SNOMED and Its Use in Nursing Care

Nursing Care and SOMED International

Whats is SNOMED,11 Modules of SNOMED International,Role of NANDA,UMLS Four Categories and SNOMED

Whats is SNOMED

    SNOMED is Clinical abbreviation (systematically organized computer-processable collection of medical terms providing codes, terms, synonyms and definitions) used in clinical documentation and reporting in health care system.

11 Modules of SNOMED International

    SNOMED International is a compilation of nomenclatures organized into 11 modules or axes: 

(a) topography

(b) morphology

(c) living organisms

(d) chemicals, drugs, and biological products

(e) functions

(f) occupation

(g) diagnosis

(h) procedures

(i) physical agents, forces, and attributes

(j) social context

(k) general (Coté, Rothwell, Palotay, & Beckett, 1993). 

Role of NANDA

    North American Nursing Diagnosis Association (NANDA) diagnoses are included in the functional axis of SNOMED, and a limited number of nursing procedures are included in the procedure module. 

    In contrast to taxonomic vocabulary systems with the primary purpose of disjunctive classification (eg, International Classification of Diseases or Current Procedural Terminology Codes), SNOMED terms can be combined for the purposes of concept representation for computer-based systems. 

    For instance, the term “pain” from the function axis can be joined with a severity modifier from the general axis to represent the clinical expression “severe pain” or with an anatomic term from the topography axis to represent “back pain.” This multiaxial approach is similar to the proposed architecture of the international classification of nursing practice. 

    Many investigations have demonstrated the usefulness of SNOMED for physician documentation, and a few have addressed the utility of SNOMED for nursing. 

    Nurses use both NANDA diagnoses and other terms (ie, symptoms, signs, medical diagnoses) to describe patient problems and that SNOMED terms other than those of NANDA diagnoses were exact matches for terms used by nurses in their clinical documentation. 

    Lange (1996) found that SNOMED terms were useful for representing terms used by nurses in inter shift reports. 

    J. Campbell and others (1997) compared SNOMED International with the Read Codes and the Unified Medical Language System (UMLS) on the attributes of completeness, clinical taxonomy, administrative mapping, term definitions, and clarity. Of the 1,929 records in the data set, 390 were nursing documents. 

UMLS Four Categories and SNOMED

    Although no separate nursing analyzes were reported, SNOMED was judged superior to Read and UMLS on the four categories of information (findings, diagnoses, interventions, and plans of care) that comprised greater than 97% of the nursing text sources and overall, on the attributes of completeness, taxonomy, and compositional nature. 

    It received lower ratings than Read and UMLS on administrative mappings. If the analyzes related to nursing interventions and plans of care had been reported separately from other health care interventions and plans of care, the findings might have differed on the attribute of completeness because the UMLS includes nursing intervention schema from the Omaha System, the Georgetown Home Health Care Classification, and the Nursing Interventions Classification, although SNOMED does not. 

    Some utility has been demonstrated, but further work is needed to increase the usefulness of SNOMED for nursing. Two areas relate specifically to SNOMED itself, and the third is a more generic requirement for representing nursing concepts in computer-based systems. 

    First, additional terms for nursing interventions must be added to SNOMED. Second, rules (grammars) for combining terms must be developed, using knowledge of formalisms such as conceptual graphs. Third, data models that describe the attribute of nursing data must be developed.