Date of Completion
Fall 2026
Document Type
DNP Scholarly Project
Academic Department
School of Nursing
Degree Type
Doctoral
Degree Name
Doctor of Nursing Practice
First Advisor
Lydia Forsythe, PhD, MA, MSN, RN, CNOR
Abstract
Problem: Hypertension is a significant chronic disease management challenge at an urban Federally Qualified Health Center (FQHC), where about 26% of adults aged 18 to 85 years have uncontrolled blood pressure (BP). Despite the organization achieving a hypertension control rate of 74%, which exceeds the national FQHC average of 57.6% and approaches the goal of 80%, there remains inconsistent implementation of evidence-based hypertension management. The lack of standardized workflow has led to variances in BP reassessment, treatment management, lifestyle counseling, documentation, and follow-up, resulting in missed opportunities for guideline-directed care.
Aim of the Project: The quality improvement (QI) project aimed to improve outcomes by implementing consistency in evidence-based hypertension management by implementing a standardized hypertension checklist during a 10-week period at the urban FQHC. The goal was to reduce practice variation and promote consistent, guideline-directed care for adults with uncontrolled hypertension.
Review of the Evidence: Evidence supports standardized clinical workflows and decision-support tools to improve adherence to hypertension guidelines and reduce practice variation. The American Heart Association (AHA) Hypertension Toolkit served as the evidence-based foundation for the intervention.
Project Design: The QI initiative followed the Institute for Healthcare Improvement (IHI) Model for Improvement (MFI) and used Plan-Do-Study-Act (PDSA) cycles, along with the OhioHealth Change Management Model (OHCM), to support stakeholder engagement, communication, workflow adaptation, feedback, and sustainability planning.
Intervention: Medical assistants were guided to initiate a paper-based hypertension management checklist during patient rooming for individuals with elevated BP (≥140/90), while providers completed the clinical components. The checklist reinforced steps such as BP reassessment, medication management, lifestyle counseling, and documentation of clinical rationale.
Significant Findings/Outcomes: During the 10-week implementation period, provider-level hypertension control rose from 58.06% pre-implementation (90/155) to 62.75% post-implementation (91/145), marking an 8.1% relative increase. Eighty-nine checklists were collected, with 66 patients eligible after exclusions. Staff reported greater consistency and confidence in sustaining the intervention.
Implications for Nursing: The QI project demonstrated that standardized hypertension workflows equip nurses and advanced practice nurses with strategies for consistent, evidence-based care. Findings support that sustainability hinges on optimizing workflows, integrating electronic health records, engaging staff, and securing organizational leadership support.
Recommended Citation
Wilson, Angelica, "Implementing an Evidence-Based Checklist to Improve Hypertension Clinical Performance" (2026). All Doctor of Nursing Practice (DNP) Scholarly Projects. 79.
https://fuse.franklin.edu/dnp-project/79
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