Implementation of a standardized nurse initiated protocol to manage severe hypertension in pregnancy

The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
Michael J MillerMonica A Lutgendorf

Abstract

Hypertensive disorders of pregnancy are a leading cause of maternal morbidity and mortality, studies have shown that standardized protocols for treating severe hypertension improves outcomes. Our goal was to examine the effects of a protocol for treating severe hypertension. Using quality improvement methodology, we developed an evidence-based nurse-initiated protocol for management of severe hypertension. We used a before and after study design, with the primary outcome of time to administration of antihypertensive medications and time to achieve blood pressure control. Secondary outcomes included medication usage, time to repeat blood pressure, and proportion of women receiving appropriate treatment. Statistical analysis was completed with Stata, using data medians, 95% confidence intervals and a rank-sum test. Data was collected for 5 months before and 5 months after protocol implementation, with 67 patients included before and 125 patients after implementation. The median time to treatment of severe range blood pressure decreased from 25 min before to 11 min after protocol implementation, p <.001. Twenty-four% of women were treated within 15 min before and 60.6% were treated within 15 min after protocol implementation. Medi...Continue Reading

References

May 21, 2011·Health Affairs·Brent C James, Lucy A Savitz
Mar 10, 2015·Obstetrics and Gynecology·Elliott K MainElizabeth S Lawton
Aug 5, 2015·Obstetrics and Gynecology·Christian M Pettker, William A Grobman
Jul 12, 2017·Obstetrics and Gynecology·Andreea A CreangaWilliam M Callaghan

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