减少无症状高血压住院患者按需降压治疗的应用

IF 0.9 4区 医学 Q4 HEALTH CARE SCIENCES & SERVICES
Kirsten M Lipps, Allison M Samuel, Deval Patel, Deborah Lemaster, Jordan Kenik
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引用次数: 0

摘要

背景:高血压(HTN)在住院环境中很常见,许多患者接受按需(PRN)抗高血压药物(anti-HTN),尽管缺乏益处和不良事件风险。我们的目的是在没有高血压急症的医疗患者中减少PRN抗HTN的使用,同时不增加未经治疗的HTN相关的不良事件。方法:我们的多模式质量改善(QI)干预措施,包括多学科教育和改变电子病历中的入院顺序,于2021年10月至2021年12月实施。我们纳入了血压升高(收缩压≥130 mm Hg或舒张压≥80 mm Hg)的成年医学患者,以评估干预前后PRN抗htn的使用情况。我们排除了入院诊断为高血压急症和需要保守血压治疗的患者。结果:干预后,使用PRN抗htn的住院比例在医嘱中下降了53%,在管理中下降了29%。使用PRN抗HTN的不良事件比未治疗的HTN更常见(4%比0.3%),干预后与未治疗的HTN相关的并发症没有增加。结论:我们的多模式、多学科QI倡议与住院患者PRN抗HTN使用减少有关,并且不会增加未治疗HTN的不良事件。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Decreasing the Use of As-Needed Antihypertensive Therapy in Hospitalized Patients With Asymptomatic Hypertension.

Background: Hypertension (HTN) is common in the inpatient setting, with many patients receiving as-needed (PRN) antihypertensive medications (anti-HTN) despite lack of benefit and risk of adverse events. We aimed to decrease PRN anti-HTN use in medical patients without hypertensive emergency without increasing adverse events associated with untreated HTN.

Methods: Our multimodal quality improvement (QI) intervention, which included multidisciplinary education and changes to the admission order set in the electronic medical record, was implemented from October 2021 through December 2021. We included adult medical patients with elevated blood pressure (BP) (systolic ≥130 mm Hg or diastolic ≥80 mm Hg) for evaluation of PRN anti-HTN use in pre- and postintervention periods. We excluded patients with admission diagnoses of hypertensive emergency and those requiring conservative BP management.

Results: Postintervention, the proportion of admissions with PRN anti-HTN use decreased by 53% for orders and 29% for administrations. Adverse events due to PRN anti-HTN use were more common than those due to untreated HTN (4% vs. 0.3%), and complications related to untreated HTN did not increase postintervention.

Conclusions: Our multimodal, multidisciplinary QI initiative was associated with decreased use of PRN anti-HTN in hospitalized medical patients and did not increase adverse events attributable to untreated HTN.

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来源期刊
Journal for Healthcare Quality
Journal for Healthcare Quality HEALTH CARE SCIENCES & SERVICES-
CiteScore
2.10
自引率
0.00%
发文量
59
期刊介绍: The Journal for Healthcare Quality (JHQ), a peer-reviewed journal, is an official publication of the National Association for Healthcare Quality. JHQ is a professional forum that continuously advances healthcare quality practice in diverse and changing environments, and is the first choice for creative and scientific solutions in the pursuit of healthcare quality. It has been selected for coverage in Thomson Reuter’s Science Citation Index Expanded, Social Sciences Citation Index®, and Current Contents®. The Journal publishes scholarly articles that are targeted to leaders of all healthcare settings, leveraging applied research and producing practical, timely and impactful evidence in healthcare system transformation. The journal covers topics such as: Quality Improvement • Patient Safety • Performance Measurement • Best Practices in Clinical and Operational Processes • Innovation • Leadership • Information Technology • Spreading Improvement • Sustaining Improvement • Cost Reduction • Payment Reform
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