Interprofessional Participation in a Statewide Collaborative to Recognize and Treat Hypertension in Pregnancy

Abstract

Poster Presentation Objective To standardize the identification and treatment pregnant/postpartum women presenting with blood pressures ≥ 160 and/or ≥ 105 within 30 minutes of validated elevated blood pressure. Design Plan‐do‐study‐act cycles (PDSA) were used to implement the evidence‐based guidelines from the California Maternal Quality Care Collaborative (CMQCC) Preeclampsia Toolkit. Physician, pharmacy, and nursing staffs were educated on the guidelines and the acute hypertensive order set developed by the Memorial Care Women's Best Practice Team. The team actively participated in the CMQCC Preeclampsia Collaborative. Sample All pregnant/postpartum women presenting perinatal care areas with elevated blood pressures. Methods Initial elevated blood pressures are reevaluated within 15 minutes using a manual sphygmomanometer and appropriate size cuff. Physicians are contacted, the acute hypertensive order set is initiated, and labetalol or hydralazine are immediately administered. Blood pressures are reassessed every 15 to 20 minutes and medication treatment is continued until blood pressures reach values less than threshold. Upon event completion, a debrief is conducted. Implementation Strategies Perinatal nursing staff were educated on the use of a manual sphygmomanometer and choice of appropriate cuff. A self‐learning module with competency evaluation was required. Postpartum nurses were taught to administer intravenous hydralazine. Physicians were provided written communication of the new protocol and order set. The pharmacist assured that the necessary level of drugs was in stock. Rolling manual blood pressure kits with assorted cuffs and guidelines were distributed. Electronic message boards were used to continually educate staff. Debrief forms provided feedback to the implementation team to complete PDSA cycles, enhance adherence to the guidelines, and improve feedback to staff. Results The baseline data from April 2013 indicate that 14.3% of women with blood pressures meeting the criteria were treated. By June 2014, 84.2% were treated within 30 minutes and 89.5% were treated within 60 minutes. Conclusion/Implications for Nursing Practice Understanding the potential for maternal morbidity and mortality has increased the recognition of care providers and enhanced the treatment of acute hypertension. Methodology and implementation strategies were effective in achieving the standardized identification and treatment of pregnant/postpartum women presenting with hypertension. Unanticipated challenges included providing training in the basic fundamentals of blood pressure measurement and obtaining institutional approval for intravenous hydralazine to become standard practice for postpartum nurses. Next steps in nursing practice include evaluation of hypertensive patient within one week of hospital discharge and implementation in the emergency department.