1. 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 http://www.cdc.gov/physicalactivity/ 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), 293-297. 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 SSigns/symptoms Physical The FLACC scale Face 0-No particular expression or smile 1-Occasional grimace or frown, withdrawn, disinterested 2-Frequent to constant quivering chin, clenched jaw Legs 0-Normal position or relaxed 1-Uneasy, restless, tense 2-Kicking, or legs drawn up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