Group led by UNC physician writes patient safety bundle for hypertension in pregnant women

Kathryn Menard, MD, MPH, director of maternal-fetal medicine at UNC, was lead author on the commentary, which makes 14 specific recommendations on how best to address the needs of pregnant and recently postpartum women who face a sudden spike in blood pressure.

Group led by UNC physician writes patient safety bundle for hypertension in pregnant women	click to enlarge Kathryn Menard, MD, MPH

Severe hypertension affects two to three percent of pregnant women and can be extremely dangerous. It is the leading cause of preventable maternal mortality. Being able to react quickly when a pregnant or recently postpartum mother presents with severe hypertension is crucial to mitigating the damage that might otherwise be done to the mother or the fetus.

To help providers get a better grasp on how to recognize and treat severe hypertension in pregnant and postpartum women, the National Partnership of Maternal Safety – a multidisciplinary workgroup of the Council on Patient Safety in Women’s Health Care – has outlined a 14-point safety bundle with specific quality improvement recommendations for every phase of the care process.  

Kathryn Menard, MD, MPH, director of maternal-fetal medicine and vice chair for obstetrics at the UNC School of Medicine, was the senior author of the commentary that describes the bundle. The safety bundle was published simultaneously in four journals: Obstetrics & Gynecology, Anesthesia & Analgesia, the Journal of Midwifery & Women’s Health, and the Journal of Obstetric, Gynecologic, & Neonatal Nursing.

According to the commentary, the purpose of the bundle is not to be a one-size-fits-all solution to the treatment challenges associated with severe hypertension and aims instead to be “a framework for facilities to adopt and foster optimal care of these at-risk patients.”

The bundle’s 14 recommendations fall into four categories: readiness, recognition and prevention, response, and reporting and system learning.

Among these recommendations are specific steps that ensure clinical staffs are educated to recognize the presentation of a pregnant or postpartum woman with severe hypertension, that the resources are present and ready in clinics to treat the problem quickly, that patients are educated so they know what to look out for, and that there are protocols for drills and debriefings so that staffs are constantly improving their responses to severe hypertension.

“Making sure a staff is ready to treat severe hypertension quickly can have an enormous positive impact for the women who present with this problem,” said Menard. “Quality improvement is an ongoing process, but we hope that this bundle will provide clinics, emergency departments and inpatient care units with the tools they need to confront this dangerous but highly treatable complication.”

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