Date of Degree

Spring 2025

Document Type

DNP Scholarly Project

Academic Department

School of Nursing

Degree Type

Doctoral

Degree Name

Doctor of Nursing Practice

First Advisor

Melanie Brewer

Abstract

Problem: The problem at the practicum site is a delay in the treatment of severe range hypertension in postpartum patients due to IV push antihypertensives being administered by resident physicians who are clinically stationed in another building as opposed to the primary nurse.

Aim of the Project: The overall aim is to institute a protocol that will prevent a time delay for the treatment of severe range blood pressures in postpartum patients.

Review of Evidence: Hypertensive disorders during pregnancy and the immediate postpartum period are the leading cause of maternal morbidity and mortality. Obstetric related governing bodies have come to consensus over the importance of timely intervention of severe range blood pressure to decrease progression of symptoms and the potential for long-term health issues including stroke and other cardiovascular risks.

Project Design: This project was guided by the PDSA cycle and tools obtained by the OhioHealth change management model. Stakeholder identification, leadership action plans, change readiness surveys and education development plans were utilized throughout various stages of the project.

Intervention: A process change was instituted allowing the postpartum patient’s primary nurse to administer the IV push antihypertensive as opposed to the resident physician to decrease the time from severe range blood pressure to treatment.

Significant Findings/Outcomes: There were issues with compliance during project implementation as well as pharmacy verification delays, which resulted in the project not decreasing the time delay between severe range blood pressure and IV antihypertensive administration. One instance of noncompliance resulted in sixty-six-minute time delay for patient treatment, well below the standard.

Implications for Nursing: Efforts should continue to pursue a decrease in time for treatment of severe range blood pressures. This practicum site plans to expand this protocol to the different areas within the maternal/child division. Increased education about the importance of timely treatment of severe range blood pressures, and collaboration with IT and pharmacy to reduce the verification process time are currently in process. Additionally, efforts to empower nurses to recognize the emergency nature of severe range blood pressures and be able to override emergency medication prior to pharmacy verification are also being employed.

Rights

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