Improving the Outcomes of Women with Severe Preeclampsia: Exploring Innovations used by an Inter-Professional Team at a Community Hospital

Purpose for the program: This program will outline how our facility implemented the California Maternal Quality Care Collaborative (CMQCC) recommendations for identification and treatment of severe preeclampsia in the Perinatal areas as well as the Emergency Department. We are a community based, non academic hospital, delivering 5000 newborns per year with a 24 bed High Risk Maternity Unit. The goal is to implement strategies to improve care and reduce morbidity and mortality.

Proposed change: Implementation of a four part change based on evidenced based research. 1) Standardization of the blood pressure assessment  method used by nurses to obtain the reportable values.  As suggested by CMQCC, we found that the methods used by the RNs varied. 2) Treatment of blood pressures of greater than 160 systolic or 105 diastolic  with IV antihypertensive treatment within 30 minutes. 3) Debriefing of the process for each patient that required antihypertensive medication. 4) Provide the patient who has a diagnosis of severe preeclampsia with specific discharge instructions and arrange for follow up within 3-10 days.

Implementation, outcomes and evaluation: Using the Plan Do Study Act (PDSA) model, Plan: we formed a multidisciplinary team including physician leaders to review and implement the recommendations. we started with identification of how a severe preeclmaptic patient was coded.  We worked with our colleagues in Health Information Management to assure that these patients were being coded in a way that allowed us to utilize the data that was generated. We abstracted 6 months of data prior to starting the program, so that we could measure our changes. Comparing our basline data to the benchmarks, we identified opportunities for imporvment. Do: MD and RN education needed to be multi faceted. We used everything from posters, computer based learning, read and sign packets and lectures that included case scenarios. Policies were updated and a Preeclampsia Order Set was developed. Case Management assisted with the setting up outpatient follow up for these patients. Study: the data collection occured concurrent with admission to Periantal or ED unit.  Our data was posted on a monthly basis after the education was complete. Balance measures were included and reported. Act: Continuing to look at our practice and systems issues through a debriefing process to achieve the benchmarks.

Implications for nursing practice: 1) Standardization of blood pressure measurement, 2) Identify hypertensive crisis, 3) Activation of a team to respond, 4) Expediated treatment with IV antihypertensive medications and, 5) debriefing of the process. 6) Revising and hardwiring best practice.

Keywords: Severe preeclampsia, hypertensive crisis