# Paper chart workflow: preeclampsia prevention

Version 1.0 | September 30, 2026 | Adaptation requested by the practice

## What changed

The supplied Nadia Kendrick project materials propose EHR smart phrases. This implementation uses a three-page signed paper chart checklist and a separate de-identified audit worksheet. It requires no eClinicalWorks smart note. It does not assume a specific eClinicalWorks scanning menu, document type, or permission configuration.

The paper format is an adaptation of the project protocol, not evidence of an approved protocol amendment. The investigator and practice should align the paper workflow, consent language, extraction process, and any required institutional review updates before study implementation. This does not prevent using the blank tools for review and preparation.

## Roles and handoffs

1. **Front office:** verify the encounter label, provide all three blank pages, offer interpreter/reading assistance, and route any reported urgent concern immediately to clinical staff. Staff do not classify clinical risk, give medication advice, determine eligibility, or authorize aspirin.
2. **Patient:** answer history questions on page 1. Use Not sure when needed. Tell the team immediately about concerning symptoms. The form is not consent or enrollment.
3. **Doctor or APP:** review and confirm history, resolve unknowns, determine clinical risk and aspirin suitability on page 2, complete counseling and the individualized plan on page 3, and sign the decision. Add a medication order through the practice's ordinary ordering process when appropriate. The checklist itself is not a standing order.
4. **Clinical care team:** clarify instructions, give the patient a copy of the relevant plan if appropriate, coordinate follow-up, and reassess use/barriers at subsequent visits. Clinical staff act within their usual scope and office protocols.
5. **Records/front office:** check identifiers on all pages, verify that the signed plan is present, and file/scan all three pages into the correct chart using the practice's established procedure. Route incomplete clinical sections to the clinical team; do not fill them on the clinician's behalf.
6. **Approved extractor:** extract only the approved de-identified fields from the chart. The researcher receives the de-identified dataset described in the protocol, not identified chart forms. Any linkage key stays within the approved practice process and is kept separate from the extract.

## How to use the tools

- Print the PDF at actual size on US Letter paper. All forms are blank printable templates, not online data-entry forms.
- Keep patient name, DOB, MRN, encounter date, and signatures in the clinical chart copy. These are necessary for safe chart filing but do not belong in the researcher-facing extract.
- Complete the screening and decision timing in weeks and days. Distinguish a future planned start from an actual initiation date. Unknown dates remain unknown.
- Repeat assessment when clinically appropriate. Record follow-up on a new encounter form or in the usual clinical record rather than reusing old signatures for a new decision.
- High-risk assessment: one or more confirmed factors supports the guideline recommendation. Moderate-risk assessment: more than one distinct factor supports recommendation; ACOG/SMFM also permits consideration for Black racial identity as a proxy for racism or lower income alone. Do not infer identity from appearance or lower income from insurance alone.
- Count the personal-history category once, even if several examples apply. Do not count an unanswered or unknown item as absent.
- Clinicians review allergies, NSAID/salicylate hypersensitivity, nasal polyps/aspirin bronchospasm, bleeding/ulcer history, serious liver disease, and relevant medicines before prescribing.

## Research fields and definitions to finalize with the investigator

The original document enumerates four evaluation domains: screening completion, counseling documentation, aspirin decision, and gestational age. The form preserves these. It also offers supplemental clinical fields for safety, planned initiation, exceptions, and follow-up.

| Field | Proposed extraction rule |
|---|---|
| Risk screening completed | Clinician assessment completed and documented; patient history alone does not count as completed clinical assessment |
| Counseling documented | Relevant counseling checked/documented by the clinician; N/A requires a reason and is reported separately |
| Aspirin decision documented | One clear clinician disposition recorded with rationale when appropriate |
| Gestational age | Weeks and days at screening and at decision; preserve Missing rather than inventing a date |
| Original decision categories | Initiated, Continued, Not indicated, Patient declined |
| Supplemental exception categories | Contraindicated, Temporarily held, Pending clarification, Planned start; investigator defines final mapping in advance |
| Actual initiation | Documented actual start, distinct from a prescription or a future plan |
| Medication use | Patient-reported use at follow-up; not inferred from prescription or checklist completion |

Agree on inclusion/exclusion rules, encounter-versus-patient denominators, how follow-up visits are counted, study-week assignment, handling missing data, exception coding, and privacy controls before collecting research data. The one-encounter audit worksheet supports review; it does not establish a finalized analysis plan.

Do not compare the project's results with the uncited “24% compliance” number in the supplied materials. Do not claim outcome benefit from process documentation alone. Clinical outcomes and causal effects would require a separate, prespecified evaluation design and adequate data.

## References

- ACOG/SMFM. Low-dose aspirin practice advisory. December 2021; reaffirmed October 2022. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2021/12/low-dose-aspirin-use-for-the-prevention-of-preeclampsia-and-related-morbidity-and-mortality
- ACOG Committee Opinion 743. Obstet Gynecol. 2018;132:e44-e52. doi:10.1097/AOG.0000000000002708.
- Kendrick N. Unpublished project consent, provider orientation, and recruitment materials supplied by user; pp. 1-5. No completed results provided.