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Identifying Advance care directives : DNR / DNI


(Gerald Pulver) #1

I am attempting to include patients’ advance care directives into an OMOP database.
For the project at hand, patient stati of interest are defined as:

  1. Do Not Resuscitate (DNR)
  2. Do Not Intubate (DNI)
  3. Do neither
  4. Full Code

The codes that I have found which seem most relevant are from the Nebraska Lexicon and LOINC:

Nebraska Lexicon

  • 3457216 143021000119109 Do not resuscitate order in place and supporting documentation present
  • 3481762 304253006 Do not resuscitate status
  • 3171146 32290001000004104 Do not initiate CPR or Defibrillate, use all other measures
  • 3172086 32300001000004105 Do not Intubate, initiate CPR or Defibrillate but use all other measures available

LOINC

  • 3044680 45986-7 Advance directives Set
  • 3044077 45476-9 Advance directive - organ donation
  • 3046125 45478-5 Advance directive - feeding restrictions
  • 3044427 45479-3 Advance directive - medication restrictions
  • 3042662 45474-4 Advance directive - do not resuscitate
  • 3047100 45480-1 Advance directive - other treatment restrictions
  • 3043357 45473-6 Advance directive/living will completed
  • 3045309 45481-9 Advance directive - none
  • 3044662 45477-7 Advance directive - autopsy request
  • 3042672 45475-1 Advance directive - do not hospitalize

Am I overlooking options that might allow for a stand-alone “Do Not Intubate” order?

Thanks,
Gerry


(Christian Reich) #2

Will add that to the list of conventions we need to set.

We could pick either one. Nebraska will become standard SNOMED, which we’d prefer, but LOINC is already there.

You would then write both DNR and DNI. No need for a combo. Or is there?

What’s that?

Plural is “status”, just as singular, but pronounced with a long U, like in Mahmoud.


(Gerald Pulver) #3

Thanks for the correction about the plural of “status”. It’s been about forty years since I had a Latin class. So, I lazily guessed that as the plural of “alumnus” is “alumni”, that would work for status as well.

While I see a clear need for a stand-alone DNI code, “combo” codes such as Nebraska provides may not be critical but could be useful.

My understanding is that “Full Code” means that there are no directives to limit efforts to resuscitate or maintain the life of a patient. One could infer this from the absence of other prior directives but might be useful to have if there is an explicit notation of such on the patient’s chart.


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