Implementation of Hypertension in Pregnancy Safety Bundle

Abstract

The number of maternal deaths in most developed nations has been flat or declining; however, rates in the United States have risen sharply. Hospital records obtained indicate that at some hospitals, less than 15% of mothers in peril got recommended treatments. Women with preeclampsia or eclampsia have 3 to 25 times the risk of severe pregnancy complications. Hypertensive disorders account for 6.6% of deaths during pregnancy, 9.3% of deaths within 42 days of pregnancy, and 5.4% of deaths between 42 days and 1 year. This safety bundle uses evidenced-based guidelines to optimally manage hypertensive disorder of pregnancy and the postpartum period. The Hypertension in Pregnancy safety bundle is designed to create standardization of care. An Institutional Review Board–approved pilot study of randomized sample data was implemented. Baseline data included patients who were coded with one or more diagnoses of hypertension in pregnancy during the birth process. The randomized sample included 30 patients. Postbundle implementation data from patients were coded with one or more diagnoses of hypertension in pregnancy during the birth process. The randomized sample 20% of patients with HTN code(s) per month. Preliminary data showed that treatment of confirmed severe-range blood pressure within 60 minutes improved by 19.4% from baseline to post–safety bundle implementation. The percentage of confirmed hypertensive patients discharged with antihypertensive medication increased 20.3% from baseline to post–safety bundle implementation. The percentage of preeclampsia education provided at discharge to all postpartum women increased by 73% from baseline to post–safety bundle implementation. It is clear that the implementation of the safety bundle has greatly improved standardization of care for pregnant women with hypertension. In addition, the safety bundle has improved the urgency and necessity of providing immediate, timely, and continued treatment and education for pregnant and postpartum women with hypertension. By implementing the safety bundle, physicians and nurses have the knowledge and understanding of the urgent need for recognition and treatment of these frequently dangerous medical conditions.