Fairview Lakes Medical Center

There is wide recognition that, with the rapid implementation of electronic health records (EHRs), large data sets are available for research. However, essential standardized nursing data are seldom integrated into EHRs and clinical data repositories. There are many diverse activities that exist to implement standardized nursing languages in EHRs; however, these activities are not coordinated, resulting in duplicate efforts rather than building a shared learning environment and resources. The purpose of this paper is to describe the historical context of nursing terminologies, challenges to the use of nursing data for purposes other than documentation of care, and a national action plan for implementing and using sharable and comparable nursing data for quality reporting and translational research. In 2013 and 2014, the University of Minnesota School of Nursing hosted a diverse group of nurses to participate in the Nursing Knowledge: Big Data and Science to Transform Health Care consensus conferences. This consensus conference was held to develop a national action plan and harmonize existing and new efforts of multiple individuals and organizations to expedite integration of standardized nursing data within EHRs and ensure their availability in clinical data repositories for secondary use. This harmonization will address the implementation of standardized nursing terminologies and subsequent access to and use of clinical nursing data. Foundational to integrating nursing data into clinical data repositories for big data and science, is the implementation of standardized nursing terminologies, common data models, and information structures within EHRs. The 2014 National Action Plan for Sharable and Comparable Nursing Data for Transforming Health and Healthcare builds on and leverages existing, but separate long standing efforts of many individuals and organizations. The plan is action focused, with accountability for coordinating and tracking progress designated.

1267 HISTORY: A 24-year old male presented to the office with progressive wax/waning severe knee pain associated with effusions for 4 weeks. He denied any acute injury or increase of his usual activities of jogging and weight training. He had a past medical history significant for a torn medial meniscus in the same knee 2 years ago confirmed by MRI, which subsided without invasive intervention. He felt that his symptoms at present were reminiscent of those associated with his prior injury. He denied locking or buckling, but admitted to difficulty pivoting in certain directions, and also admitted to pain with full weight-bearing. He denied systemic symptoms. PHYSICAL EXAMINATION: Patient walked in with a noticeable limp, but was able to fully bear weight. Patient's knee was warm and swollen, with a significant joint effusion. The skin is slightly wam, without erythema. range of motion severely limited in both flexion and extension, with knee held at 45 degrees. There was no obvious deformity. The knee was globally tender without definitive joint line tenderness. There was no patellar apprehension or associated tenderness upon gentle manipulation. Lachman, McMurray's, anterior and posterior drawer tests were limited secondary to patient discomfort, with no positive findings. Likewise, there was no appreciable laxity with valgus and varus stress (also limited). Under sterile conditions the knee joint was aspirated, yielding 37 cc. of cloudy serous fluid, with partial resolution of the patient's symptoms. DIFFERENTIAL DIAGNOSIS: Reexacerbation of medial meniscus tear Other internal derangement Septic arthritis TEST AND RESULTS: Joint aspiration-cloudy serous synovial fluid. CBC- Largely WNL Comprehensive metabolic panel, including uric acid- WNL Synovial Fluid Cell Count: WBC 13900 cells/mm-3 RBC 2200 cells/mm-3 Polys 50% Lymph 14% No crystals Glucose 51 mg/dl Protein 4.2 g/dl Fluid culture- No aerobic or anaerobic growth Lyme Western Blot of Fluid: Positive for IgM and IgG FINAL WORKING DIAGNOSIS: Lyme disease TREATMENT AND OUTCOMES: Patient was placed on Doxycycline 100 mg BID for a thirty day course, along with Ibuprofen 800 mg TID, and sent to orthopaedics for further evaluation. Patient was initially with assisted weight bearing, progress as tolerated. The patient subsequently had complete resolution of his symptoms after his course of antibiotics. Complete follow-up pending.