Improving the use of intravenous antihypertensive medications in the hospital setting: a quality improvement initiative for patient safety

[摘要] Intravenous (IV) hydralazine, enalapril and labetalol areoftentimes used without indication for the treatment ofasymptomatic hypertension in the hospital setting andhave been shown to have substantial adverse effects thatare associated with increased morbidity and mortality, aswell as longer length of stay. Their use is also associatedwith greater monetary costs. In this project, we studiedthe frequency of use and consequences of thesemedications before and after a series of education cycleswhich clarified when and when not to use intravenousantihypertensives (IVAHs). Our initial aim was to decreasethe unindicated use of IVAH by at least 25% in the settingof asymptomatic hypertension in our community hospitalwithin a 1-year period after introducing education on thetopic.Multidisciplinary involvement throughout three Plan-DoStudy-Act (PDSA) cycles yielded favourable results. Wefocused on education towards a hospital-wide knowledgegap stemming from a lack of guidelines regarding thetreatment of asymptomatic hypertension, as well asthe guideline indications for IVAH. After three cycles ofeducation targeting different groups, the unindicated useof IVAH fell by a total of 66%, decreasing patient exposureby approximately 248 cases over the total course of thestudy and ultimately, yielding a 52% increase in patientsafety. Secondary outcome included a reduction in cost.It was noted that IV drugs cost more than their oralcounterparts. The culture change in switching away fromIVAH unless otherwise indicated was driven by repetitiveeducation and group discussion to close the gap createdby a lack of guidelines.

[学科分类] 药学