Improving compliance with guidelines for hypertensive disorders of pregnancy through an electronic health record alert: A retrospective chart review

Nicole M. Spencer, Martina Gabra, Sabrina M. Bedell, Dana M. Scott, Phillip Rauk

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: Improve appropriate and timely administration of rapid acting antihypertensive medication for the management of hypertensive emergency in pregnancy with utilization of an automated electronic health record (EHR) alert in an academic birthplace. Study design: An automated alert was incorporated into an existing EHR that notified providers of a documented severe range blood pressure, defined as systolic blood pressure (SBP) ≥ 160 mmHg or diastolic blood pressure (DBP) ≥ 110 mmHg. Retrospective chart review was utilized to evaluate appropriate intervention before and after implementation of the alert (referred to as pre-implementation and post-implementation cohorts). Main outcome measures: The primary outcome was appropriate administration of rapid-acting antihypertensive medication for the management of hypertensive emergency. Secondary outcomes included: appropriate administration of intravenous (IV) magnesium sulfate for seizure prophylaxis, initiation of oral antihypertensive medication postpartum, and appropriate timing of follow up for blood pressure evaluation following discharge. Results: Of 98 patients identified as having hypertensive emergency in the pre-implementation cohort, 34 (35%) received treatment with a rapid acting antihypertensive medication within one hour compared with 54 of 104 (55%) of patients in the post-implementation cohort (35% vs 55%, RR 1.40 95% CI 1.07–1.82). Significantly more patients followed up for a blood pressure check within one week of discharge (41% vs 31%; p = 0.02). There was not a significant effect on the administration of IV magnesium sulfate or initiation of oral medications postpartum. Conclusion: An automated EHR alert improved timely administration of rapid-acting antihypertensive medications for hypertensive emergency and has the potential to improve compliance with national preeclampsia guidelines.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalPregnancy Hypertension
Volume25
DOIs
StatePublished - Aug 2021

Bibliographical note

Funding Information:
We would like to acknowledge Ananta Bangdiwala MS, of the University of Minnesota for statistical contribution to this manuscript. She has no conflicts of interest nor financial disclosures and has consented to acknowledgement herein.

Publisher Copyright:
© 2021 International Society for the Study of Hypertension in Pregnancy

Keywords

  • Automated electronic health record alert
  • IV magnesium therapy
  • Immediate acting antihypertensive medication
  • Oral antihypertensive medication
  • Pre-eclampsia with severe features

PubMed: MeSH publication types

  • Journal Article

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