Readiness in Every Unit
- Adopt standards for early warning signs, diagnostic criteria, monitoring and treatment of severe preeclampsia/eclampsia (include order sets and algorithms)\cite{pe2,2015,pe4,pe5a,pe6}
- Unit education on protocols, unit-based drills (with post-drill debriefs) (American Congress of Obstetricians and Gynecologists)
- Process for timely triage and evaluation of pregnant and postpartum women with hypertension including ED and outpatient areas (American Congress of Obstetricians and Gynecologists 2013, Committee on Obstetric Practice 2015, California Maternal Quality Care Collaborative, New York State Department of Health 2013)
- Rapid access to medications used for severe hypertension/eclampsia: Medications should be stocked and immediately available on L&D and in other areas where patients may be treated. Include brief guide for administration and dosage. (American Congress of Obstetricians and Gynecologists 2013, Committee on Obstetric Practice 2015, California Maternal Quality Care Collaborative)
- System plan for escalation, obtaining appropriate consultation, and maternal transport, as needed (American Congress of Obstetricians and Gynecologists 2013, Committee on Obstetric Practice 2015, California Maternal Quality Care Collaborative)
Recognition
- Adoption of a standard protocol for measurement and assessment of BP and urine protein for all pregnant and postpartum women (Committee on Obstetric Practice 2015, New York State Department of Health 2013)
- Implementation of standard response to maternal early warning signs including listening to and investigating patient symptoms and assessment of labs (e.g. CBC with platelets, AST and ALT) (California Maternal Quality Care Collaborative, New York State Department of Health 2013)
- Implementation of facility-wide standards for educating prenatal and postpartum women on signs and symptoms of hypertension and preeclampsia (California Maternal Quality Care Collaborative, New York State Department of Health 2013)
Response
- Facility-wide standard protocols with checklists and escalation policies for management and treatment of: (California Maternal Quality Care Collaborative, New York State Department of Health 2013)
- Severe hypertension
- Eclampsia, seizure prophylaxis, and magnesium over-dosage
Postpartum presentation of severe hypertension/preeclampsia