Timeliness of Treatment of Persistent Severe Hypertension on Labor and Delivery
Abstract
Hypertensive disorders of pregnancy remain a leading cause of preventable maternal morbidity and mortality. Delayed treatment of persistent severe range blood pressures (SRBP) increases the risk of stroke and severe maternal complications. This is particularly significant in Tennessee, where over 90% of pregnancy-related deaths have been deemed preventable, underscoring the need to evaluate systems-level processes and identify modifiable barriers to timely care. This project aimed to determine whether patients experiencing persistent SRBP on a tertiary care labor and delivery unit were treated within recommended timeframes and to identify barriers to appropriate treatment. We hypothesized that while most patients would receive evidence-based care, workflow inefficiencies would be identified. We conducted a retrospective chart review of patients ≥18 years old who experienced persistent SRBP between July 1 and December 31, 2022, at Johnson City Medical Center. Persistent SRBP was defined as systolic blood pressure ≥160 mmHg or diastolic blood pressure ≥110 mmHg persisting ≥15 minutes, or two severe readings >15 minutes apart but <60 minutes apart. Seventy-eight patient charts were reviewed, representing 534 discrete SRBP episodes. Time from confirmation of persistent SRBP to antihypertensive administration was calculated. Treatment times were compared between pregnant and postpartum patients, and documented reasons for delays exceeding 60 minutes were analyzed. Of the 534 SRBP episodes, 59.18% were treated appropriately, while 40.82% experienced delayed or absent treatment. Mean treatment time was 14.22 minutes for pregnant patients and 15.11 minutes for postpartum patients (p=0.3546), with no significant difference between groups. Delays were associated with pharmacy verification, concurrent procedures, significant pain or emotional distress, and normalization of repeat blood pressures prior to medication administration. These findings identified actionable system-level barriers and informed implementation of nurse-driven escalation protocols and standardized order sets to improve maternal safety.
Start Time
15-4-2026 1:30 PM
End Time
15-4-2026 4:30 PM
Room Number
Culp Ballroom 316
Poster Number
63
Presentation Type
Poster
Student Type
Graduate and Professional Degree Students, Residents, Fellows
Faculty Mentor
Bethany Reynolds
Timeliness of Treatment of Persistent Severe Hypertension on Labor and Delivery
Culp Ballroom 316
Hypertensive disorders of pregnancy remain a leading cause of preventable maternal morbidity and mortality. Delayed treatment of persistent severe range blood pressures (SRBP) increases the risk of stroke and severe maternal complications. This is particularly significant in Tennessee, where over 90% of pregnancy-related deaths have been deemed preventable, underscoring the need to evaluate systems-level processes and identify modifiable barriers to timely care. This project aimed to determine whether patients experiencing persistent SRBP on a tertiary care labor and delivery unit were treated within recommended timeframes and to identify barriers to appropriate treatment. We hypothesized that while most patients would receive evidence-based care, workflow inefficiencies would be identified. We conducted a retrospective chart review of patients ≥18 years old who experienced persistent SRBP between July 1 and December 31, 2022, at Johnson City Medical Center. Persistent SRBP was defined as systolic blood pressure ≥160 mmHg or diastolic blood pressure ≥110 mmHg persisting ≥15 minutes, or two severe readings >15 minutes apart but <60 minutes apart. Seventy-eight patient charts were>reviewed, representing 534 discrete SRBP episodes. Time from confirmation of persistent SRBP to antihypertensive administration was calculated. Treatment times were compared between pregnant and postpartum patients, and documented reasons for delays exceeding 60 minutes were analyzed. Of the 534 SRBP episodes, 59.18% were treated appropriately, while 40.82% experienced delayed or absent treatment. Mean treatment time was 14.22 minutes for pregnant patients and 15.11 minutes for postpartum patients (p=0.3546), with no significant difference between groups. Delays were associated with pharmacy verification, concurrent procedures, significant pain or emotional distress, and normalization of repeat blood pressures prior to medication administration. These findings identified actionable system-level barriers and informed implementation of nurse-driven escalation protocols and standardized order sets to improve maternal safety.
