ARCHETYPE ABC sjekkliste (openEHR-EHR-OBSERVATION.abc_no.v1)

Name: ABC sjekkliste
License: http://creativecommons.org/licenses/by-sa/4.0/

ARCHETYPE ID	openEHR-EHR-OBSERVATION.abc_no.v1
Concept	ABC sjekkliste
Description	En sjekkliste for vurdering av kompleksitet og nivå av tverrfaglig rehabilitering etter akutt skade og sykdom.
Use	Brukes for å registrere vurdering av kompleksitet for mer riktig henvisning til kommunal eller spesialisthelsetjeneste rehabiliteringstiltak etter behandling i sykehus. Arketypen er basert på revidert versjon fra 15.04.2021.
Purpose	For vurdering av kompleksitet og nivå av tverrfaglig rehabiliteringtiltak etter akutt sykdom og skade i henhold til ABC sjekklisten.
References	Tverrfaglige rehabliteringstiltak - ABC- sjekkliste, versjon 15.04.2021. [Internet]. Sykehuset Telemark [cited: 2022 Mar. 28]. Tilgjengelig fra https://www.sthf.no/helsefaglig/tverrfaglige-rehabiliteringstiltak-abc-sjekkliste.
Authors	Forfatternavn: Kanika Kuwelker Organisasjon: Helse Vest IKT E-post: kanika.kuwelker@helse-vest-ikt.no Opprinnelig skrevet dato: 2022-03-07
Other Details Language	Forfatternavn: Kanika Kuwelker Organisasjon: Helse Vest IKT E-post: kanika.kuwelker@helse-vest-ikt.no Opprinnelig skrevet dato: 2022-03-07
OtherDetails Language Independent	{licence=This work is licensed under the Creative Commons Attribution-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/4.0/., custodian_organisation=openEHR Foundation, references=Tverrfaglige rehabliteringstiltak - ABC- sjekkliste, versjon 15.04.2021. [Internet]. Sykehuset Telemark [cited: 2022 Mar. 28]. Tilgjengelig fra https://www.sthf.no/helsefaglig/tverrfaglige-rehabiliteringstiltak-abc-sjekkliste., original_namespace=org.openehr, original_publisher=openEHR Foundation, custodian_namespace=org.openehr, MD5-CAM-1.0.1=C200526B5DE0DD3D58F9FC255FA4A56B, build_uid=dd2e8ef9-7931-4adc-97df-63b58329fe1c, revision=1.0.0}
Keywords	ABC, rehabilitering, tverrfaglig, funksjon, ICF, behovskartlegging
Lifecycle	published
UID	8d520e34-f519-4201-ae3b-b986e1686ac8
Language used	nb
Citeable Identifier	1078.36.2697
Revision Number	1.0.0
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description=For eksempel: respiratortrengende, ustabil hjerte-/ lungefunksjon, ustabile frakturer, psykose., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_BOOLEAN, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0134]/items[at0141], code=at0141, itemType=ELEMENT, level=5, text=Samtidig alvorlig sykdom med dårlig prognose, description=For eksempel: cancer, forventet overlevelse < 6 mnd., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_BOOLEAN, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0134]/items[at0142], code=at0142, itemType=ELEMENT, level=5, text=Ikke kontaktbar, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_BOOLEAN, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0135], code=at0135, itemType=CLUSTER, level=4, text=B: Indikasjon for IKKE å anbefale rehabiliteringstiltak grunnet FRAVÆR av sykdom og symptomer, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=1.., cardinalityText= (Kardinalitet: 1.., usortert), subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0135]/items[at0136], code=at0136, itemType=ELEMENT, level=5, text=Ingen nye symptomer eller utfall, description=For eksempel: hjerte/lunge, dysfagi, vannlating, synsvansker, språk, kognitive vansker, lammelser, spastisitet, smerte, sår., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_BOOLEAN, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0135]/items[at0138], code=at0138, itemType=ELEMENT, level=5, text=Er i stand til å utføre alle sine vanlige aktiviteter, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_BOOLEAN, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem 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ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0030]/items[at0035], code=at0035, itemType=CLUSTER, level=5, text=Medisinsk oppfølgning, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=1.., cardinalityText= (Kardinalitet: 1.., usortert), subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0030]/items[at0035]/items[at0036], code=at0036, itemType=ELEMENT, level=6, text=1. Kompleks medisinsk tilstand, behov oppfølging av lege, description=For eksempel: CNS skade/sykdom, hjerte-/ lungelidelse, multiorgansvikt, sår, akutt/kronisk inflammasjon/infeksjon, psykiatri, rus, komorbiditet., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=2: at0037::3-7x per uke 1: at0038::1-2x per uke 0: at0039::Sjeldnere/nei , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0030]/items[at0035]/items[at0040], code=at0040, itemType=ELEMENT, level=6, text=2. Daglig eller flere ganger ukentlig behov for sykehusspesialister, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=3: at0041::Ja 0: at0042::Nei , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0030]/items[at0035]/items[at0043], code=at0043, itemType=ELEMENT, level=6, text=3. Behov for døgn-/ akuttberedskap, intensivfunksjoner/monitorering, annet, description=For eksempel: dialyse, billeddiagnostikk, kartleggingsutstyr, omfattende laboratorieundersøkelser., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=3: at0044::Ja 0: at0045::Nei , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0030]/items[at0035]/items[at0049], code=at0049, itemType=ELEMENT, level=6, text=4. Angst/depresjon/stressreaksjon/selvmordstanker, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=1: at0050::Ja 0: at0051::Nei , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0030]/items[at0035]/items[at0052], code=at0052, itemType=ELEMENT, level=6, text=5. Påvist smitte som krever spesiell håndtering, description=For eksempel: Covid, ESBL, MRSA, VRE, Hepatitt, HIV, etc., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=1: at0053::Ja 0: at0054::Nei , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0030]/items[at0055], code=at0055, itemType=ELEMENT, level=5, text=Forvirring/PTA med manglende orientering tid-sted-situasjon, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=3: at0056::Uavklart og behov for skjerming og oppfølging én-til-én 1: at0057::Behov skjerming og oppfølging, og kan kreve ekstraordinær bemanning 0: at0058::Nei , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0030]/items[at0060], code=at0060, itemType=CLUSTER, level=5, text=Kroppsfunksjoner, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=1.., cardinalityText= (Kardinalitet: 1.., usortert), subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0030]/items[at0060]/items[at0061], code=at0061, itemType=ELEMENT, level=6, text=1. Problematikk lunge-/hjertefunksjon, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=2: at0062::Mangelfull kartlegging/behandling 1: at0063::Tiltak igangsatt 0: at0064::Nei , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0030]/items[at0060]/items[at0065], code=at0065, itemType=ELEMENT, level=6, text=2. Dysfagi, ernærings-/hydreringsproblematikk, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=2: at0066::Mangelfull kartlegging/behandling 1: at0067::Tiltak igangsatt 0: at0068::Nei , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0030]/items[at0060]/items[at0069], code=at0069, itemType=ELEMENT, level=6, text=3. Vannlating/eliminasjonsproblematikk, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=2: at0070::Mangelfull kartlegging/behandling 1: at0071::Tiltak igangsatt 0: at0072::Nei , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0030]/items[at0060]/items[at0073], code=at0073, itemType=ELEMENT, level=6, text=4. Synsvansker, description=For eksempel: dobbeltsyn, anopsi, redusert syn., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=2: at0074::Mangelfull kartlegging/behandling 1: at0075::Tiltak igangsatt 0: at0076::Nei , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0030]/items[at0060]/items[at0077], code=at0077, itemType=ELEMENT, level=6, text=5. Språk-/kommunikasjonproblematikk, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=2: at0078::Mangelfull kartlegging/behandling 1: at0079::Tiltak igangsatt 0: at0080::Nei , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0030]/items[at0060]/items[at0081], code=at0081, itemType=ELEMENT, level=6, text=6. Kognitive vansker, description=For eksempel: oppmerksomhet, hukommelse, neglekt, apraxi, perseverasjon, agnosi, emosjonell labilitet., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=2: at0082::Mangelfull kartlegging/behandling 1: at0083::Tiltak igangsatt 0: at0084::Nei , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0030]/items[at0060]/items[at0085], code=at0085, itemType=ELEMENT, level=6, text=7. Lammelse, koordinasjonsforstyrrelse, sensoriske utfall, fallfare, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=2: at0086::Mangelfull kartlegging/behandling 1: at0087::Tiltak igangsatt 0: at0088::Nei , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0030]/items[at0060]/items[at0089], code=at0089, itemType=ELEMENT, level=6, text=8. Spastisitet/feilstillinger, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=2: at0090::Mangelfull kartlegging/behandling 1: at0091::Tiltak igangsatt 0: at0092::Nei , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0030]/items[at0060]/items[at0093], code=at0093, itemType=ELEMENT, level=6, text=9. Smerter, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=2: at0094::Mangelfull kartlegging/behandling 1: at0095::Tiltak igangsatt 0: at0096::Nei , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0030]/items[at0060]/items[at0097], code=at0097, itemType=ELEMENT, level=6, text=10. Sår, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=2: at0098::Mangelfull kartlegging/behandling 1: at0099::Tiltak igangsatt 0: at0100::Nei , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0030]/items[at0101], code=at0101, itemType=CLUSTER, level=5, text=Omgivelser/nettverk/deltagelse/individuelle forhold, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=1.., cardinalityText= (Kardinalitet: 1.., usortert), subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0030]/items[at0101]/items[at0102], code=at0102, itemType=ELEMENT, level=6, text=1. Mindreårige barn? Ektefelle eller barn med sykdom/pleiebehov?, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=1: at0103::Ja 0: at0104::Nei , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0030]/items[at0101]/items[at0108], code=at0108, itemType=ELEMENT, level=6, text=2. Evne til å ivareta seg selv i egen bolig?, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=1: at0109::Nei 0: at0110::Ja , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0030]/items[at0101]/items[at0111], code=at0111, itemType=ELEMENT, level=6, text=3. Yrkesaktiv alder eller i jobb?, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=1: at0112::Ja 0: at0113::Nei , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0030]/items[at0101]/items[at0114], code=at0114, itemType=ELEMENT, level=6, text=4. Behov for å kartlegge verge/medbestemmelsesevne?, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=1: at0115::Ja 0: at0116::Nei , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0030]/items[at0101]/items[at0117], code=at0117, itemType=ELEMENT, level=6, text=5. Behov for å kartlegge evne til å kjøre bil/håndtere skytevåpen?, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=1: at0118::Ja 0: at0119::Nei , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0030]/items[at0101]/items[at0120], code=at0120, itemType=ELEMENT, level=6, text=6. Behov for kartlegging/omfattende tilrettelegging av bolig?, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=1: at0121::Ja 0: at0122::Nei , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0030]/items[at0101]/items[at0123], code=at0123, itemType=ELEMENT, level=6, text=7. Behov for å utarbeide IP (Individuell Plan)?, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=1: at0124::Ja 0: at0125::Nei , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0030]/items[at0148], code=at0148, itemType=ELEMENT, level=5, text=Sumskår, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_COUNT, bindings=null, values=min: >=0; max: <=40 , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0007]/data[at0003]/items[at0030]/items[at0149], code=at0149, itemType=ELEMENT, level=5, text=Antall 1'ere, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Valgfritt, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_COUNT, bindings=null, values=min: >=0; 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