- Standards for early warning signs, diagnostic criteria, monitoring and treatment of severe preeclampsia/eclampsia (include order sets and algorithms)
- Unit education on protocols, unit-based drills (with post-drill debriefs)
- Process for timely triage and evaluation of pregnant and postpartum women with hypertension including ED and outpatient areas
- Rapid access to medications used for severe hypertension/eclampsia: Medications should be stocked and immediately available on L&D and in other areas where patients may be treated. Include brief guide for administration and dosage.
- System plan for escalation, obtaining appropriate consultation, and maternal transport, as needed
- Standard protocol for measurement and assessment of BP and urine protein for all pregnant and postpartum women
- Standard response to maternal early warning signs including listening to and investigating patient symptoms and assessment of labs (e.g. CBC with platelets, AST and ALT)
- Facility-wide standards for educating prenatal and postpartum women on signs and symptoms of hypertension and preeclampsia
- Hypertension in Pregnancy Task Force Report (ACOG)
- Patient Education Materials (Preeclampsia Foundation)
- Preeclampsia Early Recognition Tool (PERT) Note: contained on page 31 of Preeclampsia Toolkit: Improving Health Care Response to Preeclampsia (CMQCC)
Every case of severe hypertension/preeclampsia
Facility-wide standard protocols with checklists and escalation policies for management and treatment of:
- Severe hypertension
- Eclampsia, seizure prophylaxis, and magnesium over-dosage
- Postpartum presentation of severe hypertension/preeclampsia
Minimum requirements for protocol:
- Notification of physician or primary care provider if systolic BP =/> 160 or diastolic BP =/> 110 for two measurements within 15 minutes
- After the second elevated reading, treatment should be initiated ASAP (preferably within 60 minutes of verification)
- Includes onset and duration of magnesium sulfate therapy
- Includes escalation measures for those unresponsive to standard treatment
- Describes manner and verification of follow-up within 7 to 14 days postpartum
- Describe postpartum patient education for women with preeclampsia
- Support plan for patients, families, and staff for ICU admissions and serious complications of severe hypertension
- Establish a culture of huddles for high risk patients and post-event debriefs to identify successes and opportunities
- Multidisciplinary review of all severe hypertension/eclampsia cases admitted to ICU for systems issues
- Monitor outcomes and process metrics
Patient Safety Bundles and Tools
- Patient Safety Bundles
- Maternal Safety Bundles
- Maternal Mental Health: Depression and Anxiety
- Maternal Venous Thromboembolism (+AIM)
- Obstetric Hemorrhage (+AIM)
- Postpartum Care Basics for Maternal Safety
From Birth to the Comprehensive Postpartum Visit (+AIM)
- Reduction of Peripartum Racial/Ethnic Disparities (+AIM)
- Safe Reduction of Primary Cesarean Birth (+AIM)
- Severe Hypertension in Pregnancy (+AIM)
- Support After a Severe Maternal Event (+AIM)
- Non-Obstetric Bundles
- Maternal Safety Bundles
- Patient Safety Tools
Note: “Facility-wide” indicates all areas where pregnant or postpartum women receive care. (E.g. L&D, postpartum critical care, emergency department, and others depending on the facility).
The Obstetric Hemorrhage Patient Safety Bundle was developed as a result of the collaborative efforts of the National Partnership for Maternal Safety as part of the 2014 focused efforts on Obstetric Hemorrhage. It is important to note that this bundle is not meant to be prescriptive; facilities can and should modify the content to meet local needs.
The Council on Patient Safety in Women’s Health Care has identified the above listed resources that may be helpful for institutions that implement the bundle. These multidisciplinary materials are for information purposes only and are not meant to be comprehensive. Referral to these resources does not imply the Council’s or any individual organization of the Council’s endorsement of the organization, the organization’s website, or the content of the resource. The resources may change without notice.
All resources used with permission of the respective developing organization. All copyright remains unto that organization.
This page was developed through the support of an educational grant from Masimo Corporation.