archetype (adl_version=1.4; uid=8aef47dd-e99d-3aac-8fd3-b143ac2c1c49)
	openEHR-EHR-OBSERVATION.waterlow_score.v0

concept
	[at0000]	-- Waterlow score
language
	original_language = <[ISO_639-1::en]>
description
	original_author = <
		["name"] = <"Dr Ian McNicoll">
		["organisation"] = <"Ocean Informatics, United Kingdom">
		["email"] = <"ian.mcnicoll@oceaninformatics.com">
		["date"] = <"2011-08-01">
	>
	details = <
		["en"] = <
			language = <[ISO_639-1::en]>
			purpose = <"To record the individual elements and overall score of the Waterlow Score (or Scale), for the purpose of estimating the risk of a patient developing a pressure sore or ulcer.">
			use = <"Use to record details of a Waterlow score, normally in conjunction which a more general clinical assessment of pressure sore risk. Users and implenters should familiarise themselves with the Guidance Notes.

For some categries of recording e.g Build - weight for height, only a single score can be selected. For others e.g. Skin type Visual Risk areas, more than one risk can be entered to contribute to the overall score. 
Some categories have overall limits e.g.  although mutiple Neurological deficits can be recorded , the total score for all such risks cannot exceed 6. 
Some centres expect only a total to be recorded for a whole category in which case, individual risk elements should not be captured.">
			keywords = <"pressure", "ulcer", "risk", "sore", "scale", "skin">
			misuse = <"The Waterlow score is Copyright Protected © 2005-2007 judy-waterlow.co.uk and should not be used outside the terms of the copyright.">
			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"] = <"The Waterlow Score [Internet];[cited 2011 Aug 1] Available from: http://www.judy-waterlow.co.uk/waterlow_score.htm
The Waterlow Score Card [Internet];[cited 2011 Aug 1] Available from: http://www.judy-waterlow.co.uk/downloads/Waterlow%20Score%20Card-front.pdf
Ferguson ML, Bauer J, Gallagher B,Capra S, Christie DRH, Mason BR. Validation of a malnutrition screening tool for patients receiving radiotherapy. Australasian Radiology. 1999;43:325–327">
		["current_contact"] = <"Dr Ian McNicoll, freshEHR, ian@freshehr.com">
		["original_namespace"] = <"org.openehr">
		["original_publisher"] = <"openEHR Foundation">
		["custodian_namespace"] = <"org.openehr">
		["MD5-CAM-1.0.1"] = <"C4B49847E86B80470E251EEF1097CB75">
		["build_uid"] = <"a228e23c-c4b9-4c1b-8977-b83687d7c5e7">
		["revision"] = <"0.0.1-alpha">
	>

definition
	OBSERVATION[at0000] matches {    -- Waterlow score
		data matches {
			HISTORY[at0001] matches {    -- Event Series
				events cardinality matches {1..*; unordered} matches {
					POINT_EVENT[at0002] occurrences matches {0..8} matches {    -- Any point in time event
						data matches {
							ITEM_TREE[at0003] matches {    -- Tree
								items cardinality matches {0..*; unordered} matches {
									ELEMENT[at0008] occurrences matches {0..1} matches {    -- Sex
										value matches {
											1|[local::at0028],
											2|[local::at0029]
										}
									}
									ELEMENT[at0009] occurrences matches {0..1} matches {    -- Age group
										value matches {
											0|[local::at0134],
											1|[local::at0030],
											2|[local::at0031],
											3|[local::at0032],
											4|[local::at0033],
											5|[local::at0034]
										}
									}
									ELEMENT[at0004] occurrences matches {0..1} matches {    -- Build/weight for height
										value matches {
											0|[local::at0020],
											1|[local::at0021],
											2|[local::at0022],
											3|[local::at0023]
										}
									}
									ELEMENT[at0005] occurrences matches {0..1} matches {    -- Continence
										value matches {
											0|[local::at0024],
											1|[local::at0025],
											2|[local::at0026],
											3|[local::at0027]
										}
									}
									ELEMENT[at0007] occurrences matches {0..1} matches {    -- Mobility
										value matches {
											0|[local::at0035],
											1|[local::at0036],
											2|[local::at0037],
											3|[local::at0038],
											4|[local::at0039],
											5|[local::at0040]
										}
									}
									CLUSTER[at0129] occurrences matches {0..1} matches {    -- Nutritional risk
										items cardinality matches {1..*; unordered} matches {
											ELEMENT[at0054] occurrences matches {0..1} matches {    -- Weight loss
												value matches {
													0|[local::at0131],
													1|[local::at0055],
													2|[local::at0056],
													3|[local::at0057],
													4|[local::at0058]
												}
											}
											ELEMENT[at0044] occurrences matches {0..1} matches {    -- Appetite
												value matches {
													0|[local::at0045],
													1|[local::at0046]
												}
											}
											ELEMENT[at0130] occurrences matches {0..1} matches {    -- Nutritional score
												value matches {
													DV_COUNT matches {
														magnitude matches {|0..5|}
													}
												}
											}
										}
									}
									CLUSTER[at0066] occurrences matches {0..1} matches {    -- Skin type visual risk areas
										items cardinality matches {1..*; unordered} matches {
											ELEMENT[at0116] occurrences matches {0..1} matches {    -- Healthy
												value matches {
													0|[local::at0116]
												}
											}
											ELEMENT[at0117] occurrences matches {0..1} matches {    -- Tissue-paper
												value matches {
													1|[local::at0117]
												}
											}
											ELEMENT[at0118] occurrences matches {0..1} matches {    -- Dry
												value matches {
													1|[local::at0118]
												}
											}
											ELEMENT[at0119] occurrences matches {0..1} matches {    -- Oedematous
												value matches {
													1|[local::at0119]
												}
											}
											ELEMENT[at0120] occurrences matches {0..1} matches {    -- Clammy, pyrexia
												value matches {
													1|[local::at0120]
												}
											}
											ELEMENT[at0121] occurrences matches {0..1} matches {    -- Discoloured - Stage 1
												value matches {
													2|[local::at0121]
												}
											}
											ELEMENT[at0122] occurrences matches {0..1} matches {    -- Pressure ulcer - Stage 2-4
												value matches {
													2|[local::at0122]
												}
											}
										}
									}
									CLUSTER[at0070] occurrences matches {0..1} matches {    -- Tissue malnutrition
										items cardinality matches {1..*; unordered} matches {
											ELEMENT[at0123] occurrences matches {0..1} matches {    -- Terminal cachexia
												value matches {
													8|[local::at0123]
												}
											}
											ELEMENT[at0124] occurrences matches {0..1} matches {    -- Single organ failure
												value matches {
													5|[local::at0124]
												}
											}
											ELEMENT[at0125] occurrences matches {0..1} matches {    -- Multiple organ failure
												value matches {
													8|[local::at0125]
												}
											}
											ELEMENT[at0126] occurrences matches {0..1} matches {    -- Peripheral vascular disease
												value matches {
													5|[local::at0126]
												}
											}
											ELEMENT[at0127] occurrences matches {0..1} matches {    -- Anaemia (Hb < 8 g/dl)
												value matches {
													2|[local::at0127]
												}
											}
											ELEMENT[at0128] occurrences matches {0..1} matches {    -- Smoking
												value matches {
													1|[local::at0128]
												}
											}
										}
									}
									CLUSTER[at0073] occurrences matches {0..1} matches {    -- Neurological deficit
										items cardinality matches {1..*; unordered} matches {
											ELEMENT[at0150] occurrences matches {0..1} matches {    -- Diabetes, MS, CVA
												value matches {
													0|[local::at0136],
													4|[local::at0137],
													5|[local::at0138],
													6|[local::at0139]
												}
											}
											ELEMENT[at0151] occurrences matches {0..1} matches {    -- Motor / sensory deficit
												value matches {
													0|[local::at0136],
													4|[local::at0137],
													5|[local::at0138],
													6|[local::at0139]
												}
											}
											ELEMENT[at0152] occurrences matches {0..1} matches {    -- Paraplegia
												value matches {
													0|[local::at0136],
													4|[local::at0137],
													5|[local::at0138],
													6|[local::at0139]
												}
											}
											ELEMENT[at0135] occurrences matches {0..1} matches {    -- Combined neurological deficit
												value matches {
													0|[local::at0136],
													4|[local::at0137],
													5|[local::at0138],
													6|[local::at0139]
												}
											}
										}
									}
									CLUSTER[at0068] occurrences matches {0..1} matches {    -- Major surgery or trauma
										items cardinality matches {1..*; unordered} matches {
											ELEMENT[at0114] occurrences matches {0..1} matches {    -- Orthopaedic /spinal
												value matches {
													0|[local::at0153],
													5|[local::at0143]
												}
											}
											ELEMENT[at0144] occurrences matches {0..1} matches {    -- Duration of surgery
												value matches {
													0|[local::at0154],
													5|[local::at0145],
													8|[local::at0146]
												}
											}
										}
									}
									CLUSTER[at0067] occurrences matches {0..1} matches {    -- Medication
										items cardinality matches {1..*; unordered} matches {
											ELEMENT[at0106] occurrences matches {0..1} matches {    -- Cytotoxics
												value matches {
													0|[local::at0141],
													4|[local::at0142]
												}
											}
											ELEMENT[at0107] occurrences matches {0..1} matches {    -- Steroids
												value matches {
													0|[local::at0141],
													4|[local::at0142]
												}
											}
											ELEMENT[at0108] occurrences matches {0..1} matches {    -- Anti-inflammatories
												value matches {
													0|[local::at0141],
													4|[local::at0142]
												}
											}
											ELEMENT[at0140] occurrences matches {0..1} matches {    -- Combined medication risk
												value matches {
													0|[local::at0141],
													4|[local::at0142]
												}
											}
										}
									}
									ELEMENT[at0014] occurrences matches {0..1} matches {    -- Waterlow score
										value matches {
											DV_COUNT matches {
												magnitude matches {|>=1|}
											}
										}
									}
									ELEMENT[at0015] occurrences matches {0..1} matches {    -- Overall risk grade
										value matches {
											10|[local::at0016],
											15|[local::at0017],
											20|[local::at0018]
										}
									}
									ELEMENT[at0019] occurrences matches {0..1} matches {    -- Comment
										value matches {
											DV_TEXT matches {*}
										}
									}
								}
							}
						}
						state matches {
							ITEM_TREE[at0071] matches {    -- Tree
								items cardinality matches {0..*; unordered} matches {
									ELEMENT[at0072] occurrences matches {0..*} matches {    -- Confounding factors
										value matches {
											DV_TEXT matches {*}
										}
									}
								}
							}
						}
					}
				}
			}
		}
		protocol matches {
			ITEM_TREE[at0132] matches {    -- Tree
				items cardinality matches {0..*; unordered} matches {
					ELEMENT[at0133] occurrences matches {0..1} matches {    -- Score version
						value matches {
							DV_TEXT matches {*}
						}
					}
				}
			}
		}
	}


ontology
	term_definitions = <
		["en"] = <
			items = <
				["at0000"] = <
					text = <"Waterlow score">
					description = <"The Waterlow Score, Pressure Ulcer Risk Assessment Tool.">
				>
				["at0001"] = <
					text = <"Event Series">
					description = <"@ internal @">
				>
				["at0002"] = <
					text = <"Any point in time event">
					description = <"Unspecified point in time event which may be explicitly defined in a template or at run-time.">
				>
				["at0003"] = <
					text = <"Tree">
					description = <"@ internal @">
				>
				["at0004"] = <
					text = <"Build/weight for height">
					description = <"Risk conferred by the subject's build, based on a BMI calculation.">
				>
				["at0005"] = <
					text = <"Continence">
					description = <"Risk conferred by the subject's degree of continence.">
				>
				["at0007"] = <
					text = <"Mobility">
					description = <"Risk conferred by the mobility level of the subject.">
				>
				["at0008"] = <
					text = <"Sex">
					description = <"Risk conferred by the sex of the subject.">
				>
				["at0009"] = <
					text = <"Age group">
					description = <"Risk conferred by the age range of the subject.">
				>
				["at0014"] = <
					text = <"Waterlow score">
					description = <"The total summed score of all recorded individual risks.">
				>
				["at0015"] = <
					text = <"Overall risk grade">
					description = <"Overall Waterlow Score.">
				>
				["at0016"] = <
					text = <"10+ At risk">
					description = <"The subject is at risk of developing a pressure ulcer.">
				>
				["at0017"] = <
					text = <"15+ High risk">
					description = <"The subject is at high risk of developing a pressure ulcer.">
				>
				["at0018"] = <
					text = <"20+ Very high risk">
					description = <"The subject is at very high risk of developing a pressure ulcer.">
				>
				["at0019"] = <
					text = <"Comment">
					description = <"Additional narrative comment about the Score.">
				>
				["at0020"] = <
					text = <"Average">
					description = <"The subject's build is average : BMI 20-24.9 .">
				>
				["at0021"] = <
					text = <"Above average">
					description = <"The subject's build is above average : BMI 25-29.9 .">
				>
				["at0022"] = <
					text = <"Obese">
					description = <"The subject is obese : BMI over 30 .">
				>
				["at0023"] = <
					text = <"Below average">
					description = <"The subject's build is below average : BMI below 20 .">
				>
				["at0024"] = <
					text = <"Complete / catheterised">
					description = <"The subject is completely continent or catheterised.">
				>
				["at0025"] = <
					text = <"Urinary incontinence">
					description = <"The subject is incontinent of urine.">
				>
				["at0026"] = <
					text = <"Faecal incontinence">
					description = <"The subject is incontinent of faeces.">
				>
				["at0027"] = <
					text = <"Urinary and faecal incontinence">
					description = <"The subject is incontinent of urine and faeces.">
				>
				["at0028"] = <
					text = <"Male">
					description = <"The subject is male.">
				>
				["at0029"] = <
					text = <"Female">
					description = <"The subject is female.">
				>
				["at0030"] = <
					text = <"14-49">
					description = <"The subject is aged between 14-49.">
				>
				["at0031"] = <
					text = <"50-64">
					description = <"The subject is aged between 50-64.">
				>
				["at0032"] = <
					text = <"65-74">
					description = <"The subject is aged between 65-74.">
				>
				["at0033"] = <
					text = <"75-80">
					description = <"The subject is aged between 75-80.">
				>
				["at0034"] = <
					text = <"80+">
					description = <"The subject is aged over 80.">
				>
				["at0035"] = <
					text = <"Fully mobile">
					description = <"The subject is fully mobile.">
				>
				["at0036"] = <
					text = <"Restless/ fidgety">
					description = <"The subject is restless and fidgety.">
				>
				["at0037"] = <
					text = <"Apathetic">
					description = <"The subject is apathetic.">
				>
				["at0038"] = <
					text = <"Restricted">
					description = <"The subject's mobility is restricted.">
				>
				["at0039"] = <
					text = <"Bedbound">
					description = <"The subject is confined to bed e.g by traction.">
				>
				["at0040"] = <
					text = <"Chairbound">
					description = <"The subject is confined to a chair or wheelchair.">
				>
				["at0044"] = <
					text = <"Appetite">
					description = <"Risk conferred by the subject's appetite and eating habit.">
				>
				["at0045"] = <
					text = <"Average">
					description = <"The subject is eating normally and has a normal appetite.">
				>
				["at0046"] = <
					text = <"Poor">
					description = <"The subject is eating poorly or has a poor appetite.">
				>
				["at0054"] = <
					text = <"Weight loss">
					description = <"Risk conferred by recent weight loss.">
				>
				["at0055"] = <
					text = <"0.5-5kg">
					description = <"The subject has recently lost 0.5-5kg in weight.">
				>
				["at0056"] = <
					text = <"5-10kg (or Amount unsure)">
					description = <"The subject has recently lost 5-10kg in weight.">
				>
				["at0057"] = <
					text = <"10-15kg">
					description = <"The subject has recently lost 10-15kg in weight or the amount of weight loss is unknown.">
				>
				["at0058"] = <
					text = <"Over 15kg">
					description = <"The subject has recently lost  over 15kg in weight.">
				>
				["at0066"] = <
					text = <"Skin type visual risk areas">
					description = <"Category of risks assessed by skin inspection.">
				>
				["at0067"] = <
					text = <"Medication">
					description = <"Risk associated with medication.  Each medication can be scored between 0-4 but a total of 4 only can be given by all risks in the Medication category.">
				>
				["at0068"] = <
					text = <"Major surgery or trauma">
					description = <"Risk associated with major surgery or trauma.">
				>
				["at0070"] = <
					text = <"Tissue malnutrition">
					description = <"Category of risks conferred by tissue malnutrition.">
				>
				["at0071"] = <
					text = <"Tree">
					description = <"@ internal @">
				>
				["at0072"] = <
					text = <"Confounding factors">
					description = <"Issues that may affect interpretation of the score.">
				>
				["at0073"] = <
					text = <"Neurological deficit">
					description = <"Risk conferred by neurological deficit. Each identified risk can be scored between 4-6 but a maximum of 6 only can be given for the whole neurological deficit category.">
				>
				["at0106"] = <
					text = <"Cytotoxics">
					description = <"The subject is receiving cytotoxic medication.">
				>
				["at0107"] = <
					text = <"Steroids">
					description = <"The subject is receiving high-dose or long-term steroid medication.">
				>
				["at0108"] = <
					text = <"Anti-inflammatories">
					description = <"The subject is receiving anti-inflammatory medication.">
				>
				["at0114"] = <
					text = <"Orthopaedic /spinal">
					description = <"Risks related to orthopaedic or spinal surgery.">
				>
				["at0116"] = <
					text = <"Healthy">
					description = <"The skin appears healthy.">
				>
				["at0117"] = <
					text = <"Tissue-paper">
					description = <"The skin has a tissue-paper quality.">
				>
				["at0118"] = <
					text = <"Dry">
					description = <"The skin is dry.">
				>
				["at0119"] = <
					text = <"Oedematous">
					description = <"The skin is oedematous.">
				>
				["at0120"] = <
					text = <"Clammy, pyrexia">
					description = <"The aptient appears clammy or pyrexic.">
				>
				["at0121"] = <
					text = <"Discoloured - Stage 1">
					description = <"The skin is dicoloured - Pressure sore - Grade 1.">
				>
				["at0122"] = <
					text = <"Pressure ulcer - Stage 2-4">
					description = <"The skin has a frank pressure sore - Stage 2-4.">
				>
				["at0123"] = <
					text = <"Terminal cachexia">
					description = <"The subject is terminally-ill and shows significant weight-loss.">
				>
				["at0124"] = <
					text = <"Single organ failure">
					description = <"The patent has single organ/system failure e.g. respiratory, cardiac, liver, renal.">
				>
				["at0125"] = <
					text = <"Multiple organ failure">
					description = <"The subject has multiple organ/system failure.">
				>
				["at0126"] = <
					text = <"Peripheral vascular disease">
					description = <"The subject has peripheral vascular disease.">
				>
				["at0127"] = <
					text = <"Anaemia (Hb < 8 g/dl)">
					description = <"The subject is significantly anaemic. Hb less than 8 mg/dl.">
				>
				["at0128"] = <
					text = <"Smoking">
					description = <"The subject is a smoker.">
				>
				["at0129"] = <
					text = <"Nutritional risk">
					description = <"An estimate of nutritional risk based on the MST nutritional score but can make use of another compatible nutritional score.">
				>
				["at0130"] = <
					text = <"Nutritional score">
					description = <"The nutritional score total, derived from Appetite and Weight loss scores or recorded directly from another compatible nutritional scoring system.">
				>
				["at0131"] = <
					text = <"No recent weight loss">
					description = <"The subject has not recently lost weight.">
				>
				["at0132"] = <
					text = <"Tree">
					description = <"@ internal @">
				>
				["at0133"] = <
					text = <"Score version">
					description = <"The version of the score used, normally recorded as the year.">
				>
				["at0134"] = <
					text = <"Less than 14 years">
					description = <"The subject is under 14 years old.">
				>
				["at0135"] = <
					text = <"Combined neurological deficit">
					description = <"An overall estimate of neurological deficit. Should not be used if individual neurological deficit risks are recorded.">
				>
				["at0136"] = <
					text = <"No neurological deficit">
					description = <"The subject has no overall neurological deficit.">
				>
				["at0137"] = <
					text = <"Mild neurological deficit">
					description = <"The subject has a mild overall neurological deficit.">
				>
				["at0138"] = <
					text = <"Moderate neurological deficit">
					description = <"The subject has a moderate overall neurological deficit.">
				>
				["at0139"] = <
					text = <"Severe neurological deficit">
					description = <"The subject has a severe overall neurological deficit.">
				>
				["at0140"] = <
					text = <"Combined medication risk">
					description = <"Overall pressure ulcer risk related to medication. Should not be recorded if individual medication risks are used.">
				>
				["at0141"] = <
					text = <"No medication risk">
					description = <"The subject has no risk related to medication.">
				>
				["at0142"] = <
					text = <"Significant medication risk">
					description = <"The subject has significant risk related to medication.">
				>
				["at0143"] = <
					text = <"Orthopaedic /spinal surgery">
					description = <"The subject has undergone orthopaedic or spinal surgery.">
				>
				["at0144"] = <
					text = <"Duration of surgery">
					description = <"Risks imparted by length of surgery.">
				>
				["at0145"] = <
					text = <"On table > 2 hrs (Past 48 hrs)">
					description = <"The subject has had surgery within the past 48 hours lasting over 2 hours.">
				>
				["at0146"] = <
					text = <"On table > 6 hrs (Past 48 hrs)">
					description = <"The subject has had surgery within the past 48 hours lasting over 6 hours.">
				>
				["at0150"] = <
					text = <"Diabetes, MS, CVA">
					description = <"The subject has diabetes, multiple sclerosis or has had a stroke.">
				>
				["at0151"] = <
					text = <"Motor / sensory deficit">
					description = <"The subject has a motor or sensory deficit.">
				>
				["at0152"] = <
					text = <"Paraplegia">
					description = <"The subject has a paraplegia.">
				>
				["at0153"] = <
					text = <"No orthopaedic / spinal surgery">
					description = <"The subject has no risk related to spinal / orthopaedic surgery.">
				>
				["at0154"] = <
					text = <"On table < 2 hrs or not in past 48 hrs">
					description = <"The subject has had surgery more than 48 hrs ago or lasting for less than 2 hours.">
				>
			>
		>
	>