AKPQC AIM Hypertension Initiative – Alaska State Hospital and Nursing Home Association

AKPQC Alliance for Innovation on Maternal Health Hypertension Initiative

Alliance for Innovation on Maternal Health (AIM) Hypertension Initiative

Hypertensive disorders in pregnancy are increasing in Alaska, with hypertensive disorders contributing to two out of the six pregnancy-related deaths in Alaska during 2012-2016. In 2018, nearly 1 in 20 (4.6%) of birthing people in Alaska were diagnosed with preeclampsia. Among those births, over 1 in 10 (10.2%) experienced severe maternal morbidity (SMM). Based on these data and feedback from key stakeholders, the Alaska Perinatal Quality Collaborative (AKPQC) launched its first initiative focused on maternal hypertension in March 2019. This initiative engaged six hospitals, representing 63% of Alaska births, in implementation of the Alliance for Innovation on Maternal Health (AIM) Severe Hypertension in Pregnancy safety bundle. Using a collaborative quality improvement framework, participating hospitals were supported through monthly collaborative-wide team and data meetings, quarterly webinars, and technical assistance.

As a result of this initiative and efforts of participating hospitals, the AKPQC exceeded its primary goal by reducing the rate of SMM among birthing people with preeclampsia by 28% from 2018 to 2020. The rate of SMM among preeclampsia cases in 2020 was 7.4%, the lowest rate in the most recent five years. The AKPQC continues to support participating hospitals with sustainability planning and data reporting.

AIM Hypertension Initiative Key Driver Diagram and SMART Aim

Implementation Plan

Background and Foundational Resources

Data Resources

Quality Improvement Resources

March 2020: Resources to develop standard order sets, treatment protocols, and checklists for recognition and response to severe maternal hypertension

April 2020: Ensuring rapid access to IV and PO hypertensive medications

- Guidelines for treatment of severe hypertension (Alaska Native Medical Center or ANMC)
- Nifedipine order set (ANMC)
- Labetalol order set (ANMC)
- Severe Hypertension in Pregnancy and ED presentation by Sarah Truitt, MD and Leanne Komorowski, MD (ANMC)
- Severe Hypertension in Pregnancy presentation by Neil Murphy, MD (ANMC)

May 2020: May 2020: Train providers and nurses on recognition and response to severe maternal hypertension and accurate blood pressure measurement

June 2020: Executing protocols to treat severe hypertension within 60 minutes

Implementation of the AIM Hypertension Bundle presentation by Danette Schloeder (The Children’s Hospital at Providence)

July 2020: Ensure patient follow within 10 days for all patients with severe hypertension and within 72 hours for patients on medications

Postpartum Hypertension Follow-up at ANMC by Tirza Cannon, OB/GYN

August 2020: Implement patient-centered education of pregnant people and their families on signs and symptoms of severe hypertension/preeclampsia

September 2020: Establish a system to perform regular debriefs after all cases of severe hypertension

California Maternal Quality Care Collaborative Preeclampsia Toolkit: Teamwork and Communication. Includes strategies for effective team communication and approaches to resolving conflicts.
Pocket Guide: Team STEPPS. Includes definitions and checklists for briefs, debriefs, and huddles.
Department of Defense Briefs and Huddles Toolkit. Includes a facilitation guide for training staff on briefs and huddles with videos and case study exercises.
Florida PQC Debriefing Following a Severe Incident in Pregnancy. Includes tips and promising practices for debriefs

October 2020: Establish a process for multidisciplinary reviews of all cases of severe maternal morbidity

November 2020: Implement systems to identify pregnant and postpartum patients in all hospital departments

Identifying and treating pregnant and postpartum patients in the ED by Danette Schloeder
Emergency Care for Patients During Pregnancy and the Postpartum Period: Emergency Nurses Association and Association of Women’s Health, Obstetric and Neonatal Nurses Consensus Statement
ACOG District II: Emergency Department Postpartum Preeclampsia Checklist

December 2020: Implement systems to support patient, families, and staff following a severe maternal event

AIM Hypertension Initiative Learning Sessions

- Standardized Severe Maternal Morbidity Review: Use of Teams, Tools, and Tracking Slides18.20
- Standardized Severe Maternal Morbidity Review: Use of Teams, Tools, and Tracking Recording 18.20
- Addressing Psychological Impacts of Severe Maternal Events on Providers, Patients, and Families Slides (8/31/20)
- Addressing Psychological Impacts of Severe Maternal Events on Providers, Patients, and Families Recording (8/31/20)
- Management of Postpartum Hypertension/Preeclampsia Slides (2/20/20)
- AIM Hypertension Learning Session Recording (10/15/19)
- AIM Hypertension Learning Session Slides (10/15/19)
  - Topics: Case Study, Patient Education, Accurate BP measurement
- AIM Hypertension Learning Session Recording (8/5/19)
- AIM Hypertension Learning Session Slides (8/5/19)
  - Topics: Facility Story, AIM HTN Readiness domain, Timely treatment
- AIM Introductory Webinar Recording (3/19/19)
- AIM Introductory Webinar Slides (3/19/19)

Email [email protected] for more information.