TRANSLATING EVIDENCE FROM GUIDELINE TO A STANDARDIZED DOCUMENTATION TOOL Debra L. Foster, RN, PHN; Tammy L. Gomez, RN, BAN, Karen A. Monsen, PhD, RN University of Minnesota School of Nursing, Minneapolis, Minnesota, USA Physical activity intervention for adults with obesity Reference: Centers for Disease Control and Prevention Physical Activity Plan Weight loss occurs through combining physical activity with a decrease in daily caloric intake Physical activity contributes to enhanced overall health and well being, enhanced bone health, and improved mood Problem: Physical activity Category: Teaching, guidance, and counseling Targets: – Medical/Dental Care – Physical Therapy Care – Dietary Management – Exercises – Wellness – Support System Pain Intervention for infants, non-verbal, and cognitively impaired children Reference: Merkel, S.I., Voepel-Lewis, T., Shayevitz, J.R., & Malviya, S. (1997). The FLACC: A behavioral scale for scoring postoperative pain in young children. Pediatric Nursing, 23 (3), Young infants may perceive pain more intensely than children and adults Valid, reliable assessment tools are needed to help nurses and caregivers manage pediatric pain Problem: Pain Category-targets – Surveillance-Signs/symptoms physical – Treatments and procedures-Sickness/injury care – Treatments and procedures-Medication administration – Case management-Medical/dental care – Teaching, guidance, and counseling-Signs/symptoms physical – Teaching, guidance, and counseling-Medication action Standards + Technology + Evidence + Computerized documentation = Opportunity to disseminate evidence-based practice through interface terminology care plans SSigns/symptoms Physical Vital signs assessment: elevated heart-rate and blood pressure and increased respiratory rate may be indicators of pain. SSigns/symptoms Physical The FLACC scale Face 0-No particular expression or smile 1-Occasional grimace or frown, withdrawn, disinterested 2-Frequent to constant quivering chin, clenched jaw Legs 0-Normal position or relaxed 1-Uneasy, restless, tense 2-Kicking, or legs drawn up Activity 0-Lying quietly, normal position, moves easily 1-Squirming, shifting back and forth, tense 2-Arched, rigid or jerking Cry 0-No cry (awake or asleep) 1-Moans or whimpers; occasional complaint 2-Crying steadily, screams or sobs, frequent complaints Consolability 0-Content, relaxed 1-Reassured by occasional touching, hugging or being talked to, distractible 2-Difficult to console or comfort T&PSickness/injury careStep 1: Pain score = 0-3 Examples: swaddling, holding, repositioning, rocking, music, pacifier, feeding, changing diaper T&PMedication administrationStep 2: Pain score = 4-6 Step 1+ Non-narcotic analgesia Examples: Acetaminophen, Ibuprofen T&PMedication administrationStep 3: Pain scores = 6-10 Additional analgesia as ordered by physician If patient does not already have a prescription for additional analgesia and this level or severity of pain is a new symptom, notify physician immediately to follow their next steps. CMMedical /Dental careNotify primary physician Coordinate transportation to clinic/ED SSigns/symptoms Physical Reassess for effectiveness 30 minutes after intervention TGCSigns/symptoms Physical Teach caregivers :  Assessment of vital signs  FLACC scale  Physical cues  Non-verbal cues TGCMedication ActionTeach caregivers the following for all medications:  Purpose/benefits  Dose  Route  Frequency and schedule  Storage These evidence-based care plans are available on-line at omahasystemmn.org