Embed Size (px)
Citation preview
Ora
l Mu
co
sitis
As
se
ss
me
nt
an
d O
ral C
are
Mic
hele
Farrin
gto
n, B
SN
, RN
, CP
HO
N
Sta
ff Nu
rse
Un
ivers
ity o
f Iow
a H
osp
itals
an
d C
linic
s
Sp
ea
ke
r Dis
clo
su
re S
tate
me
nt
! T
he
sp
ea
ke
r ha
s n
o in
du
stry
re
latio
nsh
ips to
dis
clo
se
.
! N
o o
ff-lab
el u
se
will b
e d
iscu
sse
d.
Ob
jec
tive
s
! D
iscuss id
entific
atio
n a
nd u
tilizatio
n o
f an e
vid
ence-
based o
ral a
ssessm
ent to
ol fo
r adult a
nd p
edia
tric
oncolo
gy p
atie
nts
in in
patie
nt a
nd a
mbula
tory
care
settin
gs.
! Id
entify
evid
ence-b
ased in
terv
entio
ns to
pro
mote
ora
l health
and m
inim
ize th
e ris
k o
f ora
l mucositis
develo
pm
ent fo
r all o
ncolo
gy p
atie
nts
.
! P
artic
ipate
in a
n in
tera
ctiv
e d
iscussio
n o
n
assessm
ent a
nd o
ral c
are
for o
ncolo
gy p
atie
nts
in a
ll settin
gs.
Asse
mb
le R
ele
va
nt R
ese
arch
& R
ela
ted L
itera
ture
Critiq
ue
& S
yn
the
siz
e R
esea
rch
for U
se
in P
ra
ctic
e
No
Yes
Yes
Is C
ha
ng
e
App
rop
ria
te fo
r
Ado
ptio
n in
Pra
ctic
e?
Yes
Institu
te th
e C
ha
ng
e in
Pra
ctic
e
Is T
here
a S
uffic
ient
Re
se
arch
Base
?
Mo
nit
or a
nd
An
aly
ze S
tru
ctu
re,
Pro
cess, a
nd
Ou
tco
me D
ata
2. N
atio
nal A
ge
ncie
s o
r O
rg
aniz
atio
nal
Sta
nd
ard
s &
Gu
ide
line
s
3. P
hilo
sop
hie
s o
f Care
4. Q
ue
stio
ns fr
om
Institu
tiona
l Sta
nd
ard
s C
om
mitte
e5
. Iden
tifica
tion
of C
linic
al P
rob
lem
1. R
isk M
an
ag
em
ent D
ata
Pro
ble
m F
ocu
sed
Trig
gers
Kn
ow
led
ge F
ocu
sed
Trig
gers
• S
taff
• C
ost
• P
atie
nt a
nd
Fa
mily
Pilo
t t
he C
han
ge in
Practic
e
1. S
ele
ct O
utc
om
es to
be
Ach
ieve
d
2. C
olle
ct B
ase
line D
ata
3. D
esig
n E
vid
ence
-B
ase
d
Pra
ctic
e (
EB
P) G
uid
elin
e(s)
4. Im
ple
me
nt E
BP
on
Pilo
t Un
its
5. E
va
lua
te P
roce
ss &
Ou
tco
mes
6. M
od
ify th
e P
ractic
e G
uid
elin
e
Th
e Io
wa
Mo
de
l of
Evid
en
ce
-B
as
ed
Pra
ctic
e t
o P
ro
mo
te
Qu
alit
y C
are
RE
QU
ES
TS
TO
:
Ma
rita
Title
r, P
hD
, RN
Offic
e o
f Nu
rsin
g R
ese
arch
Th
e U
niv
ersity
of Io
wa
Ho
sp
itals
an
d C
linic
s
Iow
a C
ity, IA
52
24
2-1
00
9
Re
vis
ed
April 1
99
8 ©
UIH
C
DO
NO
T R
EP
RO
DU
CE
WIT
HO
UT
PE
RS
MIS
SIO
N
2. P
roce
ss Im
prove
men
t Da
ta
3. In
terna
l/Exte
rn
al B
ench
ma
rkin
g D
ata
4. F
ina
ncia
l Da
ta
1. N
ew
Re
sea
rch
or O
the
r L
itera
ture
Co
nsid
er
Oth
er
Trig
gers
Is th
is T
op
ic
a P
rio
rity
Fo
r th
e
Orga
niz
atio
n?
No
Fo
rm
a T
ea
m
Base P
ractic
e o
n O
th
er T
yp
es o
f E
vid
en
ce:
1. C
ase
Re
po
rts
2. E
xp
ert O
pin
ion
3. S
cie
ntific
Prin
cip
les
4. T
he
ory
Co
nd
uct
Research
Co
ntin
ue to
Eva
luate
Qu
ality
of C
are
an
d N
ew
Kn
ow
led
ge
No
Dis
sem
ina
te R
esu
lts• E
nviro
nm
ent
= a
de
cis
ion
poin
t
Refe
re
nce
Title
r, M
.G., K
leib
er, C
., Rake
l, B., B
udreau, G
., Everett, L
.Q., S
teelm
an, V
., Buckw
alte
r, K
.C.,
Trip
p-R
eim
er, T
., & G
oode C
. (2001).T
he Io
wa M
odel o
f Evid
ence-B
ased P
ractic
e to
Prom
ote
Quality
C
are.
Critic
al C
are N
ursin
g C
linic
s o
f North
Am
eric
a, 1
3(4), 4
97-509.
Evid
en
ce-
Based
Pra
ctic
e
Fra
mew
ork
Th
e Iow
a M
od
el of
Ev
iden
ce Ba
sed P
ractice to
Pro
mo
te Qu
ality
Ca
re
Pro
blem
Focu
sed T
riggers
1. R
isk M
an
agem
ent D
ata
2. P
rocess Im
pro
vem
ent D
ata
3. In
ternal/E
xtern
al B
ench
mark
ing
Data
4. F
inan
cial D
ata
5. Id
entifica
tion
of C
linica
l Pro
blem
Kn
ow
ledge F
ocu
sed T
riggers
1. N
ew R
esearch
or O
ther L
iteratu
re
2. N
atio
nal A
gen
cies or O
rgan
izatio
nal
Sta
nd
ard
s & G
uid
elines
3. P
hilo
sop
hies o
f Care
4. Q
uestio
ns fro
m In
stitutio
nal
Sta
nd
ard
s Com
mittee
Con
sider
Oth
er
Trig
gers
Is this T
op
ic
a P
riority
for th
e
Org
an
izatio
n?
Form
a T
eam
Yes
No
= a
decisio
n p
oin
t
Pro
jec
t Trig
ge
rs
! P
rob
lem
Fo
cu
se
d T
rigg
ers
– R
esea
rch
co
mm
ittee
receiv
ed re
que
sts
in
Jun
e 2
00
5 fo
r pro
ject s
up
po
rt rela
ted
to o
ral
hea
lth
• Pro
ble
ms w
ith a
sse
ssm
en
t of o
ral m
uco
sitis
– A
du
lt leu
ke
mia
an
d b
on
e m
arro
w tra
nsp
lan
t un
it
• Pro
ble
ms w
ith o
ral c
are
for h
ea
d a
nd
ne
ck
ca
nce
r pa
tien
ts
– A
du
lt inp
atie
nt o
nco
log
y u
nit
Pu
rpo
se
: Ora
l As
se
ss
me
nt
! Im
ple
me
nt a
n e
vid
en
ce
-ba
se
d o
ral
mu
co
sitis
asse
ssm
en
t for o
nco
log
y
pa
tien
ts to
imp
rove
ide
ntific
atio
n a
nd
d
ocu
me
nta
tion
of m
uco
sa
l ch
an
ge
s
! Im
pro
ve
co
mm
un
ica
tion
am
on
g th
e
he
alth
ca
re te
am
to fa
cilita
te p
reve
ntio
n
an
d e
arly
inte
rve
ntio
n fo
r pa
tien
ts w
ho
m
ay d
eve
lop
ora
l mu
co
sitis
Th
e Iow
a M
od
el of
Ev
iden
ce Ba
sed P
ractice to
Pro
mo
te Qu
ality
Ca
re
Pro
blem
Focu
sed T
riggers
1. R
isk M
an
agem
ent D
ata
2. P
rocess Im
pro
vem
ent D
ata
3. In
ternal/E
xtern
al B
ench
mark
ing
Data
4. F
inan
cial D
ata
5. Id
entifica
tion
of C
linica
l Pro
blem
Kn
ow
ledge F
ocu
sed T
riggers
1. N
ew R
esearch
or O
ther L
iteratu
re
2. N
atio
nal A
gen
cies or O
rgan
izatio
nal
Sta
nd
ard
s & G
uid
elines
3. P
hilo
sop
hies o
f Care
4. Q
uestio
ns fro
m In
stitutio
nal
Sta
nd
ard
s Com
mittee
Con
sider
Oth
er
Trig
gers
Is this T
op
ic
a P
riority
for th
e
Org
an
izatio
n?
Form
a T
eam
Yes
No
= a
decisio
n p
oin
t
Org
an
iza
tion
al P
riority
! B
oth
req
ue
sts
we
re c
om
bin
ed
into
on
e
pro
ject
! S
ub
mitte
d to
the
Clin
ica
l Ad
min
istra
tive
C
ou
ncil (a
co
un
cil o
f nu
rse
lea
de
rs in
the
o
rga
niz
atio
n) fo
r ap
pro
va
l
Th
e Iow
a M
od
el of
Ev
iden
ce Ba
sed P
ractice to
Pro
mo
te Qu
ality
Ca
re
Pro
blem
Focu
sed T
riggers
1. R
isk M
an
agem
ent D
ata
2. P
rocess Im
pro
vem
ent D
ata
3. In
ternal/E
xtern
al B
ench
mark
ing
Data
4. F
inan
cial D
ata
5. Id
entifica
tion
of C
linica
l Pro
blem
Kn
ow
ledge F
ocu
sed T
riggers
1. N
ew R
esearch
or O
ther L
iteratu
re
2. N
atio
nal A
gen
cies or O
rgan
izatio
nal
Sta
nd
ard
s & G
uid
elines
3. P
hilo
sop
hies o
f Care
4. Q
uestio
ns fro
m In
stitutio
nal
Sta
nd
ard
s Com
mittee
Con
sider
Oth
er
Trig
gers
Is this T
op
ic
a P
riority
for th
e
Org
an
izatio
n?
Form
a T
eam
Yes
No
= a
decisio
n p
oin
t
Te
am
!
Carry
n A
nders
on, M
D
!
Sharo
n B
aum
ler, M
SN
, RN
, C
OR
LN
, OC
N
!
Deb B
ruene, M
A, R
N, C
PH
ON
!
Laura
Culle
n, M
A, R
N, F
AA
N
!
Cin
dy D
aw
son, M
SN
, RN
, C
OR
LN
!
Rhonda E
vans, B
SN
, RN
, O
CN
!
Mic
hele
Farrin
gto
n, B
SN
, RN
, C
PH
ON
!
Peggy F
olk
mann, B
SN
, RN
!
Roger G
ingric
h, M
D, P
hD
!
John H
ells
tein
, DD
S
!
Kelly
Hochste
tler, B
SN
, RN
, O
CN
!
Shery
l Lang, M
A, R
N, C
PN
P,
CN
A-B
C
!
Robert S
chneid
er, D
DS
!
Hele
n S
tegall, B
SN
, RN
, C
OR
LN
!
Jane U
tech, B
SN
, RN
, OC
N
!
Bra
ndon V
iet, M
A, C
CC
-SLP
Is Th
ere
a S
ufficien
t
Resea
rch
Base?
Assem
ble R
elevan
t Resea
rch &
Rela
ted L
iteratu
re
Critiq
ue &
Syn
thesize R
esearch
for U
se in P
ractice
Pilo
t the C
han
ge in
Pra
ctice
1. S
elect Ou
tcom
es to b
e Ach
ieved
2. C
ollect B
aselin
e Data
3. D
esign
Evid
ence-B
ased
Pra
ctice (EB
P) G
uid
eline(s)
4. Im
plem
ent E
BP
on
Pilo
t Un
its
5. E
valu
ate P
rocess &
Ou
tcom
es
6. M
od
ify th
e Pra
ctice Gu
idelin
e
Base P
ractice o
n O
ther
Typ
es of E
vid
ence
1. C
ase R
eports
2. E
xp
ert Op
inio
n
3. S
cientific P
rincip
les
4. T
heo
ry
Con
du
ct
Resea
rch
Yes
No
Th
e Iow
a M
od
el (con
tinu
ed)
Lite
ratu
re S
ea
rch
! A
du
lt an
d P
ed
iatric
pa
tien
ts
– W
ha
t is th
e s
am
e?
– W
ha
t is d
iffere
nt?
! In
pa
tien
t an
d A
mb
ula
tory
Ca
re p
atie
nts
– W
ha
t is th
e s
am
e?
– W
ha
t is d
iffere
nt?
! H
ea
lth S
cie
nce
libra
rian
Is Th
ere
a S
ufficien
t
Resea
rch
Base?
Assem
ble R
elevan
t Resea
rch &
Rela
ted L
iteratu
re
Critiq
ue &
Syn
thesize R
esearch
for U
se in P
ractice
Pilo
t the C
han
ge in
Pra
ctice
1. S
elect Ou
tcom
es to b
e Ach
ieved
2. C
ollect B
aselin
e Data
3. D
esign
Evid
ence-B
ased
Pra
ctice (EB
P) G
uid
eline(s)
4. Im
plem
ent E
BP
on
Pilo
t Un
its
5. E
valu
ate P
rocess &
Ou
tcom
es
6. M
od
ify th
e Pra
ctice Gu
idelin
e
Base P
ractice o
n O
ther
Typ
es of E
vid
ence
1. C
ase R
eports
2. E
xp
ert Op
inio
n
3. S
cientific P
rincip
les
4. T
heo
ry
Con
du
ct
Resea
rch
Yes
No
Th
e Iow
a M
od
el (con
tinu
ed)
Sy
nth
es
is o
f Ev
ide
nc
e
! S
tan
da
rdiz
ed
ora
l he
alth
asse
ssm
en
t is th
e
first s
tep
in a
co
mp
reh
en
siv
e p
rog
ram
with
p
reve
ntio
n a
nd
trea
tme
nt (E
ilers
, 2004; E
ilers
, et a
l., 2004; J
aro
neski, 2
006; Q
uin
n, e
t al., 2
008)
! 4
0%
of o
nco
log
y p
atie
nts
de
ve
lop
ora
l m
uco
sitis
(Bro
wn &
Win
gard
, 2004; D
odd, 2
004; F
ulto
n, e
t al.,
2002) re
su
lting
from
bo
th c
he
mo
the
rap
y &
ra
dia
tion
the
rap
y (A
vrits
cher, e
t al., 2
006; B
row
n &
W
ingard
, 2004)
Sy
nth
es
is o
f Ev
ide
nc
e (c
on
t.)
! 7
0-1
00
% o
f he
ad
an
d n
eck c
an
ce
r pa
tien
ts
will e
xp
erie
nce
ora
l mu
co
sitis
(Eltin
g, e
t al., 2
007;
Murp
hy, 2
007)
! O
ral m
uco
sitis
is p
rob
lem
atic
an
d re
su
lts in
: d
ela
ye
d tre
atm
en
ts, re
du
ce
d tre
atm
en
t d
osa
ge
s, a
ltere
d n
utritio
n, d
eh
yd
ratio
n,
infe
ctio
ns, x
ero
sto
mia
, pa
in, a
nd
incre
ase
d
he
alth
ca
re c
osts
(Bro
wn &
Win
gard
, 2004; S
onis
, et a
l.,
2004)
Sy
nth
es
is o
f Ev
ide
nc
e (c
on
t.)
! P
atie
nts
rep
ort th
at o
ral m
uco
sitis
is th
e m
ost
dis
tressin
g s
ide
effe
ct fro
m c
an
ce
r trea
tme
nt
(Jaro
neski, 2
006)
! O
ral m
uco
sitis
co
sts
$1
,70
0-$
12
,60
0/p
atie
nt
(or h
igh
er) d
ep
en
din
g o
n th
e s
eve
rity (E
lting, e
t al., 2
007; J
ones, e
t al., 2
008; N
onsee, e
t al., 2
008)
! O
ral m
uco
sitis
po
ten
tially
incre
ase
s th
e ris
k
of a
loca
l an
d/o
r syste
mic
infe
ctio
n (E
ilers
, 2004;
Lalla
, et a
l., 2008; W
orth
ingto
n, e
t al., 2
007)
– T
he m
ost fre
quently
identifie
d s
ourc
e o
f sepsis
is th
e
mouth
, cre
atin
g u
nin
tended ris
k fo
r patie
nts
(van d
er
Veld
en, e
t al., 2
009)
Ch
oo
sin
g a
To
ol
! 4
tools
revie
wed:
– W
HO
tool (S
tokm
an, e
t al., 2
006; Q
uin
n, e
t al., 2
007)
– B
eck (B
eck, e
t al., 2
007)
– O
AG
(Eile
rs, 2
004; E
ilers
& E
pste
in, 2
004; E
ilers
, et a
l., 1988)
– N
CI (C
ella
, et a
l., 2003)
! E
valu
atio
n c
riteria
inclu
ded: re
pe
ata
bility
of
reassessm
ent; e
ase
of s
corin
g; s
ensitiv
ity to
chan
ges; e
vid
ence
-ba
sed; fe
asib
ility; re
liab
ility
and
valid
ity; a
nd
inclu
des o
bje
ctiv
e a
nd
sub
jectiv
e m
anife
sta
tions
To
ol S
ele
ctio
n
! E
ilers
Ora
l Assessm
ent G
uid
e (O
AG
) – B
est re
liability
and v
alid
ity
– W
idely
used in
clin
ical p
ractic
e
– F
easib
le
– S
ensitiv
e to
changes
! C
om
ponents
of th
e O
ral A
sse
ssm
ent G
uid
e
inclu
de: v
oic
e, s
wallo
w, lip
s, to
ng
ue
, saliv
a,
mucous m
em
bra
ne, g
ingiv
a, a
nd te
eth
or
dentu
res (E
ilers
, 2004; E
ilers
, et a
l., 1988)
Ad
ap
ted
Ora
l As
se
ss
me
nt G
uid
e
OR
AL A
SS
ES
SM
EN
T: O
NC
OLO
GY
U
nive
rsity of Io
wa H
osp
itals a
nd C
linics
Departm
ent o
f Nursin
g S
ervice
s and P
atie
nt C
are
Cate
go
ry V
oic
e/C
ry S
wa
llow
L
ips
T
on
gu
e
Sa
liva
M
uc
ou
s
Me
mb
ran
e
Gin
giv
a
Te
eth
Tools fo
r A
ssessm
ent
Aud
itory
Obse
rvatio
n
Obse
rvatio
n
Obse
rvatio
n
Obse
rvatio
n
Obse
rvatio
n
Obse
rvatio
n
Obse
rvatio
n
Meth
ods o
f M
easu
rem
ent
Con
verse
with
patie
nt
Ask p
atie
nt to
sw
allo
w
Obse
rve
appe
ara
nce
of
tissue
Obse
rve
appe
ara
nce
of
tissue
Visu
ally a
ssess
tong
ue a
nd
floor o
f the
mouth
for
secre
tions
Obse
rve tissu
e
appe
ara
nce
of
ora
l cavity
Visu
ally a
ssess
gin
giva
/tissue
of th
e u
pper
and lo
wer ja
ws
that su
rrou
nds
the b
ase
of th
e
teeth
(gum
s)
Obse
rve
appe
ara
nce
of
teeth
or
dentu
re
bearin
g a
rea
0
Norm
al o
r U
nab
le to
asse
ss
Norm
al o
r U
nab
le to
asse
ss
Sm
ooth
/pin
k/ m
oi st
Pin
k/moist
Norm
al
Pin
k/moist
Pin
k/firm
Cle
an/n
o
debris o
r Not
app
licab
le
1
Deep
er o
r ra
spy
Pain
/hard
to
swa
llow
D
ry or cra
cked
R
edn
ess;
Shin
y; Co
ate
d;
Patch
es; o
r S
wo
llen
Thick; R
op
y; or E
xcessive
R
ed; C
oate
d;
or P
atch
es
Edem
a w
ith o
r w
ithout
redness
Pla
qu
e o
r debris
betw
een te
eth
2
Pro
ble
m
talkin
g/p
ain
U
nab
le/se
vere
pain
U
lcers o
r ble
edin
g
Bliste
red/
cracke
d o
r S
wo
llen/
serra
ted
Abse
nt
Ulce
rs with
or
with
out
ble
edin
g
Ble
ed
ing
Genera
lized
pla
que o
r debris
Is Th
ere
a S
ufficien
t
Resea
rch
Base?
Assem
ble R
elevan
t Resea
rch &
Rela
ted L
iteratu
re
Critiq
ue &
Syn
thesize R
esearch
for U
se in P
ractice
Pilo
t the C
han
ge in
Pra
ctice
1. S
elect Ou
tcom
es to b
e Ach
ieved
2. C
ollect B
aselin
e Data
3. D
esign
Evid
ence-B
ased
Pra
ctice (EB
P) G
uid
eline(s)
4. Im
plem
ent E
BP
on
Pilo
t Un
its
5. E
valu
ate P
rocess &
Ou
tcom
es
6. M
od
ify th
e Pra
ctice Gu
idelin
e
Base P
ractice o
n O
ther
Typ
es of E
vid
ence
1. C
ase R
eports
2. E
xp
ert Op
inio
n
3. S
cientific P
rincip
les
4. T
heo
ry
Con
du
ct
Resea
rch
Yes
No
Th
e Iow
a M
od
el (con
tinu
ed)
Pilo
t
! A
du
lt Le
uke
mia
an
d B
on
e M
arro
w T
ran
sp
lan
t u
nit
! R
esu
lts (n
=2
3):
– 8
7%
had a
n a
bnorm
al a
ssessm
ent
– 6
5%
had a
change in
ora
l muco
sitis
(impro
ved o
r dete
riora
ting)
– A
bnorm
al fin
din
gs c
rossed a
ll va
riable
s w
ithin
the
scale
(e.g
., mucous m
em
bra
ne-8
3%
; to
ngue-6
7%
; saliv
a-5
0%
; lips-4
2%
; etc
.)
! S
ep
tem
be
r 20
06
Pilo
t (co
nt.)
! P
ilot d
ocu
me
nta
tion
– P
aper F
orm
! P
olic
y
! E
du
ca
tion
– In
-Serv
ices
– U
nit R
efe
rence B
inder
• Polic
y
• Researc
h a
rticle
s
• Educatio
nal m
ate
rial (P
ow
erP
oin
t™ P
resenta
tion)
Fre
qu
en
cy
of A
ss
es
sm
en
t
! In
pa
tien
t Un
its
– In
itial a
sse
ssm
ent
• Co
mp
lete
d b
y R
N/L
PN
with
in 2
4 h
ou
rs o
f a
dm
issio
n
– O
ngo
ing a
ssessm
en
t
• AT
LE
AS
T tw
ice
a d
ay a
nd
as n
ee
de
d
Fre
qu
en
cy
of A
ss
es
sm
en
t (co
nt.)
! A
mb
ula
tory
Ca
re
– O
nco
log
y p
atie
nts
will b
e s
cre
en
ed
for
pro
ble
ms w
ith th
e o
ral m
uco
sa
by a
nu
rsin
g
assis
tan
t or m
ed
ica
l assis
tan
t
• Pe
dia
tric S
pe
cia
lty C
linic
, Ra
dia
tion
On
co
log
y, O
tola
ryn
go
log
y C
linic
, & H
old
en
Co
mp
reh
en
siv
e
Ca
nce
r Ce
nte
r
– If a
pro
ble
m is
ide
ntifie
d w
ith th
e o
ral
mu
co
sa
, an
RN
/LP
N w
ill do
cu
me
nt a
full o
ral
asse
ssm
en
t
Kn
ow
led
ge
As
se
ss
me
nt: P
ilot U
nit
3.3
3.3
2.9
2.8
1.0
2.0
3.0
4.0
Feel k
no
wle
dg
ea
ble
Ab
le to
iden
tify a
t risk
pa
tien
ts
OA
G a
ccu
ra
tely
asse
sses p
t ch
an
ges
OA
G e
nh
an
ces q
ua
lity c
are
Stro
ng
ly
Ag
ree
Stro
ng
ly
Dis
ag
ree
Re
sp
on
se
Ra
te: 3
4.8
% (n
=8
/23
) M
ay 2
00
7
DO
NO
T R
EP
RO
DU
CE
WIT
HO
UT
PE
RM
ISS
ION
RE
QU
ES
TS
TO
:
Offic
es
of N
urs
ing
Re
se
arc
h a
nd
Ev
ide
nc
e-B
as
ed
Pra
ctic
e
Th
e U
niv
ers
ity o
f Iow
a H
os
pita
ls a
nd
Clin
ics
Io
wa
City
, IA 5
22
42
-10
09
Re
vis
ed
: Ap
ril 19
98
© U
IHC
Is Ch
an
ge
Ap
pro
pria
te
for
Ad
op
tion
in
Pra
ctice?
Con
tinu
e to E
valu
ate
Qu
ality
of C
are a
nd
New
Kn
ow
ledge
No
Yes
Institu
te the C
han
ge in
Pra
ctice
Mon
itor a
nd
An
aly
ze Stru
cture,
Pro
cess, an
d O
utco
me D
ata
- En
viro
nm
ent
- Sta
ff
- Cost
- Patien
t an
d F
am
ily
Dissem
inate R
esults
Title
r, M.G
., Kle
ibe
r, C., R
ak
el, B
., Bu
dre
au
, G., E
ve
rett, L
.Q., S
tee
lma
n, V
., Bu
ck
wa
lter, K
.C., T
ripp
Re
ime
r, T., &
Go
od
e, C
. (20
01
). Th
e Io
wa
Mo
de
l of E
vid
en
ce
-Ba
se
d P
rac
tice
to P
rom
ote
Qu
ality
Ca
re. C
ritica
l Ca
re N
urs
ing
Clin
ics
of N
orth
Am
eric
a, 1
3(4
):49
7-5
09
.
Th
e Iow
a M
od
el (con
tinu
ed)
Pro
jec
t Inte
gra
tion
! In
frastru
ctu
re lin
ks
–
Am
bula
tory
& In
patie
nt
Care
–
Adult &
Pedia
trics
–
Quality
Managem
ent
–
Pro
ducts
Com
mitte
e
–
Sta
ff Educatio
n C
om
mitte
e
–
Pro
fessio
nal N
urs
ing
Pra
ctic
e C
om
mitte
e (p
olic
y)
–
Patie
nt E
ducatio
n
Com
mitte
e
–
Info
rmatic
s
! U
nit a
ctiv
ities
–
Sta
ff Nurs
e In
volv
em
ent
–
Unit R
esourc
e M
anual
–
AP
N R
ole
–
NM
Com
mitm
ent
–
Com
mitte
e In
tranet S
ite
Po
licy &
Sta
ff Ed
uca
tion
Deve
lop
men
t
! P
olic
y
– A
ppro
ved b
y th
e P
rofe
ssio
nal N
urs
ing P
ractic
e
Com
mitte
e (S
ept. 2
007)
! S
taff E
ducatio
n
– A
ppro
ved b
y th
e S
taff E
ducatio
n C
om
mitte
e (S
ept.
2007)
! In
form
atic
s
– U
pdate
d d
ocum
enta
tion s
yste
ms (In
patie
nt u
nits
, IC
Us, a
nd A
mbula
tory
are
as)
– N
ew
ele
ctro
nic
docum
enta
tion s
yste
m (M
ay 2
009)
DO
NO
T R
EP
RO
DU
CE
WIT
HO
UT
PE
RM
ISS
ION
RE
QU
ES
TS
TO
:
Offic
es
of N
urs
ing
Re
se
arc
h a
nd
Ev
ide
nc
e-B
as
ed
Pra
ctic
e
Th
e U
niv
ers
ity o
f Iow
a H
os
pita
ls a
nd
Clin
ics
Io
wa
City
, IA 5
22
42
-10
09
Re
vis
ed
: Ap
ril 19
98
© U
IHC
Is Ch
an
ge
Ap
pro
pria
te
for
Ad
op
tion
in
Pra
ctice?
Con
tinu
e to E
valu
ate
Qu
ality
of C
are a
nd
New
Kn
ow
ledge
No
Yes
Institu
te the C
han
ge in
Pra
ctice
Mon
itor a
nd
An
aly
ze Stru
cture,
Pro
cess, an
d O
utco
me D
ata
- En
viro
nm
ent
- Sta
ff
- Cost
- Patien
t an
d F
am
ily
Dissem
inate R
esults
Title
r, M.G
., Kle
ibe
r, C., R
ak
el, B
., Bu
dre
au
, G., E
ve
rett, L
.Q., S
tee
lma
n, V
., Bu
ck
wa
lter, K
.C., T
ripp
Re
ime
r, T., &
Go
od
e, C
. (20
01
). Th
e Io
wa
Mo
de
l of E
vid
en
ce
-Ba
se
d P
rac
tice
to P
rom
ote
Qu
ality
Ca
re. C
ritica
l Ca
re N
urs
ing
Clin
ics
of N
orth
Am
eric
a, 1
3(4
):49
7-5
09
.
Th
e Iow
a M
od
el (con
tinu
ed)
Imp
lem
en
tatio
n
! O
cto
be
r 20
07
– S
ite v
isit b
y J
un
e E
ilers
, Ph
D, A
PR
N-B
C
– P
ow
erP
oin
t™ p
rese
nta
tion
on
ho
sp
ital
co
mp
ute
r ed
uca
tion
syste
m
– L
ive
in-s
erv
ice
s
– C
rea
tive
pro
mp
t
– T
ea
m lo
go
D
O N
OT
RE
PR
OD
UC
E W
ITH
OU
T P
ER
MIS
SIO
N
RE
QU
ES
TS
TO
:
Offic
es
of N
urs
ing
Re
se
arc
h a
nd
Ev
ide
nc
e-B
as
ed
Pra
ctic
e
Th
e U
niv
ers
ity o
f Iow
a H
os
pita
ls a
nd
Clin
ics
Io
wa
City
, IA 5
22
42
-10
09
Re
vis
ed
: Ap
ril 19
98
© U
IHC
Is Ch
an
ge
Ap
pro
pria
te
for
Ad
op
tion
in
Pra
ctice?
Con
tinu
e to E
valu
ate
Qu
ality
of C
are a
nd
New
Kn
ow
ledge
No
Yes
Institu
te the C
han
ge in
Pra
ctice
Mon
itor a
nd
An
aly
ze Stru
cture,
Pro
cess, an
d O
utco
me D
ata
- En
viro
nm
ent
- Sta
ff
- Cost
- Patien
t an
d F
am
ily
Dissem
inate R
esults
Title
r, M.G
., Kle
ibe
r, C., R
ak
el, B
., Bu
dre
au
, G., E
ve
rett, L
.Q., S
tee
lma
n, V
., Bu
ck
wa
lter, K
.C., T
ripp
Re
ime
r, T., &
Go
od
e, C
. (20
01
). Th
e Io
wa
Mo
de
l of E
vid
en
ce
-Ba
se
d P
rac
tice
to P
rom
ote
Qu
ality
Ca
re. C
ritica
l Ca
re N
urs
ing
Clin
ics
of N
orth
Am
eric
a, 1
3(4
):49
7-5
09
.
Th
e Iow
a M
od
el (con
tinu
ed)
Evalu
atio
n o
f As
se
ss
men
t Inte
gra
tion
! J
uly
20
08
– C
om
ple
ted o
ral m
ucositis
assessm
ents
: • 8
7%
acro
ss th
e n
urs
ing d
epartm
ent
• 100%
of a
dult a
nd p
edia
tric in
patie
nts
• Sele
cte
d a
mbula
tory
clin
ics o
ffer th
e g
reate
st
opportu
nity
for im
pro
vem
ent
– A
dult a
nd p
edia
tric B
MT
patie
nts
• 9
7%
develo
ped o
ral m
ucositis
– 7
1%
of p
edia
tric o
ncolo
gy in
patie
nts
had n
orm
al
ora
l assessm
ents
On
go
ing
Ev
alu
atio
n: In
pa
tien
t Un
its
0%
20%
40%
60%
80%
100%
Jul-08A
ug-09M
ay-10A
ug-10M
ar-11Jul-11
Feb-12M
ay-12
Oral A
ssessment A
verage
DO
NO
T R
EP
RO
DU
CE
WIT
HO
UT
PE
RM
ISS
ION
RE
QU
ES
TS
TO
:
Offic
es
of N
urs
ing
Re
se
arc
h a
nd
Ev
ide
nc
e-B
as
ed
Pra
ctic
e
Th
e U
niv
ers
ity o
f Iow
a H
os
pita
ls a
nd
Clin
ics
Io
wa
City
, IA 5
22
42
-10
09
Re
vis
ed
: Ap
ril 19
98
© U
IHC
Is Ch
an
ge
Ap
pro
pria
te
for
Ad
op
tion
in
Pra
ctice?
Con
tinu
e to E
valu
ate
Qu
ality
of C
are a
nd
New
Kn
ow
ledge
No
Yes
Institu
te the C
han
ge in
Pra
ctice
Mon
itor a
nd
An
aly
ze Stru
cture,
Pro
cess, an
d O
utco
me D
ata
- En
viro
nm
ent
- Sta
ff
- Cost
- Patien
t an
d F
am
ily
Dissem
inate R
esults
Title
r, M.G
., Kle
ibe
r, C., R
ak
el, B
., Bu
dre
au
, G., E
ve
rett, L
.Q., S
tee
lma
n, V
., Bu
ck
wa
lter, K
.C., T
ripp
Re
ime
r, T., &
Go
od
e, C
. (20
01
). Th
e Io
wa
Mo
de
l of E
vid
en
ce
-Ba
se
d P
rac
tice
to P
rom
ote
Qu
ality
Ca
re. C
ritica
l Ca
re N
urs
ing
Clin
ics
of N
orth
Am
eric
a, 1
3(4
):49
7-5
09
.
Th
e Iow
a M
od
el (con
tinu
ed)
Dis
se
min
atio
n
! O
ral P
resenta
tion
s
– In
tern
al
– E
xte
rnal
! P
oste
r Pre
senta
tions
– In
tern
al
– E
xte
rnal
! P
ublic
atio
n
– F
arrin
gto
n, M
., Culle
n, L
., & D
aw
son, C
. (2010).
Assessm
ent o
f ora
l mucositis
in a
dult a
nd p
edia
tric
oncolo
gy p
atie
nts
: An e
vid
ence-b
ased a
ppro
ach.
OR
L –
Head a
nd N
eck N
urs
ing, 2
8(3
), 8-1
5.
Co
nc
lus
ion
! O
ral m
uco
sitis
is a
freq
ue
nt c
om
plic
atio
n
of c
an
ce
r trea
tme
nt
! E
vid
en
ce
-ba
se
d o
ral h
ea
lth a
sse
ssm
en
t is
the
first s
tep
in a
co
mp
reh
en
siv
e
pro
gra
m w
ith p
reve
ntio
n a
nd
trea
tme
nt
DO
NO
T R
EP
RO
DU
CE
WIT
HO
UT
PE
RM
ISS
ION
RE
QU
ES
TS
TO
:
Offic
es
of N
urs
ing
Re
se
arc
h a
nd
Ev
ide
nc
e-B
as
ed
Pra
ctic
e
Th
e U
niv
ers
ity o
f Iow
a H
os
pita
ls a
nd
Clin
ics
Io
wa
City
, IA 5
22
42
-10
09
Re
vis
ed
: Ap
ril 19
98
© U
IHC
Is Ch
an
ge
Ap
pro
pria
te
for
Ad
op
tion
in
Pra
ctice?
Con
tinu
e to E
valu
ate
Qu
ality
of C
are a
nd
New
Kn
ow
ledge
No
Yes
Institu
te the C
han
ge in
Pra
ctice
Mon
itor a
nd
An
aly
ze Stru
cture,
Pro
cess, an
d O
utco
me D
ata
- En
viro
nm
ent
- Sta
ff
- Cost
- Patien
t an
d F
am
ily
Dissem
inate R
esults
Title
r, M.G
., Kle
ibe
r, C., R
ak
el, B
., Bu
dre
au
, G., E
ve
rett, L
.Q., S
tee
lma
n, V
., Bu
ck
wa
lter, K
.C., T
ripp
Re
ime
r, T., &
Go
od
e, C
. (20
01
). Th
e Io
wa
Mo
de
l of E
vid
en
ce
-Ba
se
d P
rac
tice
to P
rom
ote
Qu
ality
Ca
re. C
ritica
l Ca
re N
urs
ing
Clin
ics
of N
orth
Am
eric
a, 1
3(4
):49
7-5
09
.
Th
e Iow
a M
od
el (con
tinu
ed)
Ph
as
e 2
: Ora
l Ca
re
Pu
rpo
se
: Ora
l Ca
re
! P
rom
ote
ora
l he
alth
an
d m
inim
ize
the
ris
k o
f de
ve
lop
ing
ora
l mu
co
sitis
for
on
co
log
y p
atie
nts
in th
e in
pa
tien
t an
d
am
bu
lato
ry c
are
se
tting
s
Sy
nth
es
is o
f Ev
ide
nc
e
! E
ffectiv
e s
trate
gie
s a
re a
va
ilab
le to
pre
ve
nt
ora
l mu
co
sitis
(MA
SC
C; O
NS
; Worth
ingto
n, e
t al., 2
007)
an
d tre
at o
ral m
uco
sitis
(Cla
rkson, e
t al., 2
007; M
AS
CC
;
ON
S)
– C
ryoth
era
py fo
r 5-F
luoro
ura
cil, M
elp
hala
n, a
nd
Edatre
xate
(Keefe
, et a
l., 2007; M
ori, e
t al., 2
006;
Worth
ingto
n, e
t al., 2
011
)
– O
ral c
are
/rinses (B
rennan, e
t al., 2
010; G
lenny, e
t al., 2
010;
Harris
, et a
l., 2009; H
ogan, 2
009; J
oshi, 2
010; K
eefe
, et a
l., 2007; L
alla
, et a
l., 2008; M
eurm
an &
Grö
nro
os, 2
010; P
ete
rson,
et a
l., 2008; S
iera
cki, e
t al., 2
009; S
onis
, 2011
)
Sy
nth
es
is o
f Ev
ide
nc
e (c
on
t.)
! C
linic
ian
s k
no
wle
dg
e o
f evid
en
ce
-ba
se
d
ora
l ca
re is
limite
d (B
ark
er, e
t al., 2
005; B
inkle
y, et a
l.,
2004; P
ottin
g, e
t al., 2
008)
! N
urs
es s
kill w
ith o
ral c
are
ne
ed
s
imp
rove
me
nt (P
ottin
g, e
t al., 2
008)
Pa
tien
t/Fa
mily
Ed
uc
atio
n
! E
va
lua
te p
atie
nt a
nd
/or fa
mily
s c
urre
nt
ora
l ca
re p
ractic
es
– F
req
ue
ncy
– P
rod
ucts
– B
rush
, Flo
ss, a
nd
/or R
inse
! D
iscu
ss p
atie
nt a
nd
fam
ilys b
arrie
rs to
g
oo
d o
ral h
ea
lth
– C
ost o
f Pro
du
cts
Pa
tien
t/Fa
mily
Ed
uc
atio
n (c
on
t.)
! E
du
ca
tion
Po
ints
: – Im
po
rtance o
f go
od o
ral c
are
– C
orre
ct te
ch
niq
ue
• M
ost c
ritica
l ele
me
nt w
he
n b
rush
ing
– O
ral c
are
pro
ducts
! R
atio
na
le:
– N
ee
d to
rem
ove
foo
d d
eb
ris a
nd
pla
que
• He
lp d
ecre
ase
the
risk o
f ora
l mu
co
sitis
an
d
syste
mic
infe
ctio
n
Pa
tien
t/Fa
mily
Ed
uc
atio
n (c
on
t.) B
rus
hin
g
! S
oft to
oth
bru
sh
es
! B
iote
ne
® too
thp
aste
! B
rush
twic
e d
aily
– E
ven b
abie
s (u
se m
ois
t gauze u
ntil 1
st to
oth
eru
pts
, then u
se to
oth
bru
sh)
! B
rush
for 2
min
ute
s u
sin
g a
ge
ntle
rota
ting
/circ
ula
r mo
tion
! H
old
too
thb
rush
at a
45° a
ngle
to th
e to
oth
su
rface
Bru
sh
ing
(co
nt.)
! R
inse
the
too
thb
rush
with
wa
rm w
ate
r un
til b
ristle
s a
re c
lea
n a
fter e
ach
use
! A
llow
too
thb
rush
to a
ir dry
be
twe
en
use
s
! P
lace
too
thb
rush
with
bris
tles u
p
! O
nly
ca
p to
oth
bru
sh
brie
fly d
urin
g tra
ve
l – C
overe
d/c
apped to
oth
bru
shes p
rom
ote
mic
robia
l gro
wth
! H
ave
pa
tien
ts k
ee
p th
eir to
oth
bru
sh
ou
t of
the
ba
thro
om
wh
en
ho
sp
italiz
ed
Bru
sh
ing
(co
nt.)
! R
ep
lace
too
thb
rush
es e
ve
ry 3
mo
nth
s o
r w
he
n b
ristle
s a
re w
orn
! O
nly
a p
ea
-siz
e a
mo
un
t of to
oth
pa
ste
(or
sm
alle
r) is n
ee
de
d
– P
atie
nts
who a
re u
nable
to s
pit m
ay s
till use
to
oth
paste
with
fluorid
e d
ue to
the
ir hig
he
r risk o
f carie
s a
nd d
enta
l pro
ble
ms
! D
isco
ura
ge
use
of to
oth
ette
s
– D
o n
ot a
dequate
ly re
move b
acte
rial p
laque
Lip
Care
! L
anolin
(Lansin
oh
®) pro
ducts
for lip
care
– D
o n
ot u
se in
patie
nts
alle
rgic
to la
nolin
– M
ay b
e u
sed fo
r patie
nts
of a
ll ages
– M
ust b
e re
moved b
efo
re ra
dia
tion
! L
ip c
are
should
be c
om
ple
ted
twic
e a
day a
nd P
RN
! D
iscoura
ge u
se o
f Chap
stix
®, petro
latu
m-b
ased
pro
ducts
, and p
lain
KY
jelly
® – O
cclu
siv
e lip
balm
s fa
il to m
ois
turiz
e a
nd c
an
pote
ntia
lly p
rom
ote
bacte
rial g
row
th
Flo
ssin
g
! E
nco
ura
ge
da
ily flo
ssin
g
! W
axe
d flo
ss
– S
lides m
ore
easily
– L
ess lik
ely
to d
am
age s
oft tis
sue
! A
vo
id flo
ss a
ids w
ith h
an
dle
s
– In
cre
ased ris
k o
f causin
g m
ucosal in
jury
! P
reca
utio
ns m
ay b
e in
pla
ce
for p
late
let
co
un
t <5
0,0
00
or W
BC
<1
.0
– A
void
any a
reas w
ith b
leedin
g o
r that a
re s
ore
Ora
l Rin
ses
! S
ho
uld
be in
itiate
d w
hen
the
ora
l mu
cosa
first
sta
rts to
becom
e in
flam
ed
! O
ptio
ns:
– S
alt a
nd S
oda
– S
alt W
ate
r
– P
lain
Wate
r
! R
inse 4
times/d
ay
– R
inse fo
r 15-3
0 s
econds b
efo
re s
pittin
g o
ut th
e
solu
tion
! A
void
mouth
washes th
at c
on
tain
alc
oh
ol
(inclu
din
g C
hlo
rhexid
ine)
conds b
efo
rpittin
g o
Ora
l Rin
se
s (c
on
t.)
! O
ral rin
sin
g d
ecre
ase
s e
ryth
em
a a
nd
im
pro
ve
s o
ral h
ea
lth b
y:
– C
lea
nsin
g a
nd
lub
rica
ting tis
su
es
– P
reve
ntin
g c
rustin
g
– T
rea
ting
mucosa
l wou
nds
– H
yd
ratin
g a
nd irrig
atin
g m
uco
sal tis
sue
s
– S
oo
thin
g s
ore
gin
giv
a a
nd
mucosa
– R
em
ovin
g d
ebris
– P
reve
ntin
g a
ccum
ula
tion
of d
ebris
an
d
bacte
ria
Die
tary
/He
alth
Co
ns
ide
ratio
ns
! C
on
sid
er a
refe
rral to
die
tary
(if ap
plic
ab
le)
• Choose s
oft, e
asy-to
-chew
foods
• Avoid
foods w
ith s
harp
edges
• Avoid
foods th
at a
re to
o h
ot
• Avoid
foods th
at a
re v
ery
spic
y o
r sour
• Avoid
sugary
foods/d
rinks
• Avoid
foods th
at w
ill stic
k to
teeth
• Avoid
alc
ohol
! A
vo
id s
mo
kin
g
Alg
orith
m: O
ral C
are
Co
nc
ep
ts
Ye
s
No
Is o
ral
ass
ess
me
nt
no
rma
l?
No
Normal o
ral m
uco
sa
and
no
rmal/s
ligh
tly dry lip
s
Ye
s
Adm
inis
ter
cryo
the
rap
y3
0 m
in p
rior,
durin
g in
fusio
n,
and
30
min
a
fter in
fusio
n
as to
lera
ted
Do
cu
me
nt
Abnormal o
ral m
uco
sa a
nd
/or d
ry,
cra
cke
d, a
bno
rmal lip
s
Co
mp
lete
ora
l rinses
at le
ast Q
ID
Do
cu
me
nt
Ch
oose
rinse
base
d o
n p
atie
nt
pre
fere
nce
an
dto
lera
nce
Are
lips
dry o
rcra
cke
d?
No
App
ly L
an
olin
top
ica
lo
intm
en
t(L
ansin
oh
®)
at le
ast B
ID
Ye
s
Flo
ss
No
No
Ye
s
Ye
s
Ye
s
Assis
t with
flossin
g a
t lea
st d
aily
Patie
nt
sh
ou
ldN
OT
floss
Ha
s p
atie
nt
flosse
db
efo
re?
Do
cu
me
nt
Are
Pla
tele
ts>
50
K a
nd
WB
C>
1.0
?
Sore
s o
rb
leed
ing
pre
sen
t?
On
ad
mis
sio
n fo
r AL
L a
du
lt an
d p
ed
iatric
on
co
log
y p
atie
nts
Assess a
nd
do
cum
en
t Ora
l Asse
ssm
ent: O
ncolo
gy
Co
mp
lete
an
d d
oc
um
en
t Ora
l Ass
ess
me
nt: O
nc
olo
gy a
t lea
st B
ID
Ora
l Ca
re a
t lea
st B
ID
Ye
s
No
Cle
an
gu
ms
with
mo
iste
ne
dg
au
ze
(no
tooth
ette
)
Do
cu
me
nt
Do
cu
me
nt
Use
soft
too
thb
rush a
nd
Bio
ten
e®
too
thp
aste
Do
es
patie
nt
have
tee
th?
Lip
Care
at le
ast B
ID
Co
mp
lete
an
d d
oc
um
en
t AL
L in
terv
en
tion
s o
n L
eft
AN
D a
dd
Ora
l Rin
se
s Q
ID (a
fter O
ral C
are
/Flo
ss)
Beg
in w
ith s
alt
and
sod
a (N
eil M
ed®
sin
us rin
se p
acke
t);
If NO
T to
lera
ted
, try
one
of th
e fo
llow
ing
: O
raM
agic R
x, p
lain
wa
ter
or s
alt w
ate
r
Is p
atie
nt
rece
ivin
gM
elp
hala
n o
rF
luo
roura
cil
over <
30
min
?
Cryo
thera
py
NO
T n
ee
de
d
App
ly L
an
olin
or
CU
RA
D®
Petro
leu
m-
Fre
e lip
b
alm
at
lea
st B
ID
Do
cu
me
nt
Ne
w P
rod
uc
ts/C
os
t Sa
vin
gs
! P
ed
iatric
an
d a
du
lt so
ft too
thb
rush
es
– O
ld p
rod
ucts
rare
ly u
se
d a
nd
ha
d c
ove
rs
! W
axe
d flo
ss
! C
ha
ng
ing
too
thb
rush
es, flo
ss, a
nd
d
ecre
asin
g th
e u
se
of to
oth
ette
s p
rovid
ed
4.4
% s
avin
gs o
r ap
pro
xim
ate
ly $
90
0 fo
r 2
00
9
Po
licy &
Sta
ff Ed
ucatio
n D
ev
elo
pm
en
t
! P
olic
y
– A
ppro
ved b
y th
e P
rofe
ssio
nal N
urs
ing P
ractic
e
Com
mitte
e (S
prin
g 2
009)
! S
taff E
ducatio
n
– A
ppro
ved b
y th
e S
taff E
ducatio
n C
om
mitte
e (S
prin
g
2009)
! In
form
atic
s
– U
pdate
d e
lectro
nic
docum
enta
tion s
yste
m (J
anuary
2010, M
arc
h 2
012, a
nd J
une 2
012)
Imp
lem
en
tatio
n
! J
un
e 2
00
9
– P
ow
erP
oin
t™ p
rese
nta
tion
on
ho
sp
ital
co
mp
ute
r ed
uca
tion
syste
m
– L
ive
in-s
erv
ice
s
Ora
l Ca
re K
its
! F
un
din
g S
ou
rce
s
– A
dults
• D
AIS
Y G
rant
• Volu
nte
er S
erv
ices
– P
edia
trics
• Aim
ing fo
r a C
ure
Foundatio
n
• Univ
ers
ity o
f Iow
a D
ance M
ara
thon
Nu
rsin
g K
no
wle
dg
e A
ss
es
sm
en
t
! S
ep
tem
ber 2
009
! D
evelo
ped b
y O
ral M
uco
sitis
Co
mm
ittee
! D
issem
inate
d th
rou
gh
Web
Surv
eyor
! C
om
ple
ted b
y 11
6 n
urs
es
! D
esig
ned to
obta
in fe
edb
ack re
gard
ing a
reas fo
r additio
nal e
ducatio
n
Nu
rsin
g K
no
wle
dg
e A
ss
es
sm
en
t (co
nt.)
55%
100%
97%
56%
62%
46%
52%
52%
0%
20%
40%
60%
80%
100%
Ora
l A
sse
ssm
en
t B
ID
So
ft To
oth
bru
sh
B
iote
ne
To
oth
pa
ste
F
loss D
aily
W
axe
d F
loss
Lip
Ca
re B
ID
La
no
lin fo
r Lip
C
are
S
alt a
nd
So
da
R
inse
s
Percent
On
go
ing
Ev
alu
atio
n: In
pa
tien
t Un
its
0%
20
%
40
%
60
%
80
%
10
0%
Ma
r-10
A
ug
-10
M
ar-11
J
ul-11
F
eb
-12
M
ay
-12
Ora
l Care
Avera
ge
Ne
xt S
tep
s
! C
on
tinu
e c
ha
rt au
dits
on
at le
ast a
q
ua
rterly
ba
sis
to e
va
lua
te
do
cu
me
nta
tion
co
mp
lian
ce
! C
on
tinu
e to
rece
ive
fee
db
ack fro
m
ph
arm
acy re
ga
rdin
g o
rde
ring
of la
no
lin
an
d/o
r sa
lt an
d s
od
a rin
se
s o
n a
pp
lica
ble
un
its
! In
co
rpo
rate
the
po
licy in
the
ICU
s
! M
an
uscrip
t pu
blic
atio
n
Co
nc
lus
ion
! G
ive
n p
atie
nt d
isco
mfo
rt an
d c
ost o
f ora
l m
uco
sitis
, pre
ve
ntio
n is
pa
rticu
larly
im
po
rtan
t an
d m
ust s
tart w
ith e
vid
en
ce
-b
ase
d o
ral c
are
pra
ctic
es
Qu
es
tion
s
mic
he
le-fa
rring
ton
@u
iow
a.e
du
