2019-05-28 Anesthesia CRG Conference Call

1

Introductions and apologies

@Former user (Deleted)

Apologies received from @Zac.Whitewood-Moores

2

Minutes of previous meeting

@Andrew Marchant

Review minutes from 2019-04-10 Anesthesia CRG Face-to-Face Meeting (London)

Agreed to be a correct record

3

Matters arising from the minutes

@Andrew Marchant

A number of items carried forward to this agenda

Work continues on standards for electronic anaesthesia records and, engagement with professional bodies in adopting such standards in accreditation, It is proposed to develop a draft standard for anesthesia records in the UK aligned to the format of Professional Records Standards Body standards. This work will be informed by the HL7 Domain Analysis model for Anaesthesia Records. Feedback awaited from report to AAGBI council

Coma, unconsciousness and concussion. Felt that a true consensus document for definitions is not achievable - A brief report of what the Anesthesia CRG views as best definitions available outlining preferred approach to assessment using Glasgow Coma score and other methods.

4

SNOMED CT terminology requests

@Former user (Deleted)

@Monica Harry

Include recent correspondence on CRS request 740106 Mechanical Insufflation - Exsufflation. Marked completed. Question was whether a preexisting concept encompassed this concept, resolution was that a new concept was needed.

5

SNOMED updates

@Monica Harry

Item not reached

6

Preservative free morphine for neuraxial blocks

@Former user (Deleted) @Former user (Deleted)

CRS request 722226 refers

PF morphine has limited scope, not available in several countries. Suggest that national extensions implement this concept as necessary.

For reference, NHS DM+D shows medications in UK: https://apps.nhsbsa.nhs.uk/DMDBrowser/DMDBrowser.do

RxNav shows RxNorm listings (US):

https://rxnav.nlm.nih.gov/

7

Representation of IV fluids in revised product hierarchy

@Former user (Deleted)

@Former user (Deleted)

List of commonly used products in anesthesia (see attached Excel file IV Fluids.xlsx.)

SNOMED International is currently undertaking remodelling of products including IV fluids based on a model defining ingredients measured in metric units. This creates a partially automatically generated hierarchy of fully and sufficiently defined concepts. Work is currently in progress but anticipated that should be complete for the January 2020 release. Levels of detail that include pack sizes, manufacturers etc are deemed to be appropriate for national extensions.

Noted that the units adopted differ from current conventions, but the current view is that the International release should not be complicated by synonyms to accomodate different units or representations of composition.

Identified missing solutions were discussed and agreed that requests would be submitted before the close of the submission window (beginning October 2019) for the January 2020 release.

Noted that the representation of balanced electrolyte solutions would be difficult using the current SNOMED model.

Examples of anesthesia and ITU prescribing practice would provide use cases that inform the validation of and any amendments suggested to the current modelling approach.

8

ISO 19223 Ventilation Standard

@Steven Dain

Update on the ISO 19223 ventilation standard, now at the proofing stage. @Former user (Deleted) and @Martin Hurrell discussed the meanings of patterns and inflation types defining modes as related to commonly used artificial ventilation in anaesthesia as tabulated by @Former user (Deleted)

ventilation modes.xlsx

9

High flow (nasal) oxygen therapy

Commonly used method of oxygen delivery in high dependency care - characteristics of the method is that delivered oxygen is heated and humidified

However, the method is not just nasal - manufacturers (for example Fisher-Paykel) include adapters for delivering the same gas delivery to a tracheostomy. Consider requesting two concepts for the two delivery routes.

@Former user (Deleted) noted there will be an addendum to ISO 19223 that will cover this type of respiratory therapy

10

Any other business

11

Next meeting

Tuesday, July 23, 2019