Oral Nifedipine Use After Launch of Nurse Driven EMR Care Pathway for Severe Hypertension in Pregnancy [23L]

INTRODUCTION: The use of care pathways via EPIC EMR is an emerging technology to standardize patient care. Timely treatment of hypertension is critical to prevent morbidity and mortality. ACOG guidelines recommend the use of oral nifedipine as a first line medication, especially if there is no intravenous access. We evaluated the use of oral nifedipine before and after care pathway creation. METHODS: A nurse driven care pathway and warning system was designed and implemented in the EPIC EMR inpatient environment. The pathway protocolizes the initial management of severe hypertension in pregnancy based on ACOG guidelines. The purpose of this study was to evaluate the difference in minutes to administration of oral nifedipine after the second severe range blood pressure reading in the 12 months before and after implementation of the pathway. The second area of interest was in the change in the frequency of use. RESULTS: In the 12 months before the pathway, the average time to administration of the nifedipine from the second severe range blood pressure was 40.41 minutes versus 22.75 minutes in the following 12 months ( P= .023). There were less episodes of administration of nifedipine (54) before the launch, which increased significantly (186) in the 12 months after launch of the pathway ( P= .012). CONCLUSION: Implementation of a nurse driven, care pathway for severe hypertension in pregnancy decreased the time to administration and increased the frequency of use of oral nifedipine.