Category: Obstetric Quality and Safety
Poster Session II
To define effective strategies for implementation of a community-informed patient safety bundle for severe hypertension (HTN) during pregnancy in the outpatient setting.
Study Design:
This is a pilot for a hybrid type 3 effectiveness-implementation study to test strategies for implementation of the AIM Severe HTN in Pregnancy Patient Safety Bundle in the outpatient setting. The bundle was adapted for use in 3 Federally Qualified Health Centers (FHQCs) using a community-engaged approach. It was piloted from 9/2021 to 6/2022 with strategies including training, coaching and simulation.
Pre-intervention, clinical teams consisting of a medical assistant, nurse, provider (midwife or physician), and pharmacy staff at each FHQC participated in a simulation to establish a baseline. The simulation involved a patient actor who was found to have severe HTN during a prenatal visit. Teams were observed and evaluated on key behaviors demonstrating recognition of and response to severe HTN in pregnancy (Figure 1). Teams then received training on an adapted outpatient severe HTN management algorithm. Post-training, simulation was repeated, and teams were again evaluated.
The primary outcome was team recognition of and response to severe HTN pre/post-intervention. Mean pre/post-intervention scores were compared. Though each team had a unique provider, other team members may have participated on multiple teams which limits our ability to provide statistical inference.
Results:
Twenty teams from 3 FHQCs received the intervention. In the pre-intervention simulation, teams scored a mean of 78% overall on recognition of and response to severe HTN. Post-training, they improved to a mean of 95% (Table 1). Most notable gains were made on these key behaviors: identification of need to treat HTN, provision of timely treatment, and escalation to higher level of care.
Conclusion:
Training, coaching, and simulation are potentially effective for improving outpatient recognition of and response to severe HTN during pregnancy. These strategies hold promise for the implementation of an outpatient severe HTN patient safety bundle.
E. Nicole Teal, MD, MPH
Maternal-Fetal Medicine Fellow
University of North Carolina
Chapel Hill, NC, United States
Narges Farahi, MD
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina, United States
Piper L. Rogers, DNP, MSN
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina, United States
Joan Healy, MPH
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina, United States
Christopher M. Westgard, MPPA
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina, United States
Kimberly D. Harper, MHA, MSN, RN
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina, United States
Rebeca Moretto, CNM, MPH, MSN
Piedmont Health Services
Carborro, North Carolina, United States
Fareedat O. Oluyadi, MD
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina, United States
Kathryn Menard, MD,MPH
Distinguished Professor
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina, United States
E. Nicole Teal, MD, MPH
Maternal-Fetal Medicine Fellow
University of North Carolina
Chapel Hill, NC, United States