NURS 6412 Week 3 terminology mapping example

Twelve Respiratory Flowsheet Terms Mapped to SNOMED CT, Including the Three That Stayed Unmapped and Why

Student Name

College of Nursing, Walden University

NURS 6412: Information and Knowledge Management

Instructor Name

Month Day, Year

Twelve Respiratory Flowsheet Terms Mapped to SNOMED CT, Including the Three That Stayed Unmapped and Why

Purpose and Method

Our hospital's respiratory assessment flowsheet carries local wording that grew over years: SOB on one unit, dyspnea at rest on another, and checkboxes whose meaning only the people who built them remember. Local terms cannot be compared across units, shared with another organization or pooled for research until they are tied to a standard concept. A multisite study that mapped common nursing assessment data to national standards found that a fifth of the observation values it needed were new to SNOMED CT, which is a reminder that nursing language does not always fit the standard as it stands (Matney et al., 2017).

Method: twelve terms were taken from the composite respiratory section of the adult medical-surgical flowsheet. For each, two clinical nurses on the documentation council described what the term means when they chart it. Candidate concepts were searched in the SNOMED CT International Edition (SNOMED International, 2025) through a public terminology server, and every identifier below was copied from the search result rather than typed from memory. Each row is classed as an exact match, a broader standard concept, a narrower standard concept or no match.

The Map

Table 1

Local Respiratory Terms Mapped to SNOMED CT Concepts

Three Difficult Rows

Labored/shallow. The checkbox was built as a shortcut, and nurses use it for two different findings: breathing that takes visible effort and breathing with small tidal volumes. SNOMED CT has a concept for each, labored breathing (248549001) and shallow breathing (386616007), but no single concept for either one. Mapping the checkbox to one of them would silently misclassify every patient charted with the other. The only correct fix is to split the field itself into two checkboxes, each mapped exactly, and to leave historical entries unmapped with a note explaining why. This row shows that some mapping problems are really design problems.

Dusky. The term appears often, and nurses on the council disagreed about what it means: some use it for early cyanosis, others for pallor in patients with darker skin, others for poor perfusion in general. The standard has concepts for cyanosis (3415004) and for pallor, but mapping dusky to either would assign a precise meaning the local term never had. The council recommended retiring the term and replacing it with structured choices for skin color and capillary refill, with guidance on assessing color across skin tones.

Breathing OK. A negative finding looks easy to map, but it is not. It does not say which findings were checked and found absent. Mapping it to a general normal finding would allow a later reader to conclude that the patient was assessed for, and found free of, specific problems such as crackles or accessory muscle use, when the nurse may only have observed the patient at rest. The row is left unmapped, and the flowsheet should instead record specific negative findings where they matter.

Decision Log

Using neck muscles, broader: approved by the documentation council, since the extra specificity was not used in any report. Wet cough, narrower: approved with a condition that the flowsheet add a separate sputum field, so future entries can be mapped exactly. Labored/shallow, none: approved, with a build request to split the field submitted to the clinical informatics team. Dusky, none: approved, with the term scheduled for retirement at the next flowsheet revision. Breathing OK, none: approved; the council chair signed all five decisions. The remaining seven exact rows required no council decision. Principles of health interoperability hold that a code should carry the same meaning wherever it travels (Benson & Grieve, 2021), and each decision above was made to protect that meaning rather than to raise the count of mapped rows.

What the Map Will Be Used For

The map has three immediate uses. It allows respiratory findings charted on different units to be counted together in the hospital's quality reports, which until now required reading comment boxes. It prepares these findings to travel in structured form to the skilled nursing facilities that receive our patients, where the same codes can be recognized. And it gives the documentation council a list of flowsheet changes that would make future mapping exact rather than approximate. The map will be reviewed with each semiannual release of the standard, since concepts are occasionally retired or added, and each review will be recorded in the decision log with the release date used. The five rows with a broader, narrower or no match will be revisited first at each review, since they are where a new concept or a flowsheet change is most likely to allow an exact mapping. Any row that changes will be reported to the teams that build respiratory reports, so that their counts are adjusted at the same time.

References

Benson, T., & Grieve, G. (2021). Principles of health interoperability: FHIR, HL7 and SNOMED CT (4th ed.). Springer.

Matney, S. A., Settergren, T., Carrington, J. M., Richesson, R. L., Sheide, A., & Westra, B. L. (2017). Standardizing physiologic assessment data to enable big data analytics. Western Journal of Nursing Research, 39(1), 63-77. https://doi.org/10.1177/0193945916659471

SNOMED International. (2025). SNOMED CT International Edition (February 2025 release) [Clinical terminology].