A quality initiative at NYC Health + Hospitals reduced unnecessary medication use in patients with severely high blood pressure, The Joint Commission said June 15.
Despite research showing single doses of IV antihypertensives could have an adverse effect on patients with asymptomatic severe hypertension, the practice is still common in emergency departments and inpatient sites. To avoid this, NYC Health + Hospitals altered their process for ordering IV hydralazine and IV labetalol.
Between November 2021 and October 2022, NYC Health's electronic ordering system showed "a nonintrusive nudge in the order instructions and an additional advisory statement with the appropriate indications and recommended assessment of alternate etiologies as a potential treatment alternative," The Joint Commission said.
There was also a requirement to document why the IV antihypertensive was being used.
After implementing these tweaks, emergency departments ordered 38.7 percent fewer antihypertensives, and inpatient units ordered 13.4 percent fewer.
"Given the high prevalence of elevated blood pressure in the hospital, an intervention that is inexpensive and able to scale such as this one could have significant impacts on patient safety and cost mitigation," Zachary Jacobs, MD, a professor of medicine at Portland-based Oregon Health & Science University, wrote in response to the initiative.