Grogan Laura, Peterson Erika, Flatley Megan, Domeyer-Klenske Amy
Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin.
Department of Obstetrics and Gynecology, Froedtert Hospital and Clinics, Milwaukee, Wisconsin.
Am J Perinatol. 2025 Mar;42(4):452-461. doi: 10.1055/a-2404-4676. Epub 2024 Aug 29.
Hypertensive disorders of pregnancy, defined as chronic (<20 weeks) or gestational (>20 weeks), are a leading cause of pregnancy-related mortality in the United States. Hypertensive disorders of pregnancy had increased prevalence from 13.3 to 15.9% among delivery hospitalizations between 2017 and 2019. The objective of this project was to increase the percentage of obstetric patients with hypertensive emergency who received evidence-based treatment within 60 minutes at a single academic center.
Data were collected before and after the implementation of a hypertension patient safety bundle. Each occurrence of hypertensive emergency was assessed to determine if evidence-based intervention occurred within 60 minutes, and if the intervention steps were successfully followed. Bundle implementation included creation of a standardized order set and interdisciplinary team-based simulations. Baseline data compared 250 preimplementation to 250 postimplementation interventions. The quality improvement interdisciplinary team reevaluated data monthly and incorporated process improvements through Plan-Do-Study-Act (PDSA) cycles to achieve a goal of 80% of patients receiving evidence-based treatment within 60 minutes.
A total of 1,025 hypertensive emergencies were identified in 543 patients. Prior to the protocol on average 64% of patients received evidence-based, timely treatment. After implementation of this bundle and several PDSA cycles, we sustained >80% of patients receiving target treatment for the final 6 months of data collection. The leading deviations were "no medication given" and "incorrect medication." Improvements in order set accessibility and repeated team-based trainings led to improvement in these identified protocol deviations.
Implementation of a patient safety bundle led to a sustained 6-month improvement in the percentage of patients receiving appropriate treatment of obstetric hypertensive emergency within 60 minutes of the first severe hypertension measurement. Processes that may have helped achieve this outcome included standardized order sets, team awareness of institutional data, and team-based simulations.
· Hypertensive emergency treatment improved with patient safety bundle.. · Training and order sets improved adherence to hypertensive emergency patient safety bundle.. · Regular data review necessary for sustainability of hypertensive emergency patient safety bundle..
妊娠高血压疾病，定义为慢性高血压（妊娠<20周）或妊娠期高血压（妊娠>20周），是美国妊娠相关死亡的主要原因。2017年至2019年期间，分娩住院患者中妊娠高血压疾病的患病率从13.3%上升至15.9%。本项目的目的是提高在单一学术中心60分钟内接受循证治疗的高血压急症产科患者的比例。
在实施高血压患者安全包前后收集数据。对每例高血压急症进行评估，以确定是否在60分钟内进行了循证干预，以及是否成功遵循了干预步骤。实施安全包包括创建标准化医嘱集和基于跨学科团队的模拟。基线数据比较了实施前250例与实施后250例干预措施。质量改进跨学科团队每月重新评估数据，并通过计划-执行-研究-改进（PDSA）循环纳入流程改进措施，以实现80%的患者在60分钟内接受循证治疗的目标。
共识别出543例患者的1025次高血压急症。在该方案实施前，平均64%的患者接受了循证及时治疗。在实施该安全包并进行了几个PDSA循环后，在数据收集的最后6个月中，我们使>80%的患者接受了目标治疗。主要偏差为“未给药”和“用药错误”。医嘱集可及性的改善和基于团队的重复培训导致了这些已识别的方案偏差的改善。
实施患者安全包使在首次严重高血压测量后60分钟内接受产科高血压急症适当治疗的患者比例持续6个月得到改善。可能有助于实现这一结果的过程包括标准化医嘱集、团队对机构数据的认识以及基于团队的模拟。
· 患者安全包改善了高血压急症治疗。· 培训和医嘱集提高了对高血压急症患者安全包的依从性。· 定期数据审查对高血压急症患者安全包的可持续性至关重要。
