Abstract
Objective Hypertensive disorders of pregnancy, defined as chronic (<20 weeks) or gestational (>20 weeks), are a leading cause of pregnancy-related mortality in the United States. Hypertensive disorders of pregnancy had increased prevalence from 13.3 to 15.9% among delivery hospitalizations between 2017 and 2019. The objective of this project was to increase the percentage of obstetric patients with hypertensive emergency who received evidence-based treatment within 60 minutes at a single academic center.
Study Design Data were collected before and after the implementation of a hypertension patient safety bundle. Each occurrence of hypertensive emergency was assessed to determine if evidence-based intervention occurred within 60 minutes, and if the intervention steps were successfully followed. Bundle implementation included creation of a standardized order set and interdisciplinary team-based simulations. Baseline data compared 250 preimplementation to 250 postimplementation interventions. The quality improvement interdisciplinary team reevaluated data monthly and incorporated process improvements through Plan-Do-Study-Act (PDSA) cycles to achieve a goal of 80% of patients receiving evidence-based treatment within 60 minutes.
Results A total of 1,025 hypertensive emergencies were identified in 543 patients. Prior to the protocol on average 64% of patients received evidence-based, timely treatment. After implementation of this bundle and several PDSA cycles, we sustained >80% of patients receiving target treatment for the final 6 months of data collection. The leading deviations were “no medication given” and “incorrect medication.” Improvements in order set accessibility and repeated team-based trainings led to improvement in these identified protocol deviations.
Conclusion Implementation of a patient safety bundle led to a sustained 6-month improvement in the percentage of patients receiving appropriate treatment of obstetric hypertensive emergency within 60 minutes of the first severe hypertension measurement. Processes that may have helped achieve this outcome included standardized order sets, team awareness of institutional data, and team-based simulations.
Key Points
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Hypertensive emergency treatment improved with patient safety bundle.
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Training and order sets improved adherence to hypertensive emergency patient safety bundle.
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Regular data review necessary for sustainability of hypertensive emergency patient safety bundle.
Keywords
maternal morbidity and mortality - obstetric hypertension - hypertensive emergency - patient safety bundle
