Duke University School of Medicine, Durham, NC, USA; Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA.
Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA.
Pregnancy Hypertens. 2022 Dec;30:1-6. doi: 10.1016/j.preghy.2022.07.007. Epub 2022 Jul 29.
To assess the implementation of an antihypertensive pathway order set to improve treatment of severe hypertension in pregnancy and the postpartum period in the inpatient setting.
A multi-disciplinary task force created a hypertensive pathway order set and provided staff training. The order set allowed providers to initiate a treatment algorithm, which then gave nurses guidelines to recheck blood pressures and progressively increase short-acting antihypertensive dosage if needed. Pregnant and postpartum patients documented to have ≥2 consecutive severe range blood pressures in the year prior (2017) and the year after (2019) implementation of the pathway were included. Primary outcomes included whether any antihypertensive was given, whether it was given for all instances of severe hypertension, and time to antihypertensive administration.
A total of 566 patients with severe hypertension were included-304 in the pre-implementation year and 262 in the post-implementation year. Significantly more patients received an antihypertensive at least once (67 % versus 80 %, p < 0.01) and for all instances of severe hypertension (29 % versus 47 %, p < 0.01) in the post-intervention cohort. There was a significant improvement in time to antihypertensive administration (24 versus 10 min, p < 0.01).
This study evaluates the efficacy of an antihypertensive intervention in the Southeast United States, which is particularly significant given the region's higher rates of hypertension and hypertension-related mortality. This study provides confirmatory evidence that implementation of a standardized order set along with measuring compliance and staff education is associated with improved treatment rates and time to treatment administration.
评估降压途径医嘱集的实施情况，以改善住院孕妇和产后人群严重高血压的治疗效果。
一个多学科工作组创建了高血压途径医嘱集并提供了员工培训。该医嘱集允许医生启动治疗方案，随后为护士提供指导，根据需要重新检查血压并逐步增加短效降压药的剂量。纳入在实施途径前一年（2017 年）和实施后一年（2019 年）有≥2 次连续重度血压的孕妇和产后患者。主要结局包括是否给予任何降压药、是否在所有严重高血压情况下给予降压药以及降压药的使用时间。
共有 566 例严重高血压患者纳入研究，其中 304 例在实施前一年，262 例在实施后一年。干预后组中，至少接受一次降压药治疗的患者比例明显更高（67% vs. 80%，p<0.01），且所有严重高血压情况下均接受降压药治疗的患者比例也明显更高（29% vs. 47%，p<0.01）。降压药使用时间也明显缩短（24 分钟 vs. 10 分钟，p<0.01）。
本研究评估了降压干预在美国东南部的疗效，鉴于该地区高血压和高血压相关死亡率较高，这一研究结果具有重要意义。本研究提供了确凿的证据，表明实施标准化医嘱集以及测量依从性和员工教育与提高治疗率和治疗开始时间相关。
