description: 'Freedom restricting interventions are interventions that are used against the will of the person concerned and that consciously restrict the person''s freedom to protect the person or his environment. This definition includes many forms of freedom restriction, such as (not exhaustive) \r\n\r\n* Forced administration of fluid and nutrition \r\n* Forced administration of medication \r\n* Performing medical checks or other medical procedures \r\n* Restricting freedom of movement \r\n* Admitting to an accommodation and secluding when admitted to an accommodation. \r\n* Exercising supervision \r\n* Searching of clothing or body \r\n* Restriction of visitors and the use of communication means\r\n\r\n\r\nIn the hospital, it is usually about restricting the freedom of movement, for example by using bed rails, moving a chair near to the table or using an arm splint for infusion. In combination with freedom-restricting interventions, soothing medication can be administered. In the case of small children, it is often a question of fixing hands, for example, to prevent a stomach tube from being pulled out. \r\nFor nurses to use it in hospitals, Dutch Nurses Association (V&VN) published a guideline [ref. 3].\r\nIn mental health care, care for the disabled and psychogeriatric care, it always concerns care that is used against the will of the patient.\r\nThe legal framework for using these interventions is (per 1-1-2020) governed by two laws, namely:\r\n\r\n* The Wet verplichte ggz (Wvggz: Mandatory Care In Mental Health Act) for people with psychiatric disorders \r\n* The Wet zorg en dwang (Wzd : Care and Compulsion Act) for people with intellectual disabilities and people with a psychogeriatric disorder, such as dementia.\r\n\r\n\r\nThe Wvggz refers to the term compulsory care, while the Wzd uses the term involuntary care.\r\nA national registration system, the Argus registration, is used to register the interventions in the context of the Wvggz.\r\n#### Purpose\r\nFreedom-restricting interventions (also called involuntary / compulsory care) are applied to prevent or limit serious harm to the person concerned or others or to stabilize or restore the mental health of the person concerned.\r\nImplementing freedom-restricting interventions is risky and can result in damage to the the person concerned if they are not carefully implemented. Health professionals fulfill an important role in identifying risks, observing the effect of the interventions and any changes to the policy in terms of involuntary/compulsory care. Recording all information on the interventions is of major importance for insight into decision-making, implementing, monitoring and evaluating the freedom-restricting interventions.\r\nThe reporting of applied freedom-restricting interventions is also part of the set of quality indicators of the Healthcare and Youth Care Inspectorate\r\n#### Evidence Base\r\nThe Freedom-Restricting Intervention information model applies to both care in the hospital environment and to mental and disabled care and psychogeriatric care.\r\nThe reason for the revision of the information model is the fact that the Special Admissions for Psychiatric Hospitals Act (Bopz), on which the building block was partly based, will be replaced in January 2020 by two new laws, ie: \r\n\r\n* The Wet verplichte ggz (Wvggz) for people with psychiatric disorders \r\n* The Wet zorg en dwang (Wzd) for people with intellectual disabilities and people with a psychogeriatric disorder, such as dementia.\r\n\r\n\r\nThe new laws make new demands on what information is recorded. In the situations where the two above-mentioned laws apply, the information model is only applied when there is involuntary/compulsory care. That is why it is not recorded whether there has been resistance and to what extent. \r\nRestrictions imposed on a voluntary basis - apart from a number of exceptions described in the law - are regarded as regular care and can be recorded with the appropriate information models.\r\nDeciding whether involuntary / compulsory care is involved falls outside the scope of the building block.\r\nThe information model provides a start and end time for recording time registration. The last element is not relevant for all interventions: some interventions are momentary and not duration registrations.The information model offers the possibility to register a start and end time. The last element is not relevant for all interventions: some interventions are momentary and\n                    not duration registrations.\r\nIn this version the information model includes new value lists with interventions based on the aforementioned laws. Although is was attempted to achieve far-reaching harmonization in defining the interventions, it was nevertheless decided to make three separate lists for the different situations in order to simplify the correct application. The situations mentioned simply require other interventions.\r\n\r\n\r\n**Issues**\r\nAt the time of making this version of the information model, a number of legal texts and elaborations thereof in the aforementioned regulations were only available as a draft versions. The information reflects the situation at the end of October 2019. Any changes after this date will be processed in subsequent versions. Final references, such as to the Argus 2.0 registration, will also become available in later versions.'
package_name: healthdata.be.r4.cbb
derivation: specialization
name: HdBeFreedomRestrictingIntervention
abstract: true
type: https://fhir.healthdata.be/StructureDefinition/LogicalModel/FreedomRestrictingIntervention
elements:
  LegallyCapable:
    short: LegallyCapable
    _definition:
      extension:
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: nl-BE}
        - {url: content, valueMarkdown: 'Indicator die aangeeft of de patiënt in staat wordt geacht om de gevolgen van een bepaalde handeling, situatie of besluitvorming te overzien.'}
    type: boolean
    _short:
      extension:
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: nl-BE}
        - {url: content, valueMarkdown: Wilsbekwaam}
    index: 0
  LegallyCapableComment:
    short: LegallyCapableComment
    _definition:
      extension:
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: nl-BE}
        - {url: content, valueMarkdown: De toelichting op de beslissingen waarvoor de patiënt wils**on**bekwaam is.}
    type: string
    _short:
      extension:
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: nl-BE}
        - {url: content, valueMarkdown: WilsbekwaamToelichting}
    index: 1
  LegalSituation:
    short: LegalSituation
    _definition:
      extension:
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: nl-BE}
        - {url: content, valueMarkdown: De juridische situatie die voor de patiënt van toepassing is gedurende de interventie.}
    refers: ['https://fhir.healthdata.be/StructureDefinition/LogicalModel/HdBe-LegalSituation']
    type: Reference
    _short:
      extension:
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: nl-BE}
        - {url: content, valueMarkdown: JuridischeSituatie}
    index: 2
  TypeOfIntervention:
    short: TypeOfIntervention
    _definition:
      extension:
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: nl-BE}
        - {url: content, valueMarkdown: Het soort interventie beschrijft het type vrijheidsbeperkende interventie/onvrijwillige zorg.}
    type: CodeableConcept
    _short:
      extension:
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: nl-BE}
        - {url: content, valueMarkdown: SoortInterventie}
    binding: {strength: extensible, valueSet: 'https://fhir.healthdata.be/ValueSet/TypeOfIntervention'}
    index: 3
  ReasonForUse:
    short: ReasonForUse
    _definition:
      extension:
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: nl-BE}
        - {url: content, valueMarkdown: Reden van toepassen geeft de onderbouwing voor het toepassen van de onvrijwillige zorg}
    type: CodeableConcept
    _short:
      extension:
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: nl-BE}
        - {url: content, valueMarkdown: RedenVanToepassen}
    binding: {strength: extensible, valueSet: 'https://fhir.healthdata.be/ValueSet/ReasonForUse'}
    index: 4
  Assent:
    short: Assent
    _definition:
      extension:
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: nl-BE}
        - {url: content, valueMarkdown: De door de wettelijke vertegenwoordiger aan de zorgverlener(s) gegeven instemming voor het uitvoeren van de onvrijwillige zorg.}
    type: CodeableConcept
    _short:
      extension:
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: nl-BE}
        - {url: content, valueMarkdown: Instemming}
    binding: {strength: required, valueSet: 'https://fhir.healthdata.be/ValueSet/Assent'}
    index: 5
  Start:
    short: Start
    _definition:
      extension:
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: nl-BE}
        - {url: content, valueMarkdown: De datum en tijd waarop de interventie is uitgevoerd bij moment registraties dan wel de datum en tijd waarop de interventie gestart is bij duurregistraties.}
    type: dateTime
    _short:
      extension:
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: nl-BE}
        - {url: content, valueMarkdown: Begin}
    index: 6
  End:
    short: End
    _definition:
      extension:
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: nl-BE}
        - {url: content, valueMarkdown: De datum en tijd waarop de interventie is beëindigd.}
    type: dateTime
    _short:
      extension:
      - url: http://hl7.org/fhir/StructureDefinition/translation
        extension:
        - {url: lang, valueCode: nl-BE}
        - {url: content, valueMarkdown: Einde}
    index: 7
package_version: 0.14.0-beta
class: logical
kind: logical
url: https://fhir.healthdata.be/StructureDefinition/LogicalModel/HdBe-FreedomRestrictingIntervention
base: http://hl7.org/fhir/StructureDefinition/Element
version: null
required: [Start, TypeOfIntervention, LegallyCapable]