Implementation of a Nurse-Driven Protocol to Improve Recognition and Response to Severe Range Blood Pressures

Our institution implemented an evidence-based, nurse-driven protocol to improve the recognition and response to severe range blood pressure (SRBP) in pregnancy. We evaluated the time to treat SRBP with implementation of the protocol. Retrospective cohort of all encounters with preeclampsia or chronic hypertension (CHTN) and SRBP. Our three phases were: pre-implementation (July 2020-October 2020), implementation (November 2020-June 2021), and sustainment (July 2021-May 2022). The primary outcome was time to treat confirmed SRBP. Secondary outcomes included time to confirm SRBP, treatment administered within 30m of confirmed SRBP, receipt of treatment for SRBP, time to blood pressure recheck after treatment, maternal intensive care unit (ICU) admission, maternal hypotension, IUFD, and Apgar < 7 at 5m. Data were evaluated using Kruskal-Wallis tests. Overall, 605 encounters were identified during the study period [107 (18%) pre-implementation, 211 (35%) implementation, 287 (47%) sustainment]. There were no differences in demographic data or rates of CHTN between the groups. Mean time to treat SRBP decreased from 4h28m pre-implementation to 14m in the sustainment phase (p=0.20, Table 1); median time decreased from 33m pre-implementation to 11m in the sustainment phase (Figure 1). Time to confirm a SRBP decreased pre-implementation to sustainment (32m vs 20m, p=0.01). Treatment within 30m of confirmed SRBP, appropriate treatment, and timed post-treatment assessment were significantly improved (p< 0.001, Table 1). No episodes of maternal hypotension occurred in any phase. There were 4 maternal ICU admissions and 3 IUFDs during the initiative, but none were related to treatment of SRBP. Our nurse-driven protocol for treatment of SRBP reduced time to treatment of SRBP, time to confirm SRBP, and increased the number of patients receiving treatment when indicated. Use of similar protocols should be considered at institutions providing obstetric care to improve recognition and response to SRBP which may decrease maternal and neonatal morbidity and mortality related to SRBP.View Large Image Figure ViewerDownload Hi-res image Download (PPT)