A Nurse-Initiated Protocol to Improve Treatment of Severe Hypertension in Pregnancy

A Nurse-Initiated Protocol to Improve Treatment of Severe Hypertension in Pregnancy


Name: Patricia Butler

Rank: LCDR

Presenter/Poster: Podium

Year: 2017


DESCRIPTION: The purpose of this evidence-based practice project is to improve early management of hypertensive emergencies in pregnancy by implementing a nurse-initiated protocol for medication administration and monitoring at a large academic military medical center.

SPECIFIC AIM: We sought to implement a slightly modified standardized nurse-initiated protocol for management of severe hypertension (HTN) in peripartum women based on published guidelines.

BACKGROUND: Hypertensive disorders are a leading cause of maternal morbidity and mortality. Prompt treatment of hypertensive crises is essential to prevent peripartum stroke.

METHODS: The protocol applied to women who developed severe range blood pressures (SBP >160 or DBP >110) prior to delivery and up to 6 weeks postpartum. Registered nurses on intrapartum and high-risk postpartum units initiated sequential treatment with nifedipine, hydralazine, and/or labetalol. Time from initial detection of severe HTN to antihypertensive medication administration, effect of treatment, and blood pressure (BP) monitoring data were collected for 3 months prior to the protocol and for 3 months after protocol implementation for comparison. We collected data on 597 severe BPs (47 patients) before and 344 BPs (38 patients) after initiating the protocol.

FINDINGS: Mean time to treatment of severe BPs was 36.9 minutes prior to the protocol, and 19.6 minutes after protocol implementation (t=3.1, p=0.002). Mean time to repeat BP measurement decreased from 15.7 minutes to 12.8 minutes. Maximum time to repeat BP measurement decreased from 300 to 76 minutes. Severe BPs treated with medication within 1 hour increased from 35% to 90%.

IMPLICATIONS FOR MILITARY NURSING: In our units, implementation of a standardized nurse-initiated protocol for the treatment of severe hypertension in pregnancy decreases the time to treatment and maximum time to repeat BP measurements resulting in decreased clinical variation, improved monitoring, and overall improved patient outcomes.