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General information
Name: nl.zorg.ComfortScale
Version: 1.0
HCIM Status:Final
Release: 2017
Release status: Published
Release date: 31-12-2017
Metadata
DCM::CoderList |
Werkgroep RadB Verpleegkundige Gegevens
|
DCM::ContactInformation.Address |
*
|
DCM::ContactInformation.Name |
*
|
DCM::ContactInformation.Telecom |
*
|
DCM::ContentAuthorList |
Werkgroep RadB Verpleegkundige Gegevens
|
DCM::CreationDate |
1-8-2016
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DCM::DeprecatedDate |
|
DCM::DescriptionLanguage |
nl
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DCM::EndorsingAuthority.Address |
|
DCM::EndorsingAuthority.Name |
zorg
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DCM::EndorsingAuthority.Telecom |
|
DCM::Id |
2.16.840.1.113883.2.4.3.11.60.40.3.12.12
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DCM::KeywordList |
Pijnscore, assessment, comfort, comfortneo
|
DCM::LifecycleStatus |
Final
|
DCM::ModelerList |
Werkgroep RadB Verpleegkundige Gegevens
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DCM::Name |
nl.zorg.ComfortScore
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DCM::PublicationDate |
31-12-2017
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DCM::PublicationStatus |
Published
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DCM::ReviewerList |
Projectgroep RadB Verpleegkundige Gegevens & Kerngroep Registratie aan de Bron
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DCM::RevisionDate |
31-12-2017
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DCM::Superseeds |
|
DCM::Version |
1.0
|
HCIM::PublicationLanguage |
EN
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Revision History
Only available in Dutch
Publicatieversie 1.0 (04-09-2017).
Concept
The Comfort Behaviour scale /Comfortneo scale is an assessment tool, that is used to assess the pain behaviour of neonates (new born).
The Comfort Behaviour scale has 7 observation points that that need to be addressed. For each on observation is value is assigned from a 5-point scale, the final score indicates whether the observed child suffers pain and 'how much'. The score is combined with an NRS score that is completed by the nurses on basis of clinical experience.
Purpose
> A pain observation instrument is a tool in determining the intensity of pain and can be useful in order to determine the effectiveness of pain treatment interventions (pharmacological or non-pharmacological). For new born it is nevertheless difficult to differentiate between pain or distress/anxiety. This is relevant in determining the treatment. The score on a pain measurement instrument remains a snapshot in time.
Evidence Base
For determining the degree of pain in children with difficulty expressing themselves there are divers pain observation instruments available
- CPB
- Comfort behaviour scale/ Comfortneo scale
- Flacc
Patient Population
The COMFORT assessment scale is validated for young children up to the age of 4.
The COMFORT and COMFORTneo assessment score is validated for preterm neonates
Information Model
Type |
Id |
Concept |
Card. |
Definition |
DefinitionCode |
Reference
|
|
NL-CM:12.12.1
|
ComfortScale
|
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Rootconcept of the ComfortScale information model. This root concept contains all data elements of the ComfortScale information model.
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|
|
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NL-CM:12.12.2
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TotalScore
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0..1
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The total score is the sum of all the individual scores. The total score has a range from 0 - 35.
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|
|
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NL-CM:12.12.3
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Alertness
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0..1
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Observation of: Alertness
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|
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NL-CM:12.12.4
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Calmness_Agitation
|
0..1
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Observation: Calmness/ agitation
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|
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NL-CM:12.12.5
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RespiratoryResponse
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0..1
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Observation Respiratory response (only in mechanically ventilated children)
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|
|
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NL-CM:12.12.6
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Crying
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0..1
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Observation Crying (only in spontaneously breathing children)
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|
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NL-CM:12.12.8
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BodyMovement
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0..1
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Observation Physical movement
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|
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NL-CM:12.12.9
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FacialTone
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0..1
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Observation Facial tension
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NL-CM:12.12.10
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BodyMuscleTone
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0..1
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Observation Muscle tone
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|
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NL-CM:12.12.11
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|
ScoreDateTime
|
1
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The date and time at which the Comfort Behaviour scale/ComfortNeo scale was determined.
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|
|
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NL-CM:12.12.12
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Comment
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0..1
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A comment on the circumstances during the measurement.
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|
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Columns Concept and DefinitionCode: hover over the values for more information
For explanation of the symbols, please see the legend page
Example Instances
Only available in Dutch
ComfortScore
|
ScoreDatumTijd
|
21-12-2016 12:05
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Alertheid
|
4 (wakker en alert)
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Kalmte_Agitatie
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2 (licht angstig)
|
Huilen
|
2 (af en toe snikken of kreunen)
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Lichaamsbeweging
|
2 (incidentele beweging)
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Gezichtsspanning
|
2 (normale spanning van het gelaat)
|
Spierspanning
|
2 (verminderde spierspanning)
|
Totaalscore
|
14
|
Toelichting
|
Controle na verhogen pijnmedicatie.
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ComfortNeoScore
|
ScoreDatumTijd
|
21-12-2016 12:05
|
Alertheid
|
4 (wakker en alert)
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Kalmte_Agitatie
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2 (licht angstig)
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Ademhalingsreactie
|
3 (af en toe hoesten of verzet tegen de ventilator)
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Lichaamsbeweging
|
2 (incidentele beweging)
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Gezichtsspanning
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2 (normale spanning van het gelaat)
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Spierspanning
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2 (verminderde spierspanning)
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Totaalscore
|
15
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Toelichting
|
Controle na verhogen pijnmedicatie.
|
Instructions
In the ComfortNeo scale the item crying is replaced by respiratory reaction.
In the Comfort scale the item respiratory reaction is replaced by crying.
References
1. Comfort assessment [Online] Beschikbaar op:http://www.comfortassessment.nl/ [Geraadpleegd: 2 augustus 2016]
2. Richtlijn Pijnmeting en Behandeling van pijn bij kinderen, NVK, 2007 [Online] Beschikbaar op:https://www.nvk.nl/Kwaliteit/Richtlijnenoverzicht/Details/tabid/1558/articleType/ArticleView/articleId/760/Pijn-meting-en-behandeling-van.aspx [Geraadpleegd: 21 december 2016]
Valuesets
AlertnessCodelist
Valueset OID: 2.16.840.1.113883.2.4.3.11.60.40.2.12.12.1
|
Binding:
|
Conceptname
|
Conceptcode
|
Conceptvalue
|
Codesystem name |
Codesystem OID
|
Description
|
Deeply asleep
|
Alert1
|
1
|
CN_Alertheid
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.1
|
Diep in slaap (ogen dicht, geen reactie op omgeving)
|
Lightly asleep
|
Alert2
|
2
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CN_Alertheid
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.1
|
Licht in slaap (ogen grotendeels gesloten, af en toe reactie)
|
Drowsy
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Alert3
|
3
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CN_Alertheid
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.1
|
Slaperig (kind sluit vaak zijn ogen, reageert minder op omgeving)
|
Awake and alert
|
Alert4
|
4
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CN_Alertheid
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.1
|
Wakker en alert (kind reageert op omgeving)
|
Awake and hyperalert
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Alert5
|
5
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CN_Alertheid
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.1
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Wakker en hyper-alert (overdreven reactie op veranderingen)
|
BodyMovementCodelist
Valueset OID: 2.16.840.1.113883.2.4.3.11.60.40.2.12.12.5
|
Binding:
|
Conceptname
|
Conceptcode
|
Conceptvalue
|
Codesystem name |
Codesystem OID
|
Description
|
No movement
|
Mov1
|
1
|
CN_Lichaamsbeweging
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.5
|
Geen beweging
|
Occasional, slight movements
|
Mov2
|
2
|
CN_Lichaamsbeweging
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.5
|
Incidentele (3 of minder) kleine bewegingen
|
Frequent, slight movements
|
Mov3
|
3
|
CN_Lichaamsbeweging
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.5
|
Frequente (3 of meer) kleine bewegingen
|
Vigorous movements limited to extremities
|
Mov4
|
4
|
CN_Lichaamsbeweging
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.5
|
Heftige bewegingen met armen en benen
|
Vigorous movements including torso and head
|
Mov5
|
5
|
CN_Lichaamsbeweging
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.5
|
Heftige bewegingen ook met romp en hoofd
|
BodyMuscleToneCodelist
Valueset OID: 2.16.840.1.113883.2.4.3.11.60.40.2.12.12.7
|
Binding:
|
Conceptname
|
Conceptcode
|
Conceptvalue
|
Codesystem name |
Codesystem OID
|
Description
|
Muscles fully relaxed
|
Musc1
|
1
|
CN_Spierspanning
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.7
|
Spieren volledig ontspannen; geen spierspanning
|
Reduced muscle tone
|
Musc2
|
2
|
CN_Spierspanning
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.7
|
Verminderde spierspanning; minder weerstand dan normaal
|
Normal muscle tone
|
Musc3
|
3
|
CN_Spierspanning
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.7
|
Normale spierspanning
|
Increased muscle tone
|
Musc4
|
4
|
CN_Spierspanning
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.7
|
Toegenomen spierspanning en buiging van vingers en tenen
|
Extreme muscle rigidity
|
Musc5
|
5
|
CN_Spierspanning
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.7
|
Extreme spierstijfheid en buiging van vingers en tenen
|
Calmness_AgitationCodelist
Valueset OID: 2.16.840.1.113883.2.4.3.11.60.40.2.12.12.2
|
Binding:
|
Conceptname
|
Conceptcode
|
Conceptvalue
|
Codesystem name |
Codesystem OID
|
Description
|
Calm
|
Calm1
|
1
|
CN_Kalmte_Agitatie
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.2
|
Kalm (kind helder en rustig)
|
Slightly anxious
|
Calm2
|
2
|
CN_Kalmte_Agitatie
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.2
|
Licht angstig (kind toont lichte onrust)
|
Anxious
|
Calm3
|
3
|
CN_Kalmte_Agitatie
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.2
|
Angstig (kind lijkt onrustig, kan zich beheersen)
|
Very anxious
|
Calm4
|
4
|
CN_Kalmte_Agitatie
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.2
|
Zeer angstig (kind lijkt zeer onrustig, kan zich nog net beheersen)
|
Panicky
|
Calm5
|
5
|
CN_Kalmte_Agitatie
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.2
|
Paniekerig (ernstige onrust met verlies van beheersing)
|
CryingCodelist
Valueset OID: 2.16.840.1.113883.2.4.3.11.60.40.2.12.12.4
|
Binding:
|
Conceptname
|
Conceptcode
|
Conceptvalue
|
Codesystem name |
Codesystem OID
|
Description
|
Quiet breathing
|
Cry1
|
1
|
CN_Huilen
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.4
|
Geen huilgeluiden
|
Occasional sobbing or moaning
|
Cry2
|
2
|
CN_Huilen
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.4
|
Af en toe snikken of kreunen (nasnikken)
|
Whining
|
Cry3
|
3
|
CN_Huilen
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.4
|
Jengelen of dreinen (monotoon geluid)
|
Crying
|
Cry4
|
4
|
CN_Huilen
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.4
|
Huilen
|
Screaming or shrieking
|
Cry5
|
5
|
CN_Huilen
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.4
|
Schreeuwen of krijsen
|
FacialToneCodelist
Valueset OID: 2.16.840.1.113883.2.4.3.11.60.40.2.12.12.6
|
Binding:
|
Conceptname
|
Conceptcode
|
Conceptvalue
|
Codesystem name |
Codesystem OID
|
Description
|
Facial muscles totally relaxed
|
Face1
|
1
|
CN_Gezichtsspanning
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.6
|
Gezichtsspieren volkomen ontspannen
|
Normal facial tone
|
Face2
|
2
|
CN_Gezichtsspanning
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.6
|
Normale spanning van het gezicht
|
Tension evident in some facial muscles
|
Face3
|
3
|
CN_Gezichtsspanning
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.6
|
Spanning duidelijk in sommige gelaatsspieren (niet aanhoudend)
|
Tension evident throughout facial muscles
|
Face4
|
4
|
CN_Gezichtsspanning
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.6
|
Spanning duidelijk in alle gelaatsspieren (aanhoudend)
|
Facial muscles contorted and grimacing
|
Face5
|
5
|
CN_Gezichtsspanning
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.6
|
Gezichtsspieren verwrongen en in een grimas
|
RespiratoryResponseCodelist
Valueset OID: 2.16.840.1.113883.2.4.3.11.60.40.2.12.12.3
|
Binding:
|
Conceptname
|
Conceptcode
|
Conceptvalue
|
Codesystem name |
Codesystem OID
|
Description
|
No spontaneous respiration
|
Vent1
|
1
|
CN_Ademhalingsreactie
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.3
|
Geen spontane ademhaling
|
Spontaneous respiration on ventilator
|
Vent2
|
2
|
CN_Ademhalingsreactie
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.3
|
Spontane ademhaling aan de beademing
|
Unrest or resistance to ventilator
|
Vent3
|
3
|
CN_Ademhalingsreactie
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.3
|
Onrust of verzet tegen de beademing
|
Actively breathes against ventilator or coughs regularly
|
Vent4
|
4
|
CN_Ademhalingsreactie
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.3
|
Ademt actief tegen de beademing in of hoest regelmatig
|
Fights ventilator
|
Vent5
|
5
|
CN_Ademhalingsreactie
|
2.16.840.1.113883.2.4.3.11.60.40.4.20.3
|
Vecht tegen de beademing
|
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The information in this wikipage is based on Release 2017
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