Learning Objective #1: The learner will be able to identify the advantages of using an online documentation system in a Labor & Delivery setting.

Learning Objective #2: The learner will be able to identify the challenges associated with change when implementing an online documentation system.

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The Computerized Patient Record (CPR) is fast becoming a high-tech addition to many Labor & Delivery units. Interfacing with fetal monitoring technology the CPR has the capacity to provide surveillance of fetal heart rate tracings, archival on CD-ROM, a complete online documentation system including direct notation on the fetal heart rate tracings and an online documentation package that is configurable for all Maternal/Child Health areas. The institution purchased the QS product in 2001 and the surveillance option was implemented immediately. By the winter of 2003 it was clear that the system had been underutilized. A project plan was designed and a multidisciplinary team organized and then charged with implementation of the archival feature and the QS online documentation system. In a time of strict resource management it was necessary to define the benefits as a rationale for the time to be invested. Benefits of CPR implementation included: improved documentation and compliance with clinical guidelines, increased nurse to patient contact, support decision analysis, identification of outcome measures resulting in MCH system improvement and the incorporation of patient education materials and clinical pathways into the CPR. These benefits became the team's goals but were not without associated challenges including allocation of both personnel and financial resources, orientation and ongoing support (24/7) for nursing staff during implementation of the new documentation model, consideration for staff stress during the change process and the challenge of providing high quality patient care throughout implementation of the practice change. Evaluation tools were developed and used throughout to determine the projects successes and challenges. Celebrations of successes and meeting the uncovered challenges became goals for the future.