An Interprofessional Approach to Improving Identification and Time to Treatment of Severe Hypertension in Pregnant Women

Abstract

To develop and implement a protocol to improve the quality of care for women with severe hypertension during pregnancy and reduce adverse outcomes. Severe maternal morbidity associated with preeclampsia and eclampsia occurs in 12%–22% of pregnancies and is a leading cause of maternal death, contributing to 18% of maternal deaths in the United States. Other adverse outcomes include abruption, hemorrhage, disseminated intravascular coagulation, intrauterine growth restriction, intrauterine death, and increased health care costs. Organizational factors that contribute to adverse outcomes include delayed diagnosis and ineffective treatment. In Illinois, the goal is to treat 80% of women within 60 min of identification of severe hypertension. This quality improvement project was conducted in a Level III perinatal center in a community-based hospital with 2,600 births annually. In in March 2016, a multidisciplinary team was created that reviewed baseline data, identified areas for improvement in the care processes, and developed a treatment protocol followed by implementation of a multimodal educational strategy for physicians and nurses. An order set was created in the electronic medical record and visual reminders of the new protocol were posted. Data were collected from Calendar Year 2015 through the first quarter of 2018. Time-to-treatment within 1 hr was 8% in 2015 and 2016 and 90% in 2017; 100% of women were treated within 30 min in 2018. Rates of adverse maternal outcomes were at 17% (2016), 18% (2017), and 7% (2018). Findings support the effectiveness of our strategies to develop and implement a protocol to improve the quality of care for women with severe hypertension during pregnancy and reduce adverse outcomes. It is important to use an interprofessional approach to protocol development and education and to offer intensive initial education as well as ongoing education to sustain practice change. Use of the protocol was critical for empowering nurses to communicate more effectively with physicians about the status of patients and subsequent timely treatment to improve maternal outcomes.