Why the study?
Guidelines recommend oral agents for inpatient asymptomatic blood pressure elevation, yet many clinicians use intravenous antihypertensives, risking unpredictable blood pressure changes.
Does a multidisciplinary quality improvement intervention reduce inappropriate orders of intravenous antihypertensives and associated adverse events in inpatients with asymptomatic blood pressure elevation?
Does a multidisciplinary quality improvement intervention reduce inappropriate orders of intravenous antihypertensives and associated adverse events in inpatients with asymptomatic blood pressure elevation?
A multidisciplinary quality improvement intervention significantly reduced the inappropriate use of IV antihypertensives for asymptomatic inpatient hypertension, leading to a concurrent decrease in adverse events.
Supports reducing inappropriate IV antihypertensive use in asymptomatic inpatients; hypothesis-generating and requires prospective validation.
BACKGROUND: Asymptomatic blood pressure elevation is common in the inpatient setting. National guidelines recommend treating with oral agents to slowly decrease blood pressure; however, many clinicians use intravenous antihypertensive medications, which can lead to unpredictable changes in blood pressure. OBJECTIVE: To decrease the number of inappropriate orders (without symptoms of hypertensive emergency or order for NPO) of intravenous antihypertensives and adverse events associated with intravenous orders. DESIGN: Quasi-experimental study with multidisciplinary intervention. PARTICIPANTS: Inpatients with a one-time order for an intravenous antihypertensive agent from January 2016 to February 2018. MAIN MEASURES: The main outcomes were the total numbers of orders and inappropriate orders, adverse events, and alternate etiologies per 1,000 patient-days. As a balancing measure, patients were monitored for adverse events when blood pressure was elevated and not treated. KEY RESULTS: There were a total of 260 one-time orders of intravenous antihypertensives on two medical units. Inappropriate orders decreased from 8.3 to 3.3 per 1,000 patient days (P = .0099). Adverse events associated with intravenous antihypertensives decreased from 3.7 to 0.8 per 1,000 patient days (P = .0072). CONCLUSION: This initiative demonstrated a significant reduction in inappropriate use of IV antihypertensives and an associated reduction in adverse events.
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Pasik et al. (2019) studied this question.
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