Reducing the Nonindicated Use of IV Hydralazine in the Inpatient Setting

Figures

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  Figure 1. The AIM-AIM Approach Model The figure demonstrates an example model for managing BP in a holistic fashion and provides an alternative approach to managing elevated blood pressure without IV hypertensives. This was incorporated into the Epic order and educational materials. This model was derived from the American Heart Association Scientific Statement.1 BP = blood pressure.

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  Figure 2. Epic Order Set Modifications The figure shows the modified IV hydralazine order set. In bold red letters, on the top left of the interface, there is a reminder about potential risks of nonindicated IV hydralazine use. There is also the AIM approach model below to help guide decision making. The patient's 5 most recent blood pressures are also displayed. “Indication(s) of Use” represents a hard stop where clinicians must choose the indication for IV hydralazine to prescribe it. The dosage frequency has also been altered to serve a single PRN dose, and not a recurring dose by default. IV = intravenous; PRN = pro re nata.

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  Figure 3. Trends of IV Hydralazine Use Post Intervention (A) Documentation of all IV hydralazine use including severe HTN in pregnancy, end-organ damage, and nonindicated use. (B) Percentage breakdown of orders for each nonindicated use of IV hydralazine, with hypertensive urgency being the most common, followed by postop patients. (C) Changes in nonindicated use by provider role (attending, housestaff, APP) from preintervention (purple) to postintervention (magenta). APP = advanced practice provider; CAD = coronary artery disease; HTN = hypertension; IV = intravenous; MI = myocardial infarction; NPO = nil per os; TAVR = transcatheter aortic valve replacement.