Key result
A multimodal quality improvement intervention decreased the proportion of admissions with PRN antihypertensive orders by 53% and administrations by 29% without increasing adverse events.
Why the study?
Inpatient PRN antihypertensive medications are frequently administered despite a lack of benefit and risk of adverse events, prompting an initiative to reduce their use without increasing adverse events from untreated hypertension.
Does a multimodal QI intervention reduce the use of PRN antihypertensive therapy in hospitalized adult medical patients with asymptomatic hypertension?
Does a multimodal QI intervention reduce the use of PRN antihypertensive therapy in hospitalized adult medical patients with asymptomatic hypertension?
Effect estimate: 53% decrease for orders and 29% decrease for administrations
A multimodal quality improvement intervention successfully reduced unnecessary PRN antihypertensive orders and administrations in hospitalized patients without increasing adverse events from untreated hypertension.
May safely reduce unnecessary PRN antihypertensive orders in non-emergent inpatients; leaves open need for randomized outcome confirmation.
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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Lipps et al. (2025) studied Asymptomatic Hypertension. Multimodal quality improvement intervention vs. Preintervention period was evaluated on Proportion of admissions with PRN anti-HTN use (53% decrease for orders and 29% decrease for administrations). A multimodal quality improvement intervention decreased the proportion of admissions with PRN antihypertensive orders by 53% and administrations by 29% without increasing adverse events.
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