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Nursing Excellence

The Online Newsletter for Children's Nurses
e-Edition, Issue 9

Beverly Hayden Pugh

A Recipe for Advanced Clinical Systems

By Beverly Hayden-Pugh, MOB, BSN, RN, NE-BC
Vice President & Chief Nursing Officer

Recipe for Advanced Clinical Systems (ACS)


One part technology

Two parts expertise

Three parts interdisciplinary teamwork

A healthy portion of commitment and dedication

The result is ACS, a tool designed to support quality patient care, improve access to information and promote patient-centered communication. 


It was late one evening, not too long ago, when super users began arriving to prepare for go-live. Nervousness and excitement were evident, with a focused attention to the task at hand. The goal was to initiate online care plans for all inpatients as the start to our ACS implementation. By 7 a.m. that goal was achieved. This was the first of many goals to be achieved and the first of many changes and challenges we would encounter as the ACS journey continued. As I walked through the patient care units and listened to debriefings in the command center, this is what I saw, heard and felt.

What I SAW:

  • A red wave, not the Fresno State “red wave,” but the wave of red shirts identifying talented super users who shared their knowledge, expertise and support with fellow staff. 
  • Clinicians focusing on ensuring that the patient care they delivered remained exceptional. That was a challenge during this significant change process, but I repeatedly saw staff demonstrate this value amid the stresses of learning a new world of electronic documentation.
  • Nurses, pharmacists, physicians, respiratory therapists, information technologists, leaders and educators working together to address issues.  As the command center team, they ensured that timely solutions were developed and communicated.


  • The level of expertise and effort was extraordinary. Team members provided “just in time” answers. They shared their observations, findings, solutions and concerns with each other each day at debriefings and during hand off. Teamwork kept the initial implementation afloat.
  • The command center was abuzz with phone calls, the sound of key strokes capturing issues and the resolution of issues ranging from access and “where to find it,” to suggestions for “how to do it better.”

What I FELT:

  • Pride in the staff, physicians and leaders who moved through the change with determination
  • Collegiality between all disciplines
  • Awe as a long-planned vision started to become a reality

The level of commitment to the ACS implementation was exceptional, beyond my expectations. I continue to be humbled by the focus of staff in doing what is needed to support patient care. It was – and is – for many a difficult transition; for others that transition was easier. What I really appreciate is the camaraderie and teamwork that is making the journey possible. ACS is not perfect; we are in our infancy of using the tools to leverage information to support patient care. I look forward to your support and continued commitment as we grow our ACS “infant into adulthood.”

We certainly have made huge strides in advancing our clinical systems and we will continue our journey. Next stop – a fully implemented computerized physician order entry (CPOE) while continuing with focused efforts on ever-evolving processes, systems and tools that support quality and safe pediatric patient care.



In This Issue

A Recipe for Advanced Clinical Systems

Code of Ethics for Nurses

Champions… A Key to Success

Optimizing the Wound Healing Environment

Electronic Documentation

The Pace of Regulatory Change

Alphabet Soup in the Ambulatory Division

Shared Governance: PICU Skin Care Program

Striving for Excellence in Children's Asthma Care

Patient Satisfaction Comments