Severe Hypertension in Pregnancy 

Readiness

Every Unit

  • 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

Readiness Resources

Recognition & Prevention

Every Patient

  • 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

 

Recognition & Prevention  Resources

Response

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

Response Resources

Reporting/Systems Learning

Every Unit

  • 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

Reporting & Systems Learning Resources

Severe Hypertension in Pregnancy Impact Statement

In response to rising rates of severe pregnancy complications associated with hypertension, the Illinois Perinatal Quality Collaborative (ILPQC) began the Severe Maternal Hypertension Initiative based on the AIM Severe Hypertension in Pregnancy patient safety bundle. Between January 2016 and December 2017, ILPQC engaged clinical teams and public health leaders from 108 of 120 birthing facilities that were operational as of January 2016.  The goal was to improve care for pregnant and postpartum patients with hypertensive conditions. During the time period, the percentage of patients with sustained, new-onset severe hypertension who received treatment within 60 minutes of an elevated reading increased from 41% to 89%, and the statewide rate of severe maternal morbidity among patients with hypertension at delivery decreased by 40%. Since completing this initiative, ILPQC continues to assist birthing facilities with sustainability planning, monthly review and reporting of data, quarterly webinars, and quality improvement support.

 

For more impact statements from state teams implementing AIM patient safety bundles, click here 

 

© 2015 American College of Obstetricians and Gynecologists. Permission is hereby granted for duplication and distribution of the bundle document, in its entirety and without modification, for solely non-commercial activities that are for educational, quality improvement, and patient safety purposes. All other uses require written permission from ACOG.

Standardization of health care processes and reduced variation has been shown to improve outcomes and quality of care. The Council on Patient Safety in Women’s Health Care disseminates patient safety bundles to help facilitate the standardization process. This bundle reflects emerging clinical, scientific, and patient safety advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Although the components of a particular bundle may be adapted to local resources, standardization within an institution is strongly encouraged.

The Council on Patient Safety in Women’s Health Care is a broad consortium of organizations across the spectrum of women’s health for the promotion of safe health care for every woman.

May 2015