Download Pregnancy Summary Detailed

PowerChart Maternity: Pregnancy Summary Page
The Pregnancy Summary Page is an interactive page that displays patient specific information
related to an active pregnancy. This information has been pulled from previously charted data in
various locations in PowerChart. You can also add information, and can easily navigate to other
PowerChart locations by clicking links on this page.
The following instructions will describe how to view information on the page, how to add information,
and how to navigate throughout the chart from the page.
Table of Contents:
Instructions
 Pregnancy Summary Page: Navigation To
 Add the current pregnancy & Add EDD
 Appearance of Pregnancy Summary Page
o Sections
o Links
• Overview
 Labor Flowsheet/Labor Graph
 Vital Signs/Labor Graph
 Results Timeline
 Delivery Summary
 Risk Factors
 Stages of Labor
 Pregnancy History
 Birth Plan
 Education and Counseling
 Procedure History
 Documents
 Fetal Monitoring-Archived Strips
 Labs
 Microbiology
 Intake/Output
 Consolidated Problems
 Home Medications
 Medications
 Immunizations
 Lines/Tubes/Drains
 EDD Maintenance
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PowerChart Maternity: Pregnancy Summary Page
Pregnancy Summary Page: Navigation To
There are a couple ways to open the Pregnancy Summary Page:
1. From the tracking shell, double click on the patient indicator to open the patient’s
chart. The Pregnancy Summary will open as your default view.
2. Click the Pregnancy Summary icon from the toolbar,
click MPages then Pregnancy Summary.
If the patient does not yet have a pregnancy opened, this page will appear blank and will display the notice
There are currently no active pregnancies for this patient. You must document confirmation of pregnancy
to open a pregnancy so that information will display on the Pregnancy Summary Page.
Add the current pregnancy
Add Pregnancy
All patients must have a Pregnancy Added through the Pregnancy Summary tab. It is recommended to do this
prior to any documentation.
1. Click Add Pregnancy
2. The Add Pregnancy window opens. The Onset date is used to document the date of onset of pregnancy.
Enter the date that incorporates the entire pregnancy like the LMP date, if known. This date is used to set the
starting point or ‘bookend’ for all visits to be included in this pregnancy.

Number of Gestations=Number of Baby Labels. This selection will automatically create the Baby A in Interactive
View.
 Note: Once the label is created any change must be made in IView.
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3. Adding EDD/EGA-click the drop down arrow to select Method: LMP or Unknown.
o Once entered, the LMP will auto-populate the EDD and EGA fields.
o When Unknown is selected, nurse will need to enter the EDD which will calculate the EGA.

EDD/EGA by Unknown-select unknown if LMP or ultrasound results are not available. Enter EDD.

EDD/EGA by Ultrasound
o Method, select Ultrasound.
o Date of Method, enter date of ultrasound.
o Enter EGA by ultrasound results.
o The Current EGA will be auto-calculated.
4. Overview of fields:
 Method-Click drop down to click selection. Additional fields will become required, depending on
Method selected. EDD will be calculated when the required fields are completed. See examples
below.


Date of Method-required field
Confirmation-defaults to Confirmed. Do not change.
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


EGA-enter weeks and days (only for ultrasound others will auto populate.)
EDD-will automatically populate when other fields are completed
o Exception-when Unknown is selected as Method, you must enter EDD.
Comments-type, as needed
Description-will change depending on type of Method chosen. Entry not required.
If Final is selected, no new estimates will be allowed for this pregnancy. Do NOT select Final.
o If Final is selected, modify the Final method to remove the checkmark.
Click OK

Pregnancy is listed as an Active Problem on the patient’s Problem List.



Do Not click Add Problem and
Diagnosis, as this will add the
Pregnancy as a Diagnosis as well.
5. You are returned to the Pregnancy Summary Page, which now displays the Active Pregnancy information.
All sections on page are activated and in IView. EDD will now appear on Pregnancy Summary Page.

The Authoritative EDD drives what displays at the top of the Pregnancy Summary as well as the EGA
on the Tracking Shell. When there is only one EDD documented, it is considered “Authoritative”.
Additional EDD methods can be entered through EDD Maintenance section. (See instructions for EDD
Maintenance section.)
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Appearance of Pregnancy Summary Page

Sections
o Display information pulled from previous documentation in various locations in PowerChart.
o Click arrow at right of section heading to open or close section to view data.

Links
o Section headings serve as links to click to navigate to various locations in the chart.
o Information displayed in blue also serves as a link to click to navigate to the source of the
information.
o You can also hover on blue information to view details, such as date/time of entry, who
documented, etc.
o
Selected
sections will
default open.
Click drop down
arrow to view
Labor or Fundal
Height Graph.
Hover to view link.
Click section header to
go to link.
Click blue + to make
additions.
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Description of Sections
Hover over blue text to view
additional information.
Overview

Current Pregnancy tab displays information added from previous charting, along with demographic
information from IDX.
Description of Sections
Overview

To Update the Pregnancy, click
o Cancel
 Click to Cancel pregnancy. Pregnancy Summary page will be out of view
o Modify
 Click to view Modify Pregnancy box, which is same box as Add Pregnancy box.
 Modify as needed
 Click OK to save information
o
Close
 Click after patient is discharged home
 Close Pregnancy box will open for you to enter required delivery information. Yellow
indicates required.
 Delivery Outcome time/date
 Gestation at birth
 Pregnancy outcome/result
 Neonatal Outcome will update Para Living status
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

Click OK
Pregnancy Summary Page will no longer contain information
Labor Flowsheet

Displays information related to the status of the amniotic fluid
Vital Signs


Scroll to right to view entire display
Click drop down button to select and view graphs for Fundal Height or Labor Graph.
Labor Graph
The Labor Graph-Partogram is a graphic summary of a patient’s labor progress. The graph is linked to a
specific pregnancy. Click the drop down arrow on either the Labor or Vital Signs flowsheet.
 The window displays to define the start of labor. Complete the date/time for the beginning of labor. The
date will determine what information will display in the graph.
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
The Fetal Heart Rate graph displays the documented/signed results of the FHR. Multiple gestations
display with a unique symbol and color for each fetus.

The Labor Graph displays the cervical dilatation, fetal station, and epidural information.
Alert and action lines are displayed with red dashed lines. The alert/action lines serve as a visual guide to
the clinician, supporting decision making. Click the Hide button to remove the alert/action lines.

The Flowsheet table displays the last documented clinical results closest to the specified time interval for
each of the items displayed. The user can view the details of the displayed result by double-clicking on the
result.

The Maternal Vitals graph displays the mother’s blood pressure, pulse, and temperature. Hover your
mouse over the data point to display the date/time of the results.
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Results Timeline

Provides a graphical view of key clinical events that have occurred during the pregnancy. You can view
the labs and ultrasounds for each trimester. The events are displayed by gestational age in weeks.
Vertical lines mark Today, Estimated Delivery Date, and Delivery Date on the timeline. Hover over icon to
view results.
Delivery Summary
 Provides a summary of the delivery details.
Risk Factors



Maternal risk factors will display from documentation completed on the Admission Health
Assessment/Admission Profile. Antepartum risk factors will cross all encounters
Infant and maternal delivery risk factors will also display once delivery has occurred
Additional risk factors may be added by clicking the blue +
Stages of Labor
 Summarizes the stages of labor. Display for last 24
hours.
Pregnancy History-Displays historical pregnancies previously documented.


To add initial information, go to the Ad Hoc OB Maternity folder and add from there.
You can make changes to the document from the pregnancy summary but don’t put in initial info in this
way.
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Birth Plan

Displays information previously documented by nurses (from AHA, AP, or Ad Hoc PowerForm)
Education & Counseling-contains documentation obtained from AHA/AP and documented education
based on EDD
Procedure History-contains all procedures for the lifetime of the patient sorted alphabetically

Not currently entering procedures
Documents-contains documents similar to Clinical
Notes
Fetal Monitoring-Archived Strips-contains archived
fetal monitoring episodes
1. Place check mark in desired episode
2. Click Show
3. FetaLink will open for viewing only. Once an episode has been finalized, no further charting can occur on
that episode.
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Labs-includes lab results obtained at a MHC facility and results transcribed on to Admission Health
Assessment
 Contains labs reported after opening date of Pregnancy
Summary page
Microbiology-displays all Micro results
Intake and Output-displays I and O results
Consolidated Problems


Displays information charted on Problems & Diagnosis
Click heading link to move to Problems & Diagnosis
o Diagnosis will appear under This Visit Diagnosis
Home Medications



Displays previously documented Home Medications
Click blue + to open Add Order window
Click Document Medication by Hx

Providers can click Medication Reconciliation to reconcile medications
Medications


Displays inpatient medications, organized by
categories
Click blue + to open the MAR Summary
Immunizations
 Displays documented immunizations
 Crosses encounters
Lines/Tubes/Drains-displays IVs, tubes, drains
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EDD Maintenance
 Displays information previously entered
o Number in parentheses-number of confirmation methods entered
o Status-Initial, Authoritative, Non-Authoritative
o EDD-determined by method with Authoritative Status
o EGA on Method Date (Estimated Gestational Age)
o Method-LMP, ultrasound, etc.
o Date of Method
Hover on blue EDD
date to view more
information.

How to add EDD method
o Click blue + to view EDD Maintenance window.
o Click drop down to select method.
o Enter information in yellow required fields to calculate EDD. See instructions above in How to Open
Current Pregnancy.
o Click OK.

How to set specific EDD method as authoritative
o Click Use this estimate for EDD calculations.
o If Final is selected, it is always designed the authoritative EDD.
o No new estimates will be allowed for this pregnancy when Final is selected.
o If you need to add additional estimates to a Final EDD, click on date to open for modifying.
Remove Final check mark and click OK.
o If multiple methods exist, and Final is not selected, and no method has been marked Use this
estimate for EDD calculations, the system will calculate the EDD by selecting the method with the
latest date/time.

How to modify EDD method
o Click Modify in the EDD Maintenance section
o Make changes and click OK.
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