Improving Compliance With Preeclampsia Guidelines Through an Electronic Health Record Alert [19L]

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 133 Suppl 1; no. 1; pp. 133S - 134S
• Main Authors: Spencer, Nicole Marie, Gabra, Martina, Bedell, Sabrina M, Scott, Dana, Ananta, Bangdiwala, Rauk, Phillip N
• Format: Journal Article
• Language: English
• Published: by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved 01.05.2019
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1097/01.AOG/01.AOG.0000559253.69867.24

INTRODUCTION:Hypertensive disorders of pregnancy occur in 12-22% of all pregnancies and account for 17% of maternal mortality in the US. National guidelines for management of hypertensive disorders were developed by the American College of Obstetrics and Gynecology (ACOG) and the California Maternal Quality Care Collaborative (CMQCC). An electronic health record automated alert offers an opportunity to improve compliance with these guidelines. METHODS:A Blood Pressure Alert (BPA) was incorporated into an existing electronic health record to notify providers when a patient had a documented severe range blood pressure, defined as systolic blood pressure ≥-160 or diastolic blood pressure ≥110. Pre- and post-intervention data was collected via retrospective chart review. Compliance with national guidelines for administration of rapid-acting antihypertensive medication, IV magnesium for seizure prophylaxis, and initiation of oral antihypertensive medication postpartum was evaluated. RESULTS:Appropriate treatment of sustained severe-range blood pressure episodes with a rapid-acting antihypertensive medication within 1 hour of diagnosis improved after the implementation of the BPA (35% vs 54%, p<0.01), which was statistically significant. There was no significant change in the administration of IV magnesium sulfate (89% vs 80%, p=0.06) or prescription of oral antihypertensive medications at discharge (89% vs 93%, p=0.31). CONCLUSION:An automated electronic health record alert improved timely administration of rapid-acting anti-hypertensive medications for severe range blood pressures on an academic Labor and Delivery Unit and has the potential to improve overall compliance with ACOG and CMQCC preeclampsia guidelines. Increased adherence to these guidelines may improve maternal morbidity and mortality rates in the US.