Maternal Hypertension Initiative
Hypertensive disorders of pregnancy (HDPs) are among the leading causes of severe maternal morbidity (SMM) and maternal mortality in the US and Alabama and have been on the rise in recent years. Further, maternal mortality rates in the US are higher than in other developed countries, and non-Hispanic black women experience maternal deaths at a rate three to four times that of non-Hispanic white women. HDPs are preventable if caught and treated appropriately. Although evidence-based guidelines are available, screening for and treatment of HDP does not occur consistently across labor and delivery units in a timely manner.
Project Aim
In 2021 ALPQC launched the Maternal Hypertension Collaborative, with the aim of reducing by 20% SMM in pregnant and postpartum patients with preeclampsia/eclampsia.
In efforts to achieve the ALPQC’s project aim for maternal hypertension, the Alliance for Innovation on Maternal Health (AIM) provides structured patient safety bundles with actionable steps to improve patient outcomes and data collection.
Increase timely treatment of severe hypertension
Increase proportion of patients receiving follow-up appointments and preeclampsia education at discharge
Narrow Black-White inequities in SMM
Key Documents
Plan-Do-Study-Act (PDSA)
Data Resources
- HTN Outcome Measures Codes (Excel) (March 2023)
- HTN Data Measures Form (PDF) (September 2022)
- HTN Data Collection Form – Outcome Measures (Excel) (September 2022)
- HTN Data Collection Form – Process+Structure Measures (Excel) (September 2022)
- How to Use Random Number Generator (PDF)
- HTN Outcome Baseline Data Collection Instructions (PDF) (August 2022)
- ALPQC Maternal HTN FAQs (June 2022)
- AIM HTN Bundle Data Collection Plan (PDF) (September 2022)
- AlaHA Data Portal Graphing How-To (PDF)
Toolkit
Readiness: Develop & Implement Standard Processes for Optimal Care
Recognition & Prevention: Educate, Identify, Assess
Clinical Staff Education
- Severe Hypertension in Pregnancy – ACOG District II
- Patient, Family and Staff Support After a Severe Maternal Event AIM Bundle & Resources
- Getting Back Up: Being and Helping the Second Victim – SMFM
Conduct Regular Drills of Severe Hypertension Protocols
- Obstetric In-Site Drill Program Manual – AIM
- The Role of Medical Simulation – CMQCC
- ACOG District II Simulation and Drill Scenarios & Tools (bottom of page)
- ACOG Simulation Eclampsia Formative Evaluation
- Simulation Scenario – CMQCC
- Safety Action Series: Hypertension Drills
- Support After a Severe Maternal Event AIM Bundle & Resources
- Getting Back Up: Being and Helping the Second Victim – SMFM
Respond: Timely Treatment of Severe Hypertension
Timely treatment of severe hypertension
- AIM FAQ: Treatment for Acute Onset Severe Hypertension
- First Line Therapies and Seizure Prophylaxis – ACOG District II
- Steps for Preparation, Storage, Ordering and Administration of Magnesium Sulfate – CMQCC
- Post-Discharge Evaluation of Elevated BP – ACOG District II
Protocols, Draft Order Sets and Checklists:
- ACOG Hypertensive Emergency Checklist
- ACOG Eclampsia Checklist
- ACOG Emergency Department Postpartum Preeclampsia Checklist
- First Line Therapies Algorithms – ACOG District II
- ACOG Sample Order Sets Pocket Guide – ILPQC
- CMQCC Preeclampsia Toolkit
- Sample Preeclampsia/Eclampsia Medication Toolbox – CMQCC
- ACOG District II Safe Motherhood Initiative App (NEW)
Change Systems: Foster a Culture of Safety and Improvement
Respectful Patient Partnership
- Visualizing Health Equity: One Size Does Not Fit All (NEW)
- Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families – AHRQ (NEW)
- Safety Action Series – Empowering Patients, Improving Outcomes
- ACOG District II Symposium on Racial Disparities and Implicit Bias in Obstetrical Care
- Reduction of Peripartum Racial/Ethnic Disparities AIM Bundle & Resources
- Harvard Project Implicit
- IHI Achieving Health Equity: A Guide for Health Care Organizations
- March of Dimes – A Health Crisis Impacting Women and Babies of Color
- CDC Hear Her Campaign
Conduct Debriefs to Evaluate Effectiveness of Care, Treatment, Services
Huddles, Debriefs, Multi-Disciplinary Reviews Tools
- TeamSTEPPS Team Strategies & Tools to Enhance Performance and Patient Safety: Briefs, Debriefs and Huddles
- Hypertensive Emergency Team Debriefing Form – Huntsville Hospital System
- Severe Hypertension-Preeclampsia Debrief Form – CMQCC
- Hypertension in Pregnancy Debriefing Guidance, Forms and Tips – FPQC
- Severe Hypertension Debrief Form- ILPQC
- Severe Maternal Morbidity Review Guidance & Forms – Council on Patient Safety in Women’s Health Care
Additional Resources
- AIM Severe Hypertension in Pregnancy Patient Safety Bundle webpage
- ILPQC Severe Maternal Hypertension Initiative
- FPQC Hypertension in Pregnancy Initiative
- SMFM Course: New Joint Commission Standards for Maternal Safety – Practical Strategies for Implementation
- The Joint Commission R3 Report Issue 24: PC Standards for Maternal Safety
Action Period Calls & Webinars
2023
- October 2023 Action Period Call: Transition Into Sustainability | Slides
- August 2023 Action Period Call: Data Overview & Hospital Team Share | Slides
- June 2023 Action Period Call: Hospital Team Share | Slides
- April 2023 Action Period Call: Hospital Team Share | Slides
- February 2023 Action Period Call: Hospital Team Share & Data Review | Slides
2022
- December 2022 Action Period Call: Hospital Team Share & Severe Maternal Mortality Review | Slides
- October 2022 Action Period Call: Reviewing Baseline Data & Protocols for Treatment | Slides
- September 2022 Action Period Call: Data Collection & Reporting Clarifications | Slides
- August 2022 Action Period Call: Data Collection Strategies & Reporting | Slides
- July 2022 Learning Session 1.2: QI and Data | Slides | Recording
- June 2022 Learning Session 1: Maternal Hypertension Overview | Slides | Recording
Archive
- Drills, Simulations and Debriefs – July 2021
- Team Talks – June 2021
- Readiness – May 2021
- Data Measures and Portal Review – April 2021
- Severe Hypertension Identification & Management – March 2021
- Collecting & Entering Data – February 2021
- 2021 Learning Session: Maternal Hypertension Overview – January 2021
- ALPQC 2020 Summit