By: Debbie Turner, Director, Quality and Professional Practice, St. Thomas Elgin General Hospital
St. Thomas Elgin General Hospital (STEGH) supports approximately 700 to 800 births each year. The Women and Children’s Unit (W&C) is currently one of the few clinical areas within the hospital that continues to rely primarily on paper-based documentation for patient care. While migration to the electronic obstetrical module is anticipated in the coming years, Clinical Educators have been working alongside W&C staff to increase the use of available electronic documentation in the interim. This includes documentation of vital signs, intake, and output within the existing Cerner platform.
W&C staff deliver high-quality, evidence-informed care guided by several clinical algorithms that support assessment, decision-making, and treatment. Historically, these tools have existed within a paper-based environment. Recognizing an opportunity to enhance workflow and strengthen alignment between clinical practice and electronic documentation, the Clinical Educator team partnered with Clinical Informatics and W&C nursing leadership to embed these established algorithms into existing order sets, referred to as PowerPlans, within Cerner.
Continuous quality improvement is strongly embedded in STEGH’s culture. Although this initiative progressed with minimal technical barriers, organizations considering a similar approach may benefit from early application of change management principles. This includes engaging appropriate stakeholders throughout the development process, clearly communicating the rationale for change, and involving end users to support adoption and long-term sustainability.
Over several months, a working group comprised of Clinical Educators, Clinical Informatics specialists, W&C clinical nurses, and unit leadership met regularly to review PowerPlan content currently in use across other health care organizations and to draft an enhanced primary admission PowerPlan. Through this process, the team also identified an opportunity to develop two additional subplans to further streamline workflow. W&C team members served as subject matter experts, contributing best practice guidance throughout development.
Clinical Informatics led the technical design and build within the test environment, while Clinical Educators ensured alignment with professional practice standards, policy requirements, and regulatory expectations. An equity lens was also applied to identify evidence-based practices that were not currently reflected in STEGH’s existing PowerPlans and to guide the introduction of necessary enhancements. Reviewing comparable PowerPlans from peer organizations proved valuable, allowing the team to incorporate leading practices while maintaining flexibility for physician-informed customization.
The outcome of this interdisciplinary collaboration is a comprehensive “Well Baby” admission PowerPlan, supported by two subplans addressing hypoglycemia and hyperbilirubinemia at birth. Previously paper-based decision trees, routine and timed laboratory investigations, and other treatments requiring provider orders are now consolidated within a single, easily accessible electronic plan.
Integrating these clinical reference points into one location has enabled the organization to retire several legacy policies, clinical practice guidelines, and paper-based tools. This has reduced the risk of outdated reference materials in clinical areas, ensured practice activities are consistently supported by appropriate provider orders, and decreased the administrative burden associated with ongoing policy review.
Building on this success, the same working group is currently developing a Neonatal Intensive Care Unit admission PowerPlan with the goal of creating a similarly comprehensive electronic tool to support nursing practice, quality-based procedures, and the delivery of safe patient care.