos">
					description = <"No se observan movimiento. Esto no necesariamente indica ausencia de dolor.">
				>
				["at0018"] = <
					text = <"Protección">
					description = <"Movimientos lentos y cautelosos. Se toca o frota el sitio del dolor. Busca atención mediante movimientos.">
				>
				["at0019"] = <
					text = <"Agitado">
					description = <"Empuja el tubo. Intenta sentarse. Mueve los labios. No obedece órdenes. Molesta al personal. Trata de salir de la cama.">
				>
				["at0020"] = <
					text = <"Tensión muscular">
					description = <"Generalmente evaluada realizando flexión y extensión pasiva del brazo del paciente.">
				>
				["at0021"] = <
					text = <"Relajado">
					description = <"No se resiste a movimientos pasivos.">
				>
				["at0022"] = <
					text = <"Tenso, rígido">
					description = <"Se resiste a movimientos pasivos.">
				>
				["at0023"] = <
					text = <"Muy tenso o muy rígido">
					description = <"Fuerte resistencia a movimientos pasivos, incapacidad para finalizarlos.">
				>
				["at0024"] = <
					text = <"Intubado?">
					description = <"Verdadero si el paciente se encuentra intubado.">
				>
				["at0025"] = <
					text = <"Puntaje total">
					description = <"El valor resultante de la suma de las cinco variables evaluadas.">
				>
				["at0026"] = <
					text = <"Comentario">
					description = <"Información adicional acerca del dolor que no pudo capturarse en las variables estructuradas pero que podría ser de interés en la evaluación de un paciente individual.">
				>
				["at0027"] = <
					text = <"Tree">
					description = <"@ internal @">
				>
				["at0032"] = <
					text = <"Tree">
					description = <"@ internal @">
				>
				["at0033"] = <
					text = <"Factores de confusión">
					description = <"Todo factor incidental relacionado con el estado del sujeto y que pueda afectar la interpretación clínica de la medición. measurement. Por ejemplo, el delirio es una complicación común en las Unidades de Cuidados Intensivos y puede afectar los valores medidos.">
				>
				["at0034"] = <
					text = <"*Extension(en)">
					description = <"*Additional information required to capture local context or to align with other reference models/formalisms.(en)">
					comment = <"*For example: Local hospital departmental infomation or additional metadata to align with FHIR or CIMI equivalents.(en)">
				>
			>
		>
	>