Maternal Hypertension Change Package

This is the Change Package for Maternal Hypertension. It includes information relevant to the AIM Severe Hypertension bundle and The Joint Commission requirements.

SETTING THE FOUNDATION

General Resources
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Expected Outcomes and Measures This document lists the expected outcomes for and the measures associated with the initiative.
Definitions This document gives key definitions used to guide data collection.
Data Collection Form This document was developed to facilitate data collection.
Driver Diagram The diagram provides the underlying approach for the initiative.
Kick-off Webinar View recorded Webinar.
The Family Voice
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Voices of Impact

The Voices of Impact video series is available through the Council on Patient Safety in Women’s Health Care. The goal of the Voices of Impact video series is to elevate the voices of women and families who have experienced severe maternal events. Putting voices to the numbers can bring awareness to this critical issue and empower women and their care providers to make a positive impact.
Voices of Impact: Irving Family’s Story  
   
   
   
   
   
Getting Started
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Always Events Toolkit Always Events(R) are defined as those aspects of the care experience that should always occur when patients, their family members or other care partners, and service users interact with health care professionals and the health care delivery system. A one page overview is also available.
Illinois Perinatal Quality Collaborative (ILPQC) The section describing the Severe Maternal Hypertension Initiative contains useful information.
Institute for Healthcare Improvement (IHI) The Institute for Healthcare Improvement (IHI), an independent not-for-profit organization based in Boston, Massachusetts, is a leading innovator, convener, partner, and driver of results in health and health care improvement worldwide. At its core, IHI believes everyone should get the best care and health possible. IHI has a commitment to Person- and Family-Centered Care. This page lists resources for getting started.
PDSA Worksheet This worksheet is a component of IHI’s QI Essential Toolkit. The Plan-Do-Study-Act (PDSA) cycle is a useful tool for documenting a test of change. Use this worksheet for each change you test.
QI Project Charter The QI Project Charter provides a rationale and roadmap for team to clarify thinking about what needs to be done and why.
Walk-through Walk-throughs enable providers to understand the experience of care from the patient’s and family’s points of view by going through the experience themselves.
Reducing peripartum disparities
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Reduction of Peripartum Racial/Ethnic Disparities (+AIM) This link provides PDFs of the AIM bundle, complete and supplemental resource listings, and other materials.
Britton LE, Berry DC, Hussey JM. Comorbid Hypertension and Diabetes among U.S. Women of Reproductive Age: Prevalence and Disparities. J Diabetes Complications. 2018;32(12):1148-1152. Comorbid hypertension and diabetes are more common among non-Hispanic black women and less likely to be diagnosed.
Cabacungan ET, Ngui EM, McGinley EL. Racial/ethnic disparities in maternal morbidities: a statewide study of labor and delivery hospitalizations in Wisconsin. Matern Child Health J. 2012;16(7):1455-1467. Findings show significant racial/ethnic disparities in maternal morbidities, and suggest the need for better screening, management, and timely referral of these conditions, particularly among racial/ethnic women.
Mayne SL, Yellayi D, Pool LR, Grobman WA, Kershaw KN. Racial Residential Segregation and Hypertensive Disorder of Pregnancy Among Women in Chicago: Analysis of Electronic Health Record Data. Am J Hypertens. 2018;31(11):1221-1227. Racial residential segregation was associated with greater prevalence of hypertensive disorder of pregnancy among those living in higher poverty neighborhoods.
Miller EC, Zambrano Espinoza MD, Huang Y, et al. Maternal Race/Ethnicity, Hypertension, and Risk of Stroke During Delivery Admission. J Am Heart Assoc. 2020;9(3):e014775. Pregnant US women from minority groups had higher stroke risk during delivery admissions, compared with non-Hispanic whites.
Shahul S, Tung A, Minhaj M, et al. Racial Disparities in Comorbidities, Complications, and Maternal and Fetal Outcomes in Women with Preeclampsia/Eclampsia. Hypertens Pregnancy. 2015;34(4):506-515. Results suggest that African-American women are more likely to have risk factors for preeclampsia and more likely to suffer an adverse outcome during peripartum care.
Singh GK, Siahpush M, Liu L, Allender M. Racial/Ethnic, Nativity, and Sociodemographic Disparities in Maternal Hypertension in the United States, 2014-2015. Int J Hypertens. 2018;2018:7897189. Ethnicity, nativity status, older maternal age, and prepregnancy obesity and excess weight gain should be included among the criteria used for screening for gestational hypertension.
The Joint Commission
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R3 Report Issue 24: PC Standards for Maternal Safety Effective July 1, 2020, 13 new elements of performance were applicable to Joint Commission-accredited hospitals. Prevention, early recognition, and timely treatment for maternal hemorrhage and severe hypertension/preeclampsia had the highest impact in states working on decreasing maternal complications.
   
   
   
   
   

READINESS: Every Unit

Standards for early warning signs, diagnostic criteria, monitoring, and treatment
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Maternal Early Warning Criteria A multidisciplinary working group convened by the National Partnership of Maternal Safety used a consensus-based approach to define the Maternal Early Warning Criteria, a list of abnormal parameters that indicate the need for urgent bedside evaluation by a clinician with the capacity to escalate care.
Friedman AM, Campbell ML, Kline CR, et al. Implementing Obstetric Early Warning Signs. AJP Rep. 2018;8(2):e79-e84. To reduce maternal risk effectively, early warning systems that capture deterioration from a broad range of conditions may be required in addition to bundles tailored to specific conditions such as hemorrhage, thromboembolism, and hypertension.
   
   
   
   
Unit education on protocols, unit-based drills
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Rapid access to medications
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System plan for escalation, appropriate consultation, and maternal transport
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RECOGNITION AND PREVENTION: Every patient

Standard protocol for measurement and assessment of BP
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Standard response to maternal early warning signs
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Standards for educating women on signs/symptoms of hypertension and preeclampsia
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RESPONSE: Every case of severe hypertension/preeclampsia

Standard protocols for hypertensive disorders
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Preeclampsia Early Recognition Tool (PERT)
Severe hypertension checklist
Suspected preeclampsia algorithm
Eclampsia algorithm
Labetalol algorithm
Hydralazine algorithm
Oral nifedipine algorithm
Support plan for patients, families, and staff for ICU admissions and serious complications
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REPORTING/SYSTEMS LEARNING: Every unit

Establishing a culture of huddles and post-event debriefs
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Multidisciplinary review for systems issues
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Monitoring outcomes and process metrics
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INFORMATION FOR EMERGENCY DEPARTMENT PROVIDERS

Readiness
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Recognition
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Response
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Reporting and systems learning
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INFORMATION FOR PEDIATRIC CARE PROVIDERS

Care in the nursery
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Care after discharge
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