1 Introduction

SNOMED CT is the most comprehensive and precise clinical health terminology product in the world, owned and distributed around the world by The International Health Terminology Standards Development Organisation (IHTSDO)SNOMED International. 

The SNOMED CT Nursing Activities Reference Set is the result of work carried out by the Nursing Refsets Clinical Project Group, a subgroup of the Nursing Clinical Reference Group, one of several Clinical Reference Groups working collaboratively to develop new and improve existing content in SNOMED CT. 

2 Background

Nursing Activities has been defined as:

• activity intended directly or indirectly to improve or maintain a health state

EXAMPLE: A blood pressure measurement completed by a qualified nurse including the healthcare activity elements of taking, documenting and evaluation.

The initial content of this reference set was informed by the previously published:

• Equivalence table between ICNP and SNOMED CT between International Classification for Nursing Practice (ICNP®) and SNOMED Clinical Terms (SNOMED CT®) for nursing interventions.

The result is intended to support nursing care and enable effective decision-making, and to provide information to inform nursing education and health policy. As the subset is implemented, feedback will lead to further development, with the professional oversight by the Nursing Clinical Reference Group.

3 Purpose

To provide a subset of frequently used SNOMED CT concepts for use in nursing practice within the following data fields:

• Nursing Activities

4 Content

The Nursing Activities Reference Set is comprised of 884 891 active concepts from the SNOMED CT Procedure hierarchy. The Reference Set will be maintained in line with each release of SNOMED CT and content added based on usage overtime. Where clinical expertise is required, consultation with the Nursing Clinical Reference Group will be undertaken. 

4.1 Updates

The Nursing Activities Reference set Set content has been updated to reflect changes published in the July 2020 2021 release of SNOMED CT as follows: 

Concept ID

. There were no reference set member inactivations or additions as a result of this.  

Given the current development of the International Classification for Nursing Practice Reference Set, the Nursing Activities Reference Set will not be maintained following this release.  

5 Obtaining the Reference Sets

Access within SNOMED International member countries is provided by the Member National Release Centre in each country, via the relevant Member web page. Affiliates of SNOMED International in non-member countries can access the reference sets in SNOMED CT Release Format 2 (RF2) through their MLDS (Member Licensing & Distribution Service) account https://mlds.ihtsdotools.org. Please contact info@ihtsdo.org for more information if required. 

6 Feedback

SNOMED international are keen to receive feedback on this product – from both a clinical content perspective and from an implementer's perspective. Feedback should be sent to info@ihtsdo.org. Feedback should include any issues relating to implementation , suggestions for future content inclusion and/or general comments regarding the Reference Set.

7 Technical Notes

7.1 RF2 package format

The RF2 package convention dictates that it contains all relevant files, regardless of whether or not there is content to be included in each particular release.  Therefore, the package contains a mixture of files which contain both header rows and content data, and also files that are intentionally left blank (including only a header record).  The reason that these files are not removed from the package is to draw a clear distinction between:

1. ...files that have been deprecated (and therefore removed from the package completely), due to the content no longer being relevant to RF2 in this or future releases, and 
2. ...files that just happen to contain no data in this particular release (and are therefore included in the package but left blank, with only a header record), but are still relevant to RF2, and could therefore potentially contain data in future releases.

This allows users to easily distinguish between files that have purposefully been removed or not, as otherwise if files in option 2 above were left out of the package it could be interpreted as an error, rather than an intentional lack of content in that release.

7.2 New files added to the RF2 package format for Derivative products

In order to bring the package format in line with the latest SNOMED International packaging conventions, several new files have been added to the 2021 derivative product release packages:

• > sct2_RelationshipConcreteValues_NursingActivitiesDelta_INT_20210731.txt
  > sct2_RelationshipConcreteValues_NursingActivitiesFull_INT_20210731.txt
  > sct2_RelationshipConcreteValues_NursingActivitiesSnapshot_INT_20210731.txt
• > sct2_sRefset_NursingActivitiesOWLExpressionDelta_INT_20210731.txt
  > sct2_sRefset_NursingActivitiesOWLExpressionFull_INT_20210731.txt
  > sct2_sRefset_NursingActivitiesOWLExpressionSnapshot_INT_20210731.txt
• > der2_ssccRefset_NursingActivitiesMRCMAttributeRangeDelta_INT_20210731.txt
  > der2_ssccRefset_NursingActivitiesMRCMAttributeRangeFull_INT_20210731.txt
  > der2_ssccRefset_NursingActivitiesMRCMAttributeRangeSnapshot_INT_20210731.txt
• > der2_sssssssRefset_NursingActivitiesMRCMDomainDelta_INT_20210731.txt
  > der2_sssssssRefset_NursingActivitiesMRCMDomainFull_INT_20210731.txt
  > der2_sssssssRefset_NursingActivitiesMRCMDomainSnapshot_INT_20210731.txt
• > der2_cRefset_NursingActivitiesMRCMModuleScopeDelta_INT_20210731.txt
  > der2_cRefset_NursingActivitiesMRCMModuleScopeFull_INT_20210731.txt
  > der2_cRefset_NursingActivitiesMRCMModuleScopeSnapshot_INT_20210731.txt
• > der2_cissccRefset_NursingActivitiesMRCMAttributeDomainDelta_INT_20210731.txt
  > der2_cissccRefset_NursingActivitiesMRCMAttributeDomainFull_INT_20210731.txt
  > der2_cissccRefset_NursingActivitiesMRCMAttributeDomainSnapshot_INT_20210731.txt

These files will likely remain empty of content in this derivative product package, but are included to ensure consistency across the SNOMED International catalog of products.