Management Protocols at Axim Government & Apam District - - PowerPoint PPT Presentation

Addressing Hypertension Management Protocols at Axim Government & Apam District Hospitals

Brian Perry Mentor: Dr. Alfred Yawson GE/NMF Scholar 2014 May 2014

Study Aims

 The aims of this project are to:

• 1. Explore the knowledge base of hypertension management

amongst hospital staff at Axim Government Hospital and Apam District Hospital

• 2. Highlight situations where IV Lasix would resolve in morbidity

especially in the setting of acute renal failure

• 3. Suggest an alternative approach to the current hypertensive

protocol

• 4. Facilitate educational exercises with local health care

professionals to implement a safer approach to the management of chronic hypertension and hypertensive urgencies/emergencies.

Hypertension Statistics

Hypertension Statistics: Axim

Hypertension Statistics: Apam

Standard Treatment Guidelines

Standard Treatment Guidelines

Approved Antihypertensive Medications

Approved Antihypertensive Medications

Methods

 On April 7, 2014 an hour and a half lecture training session was given  Attended by 36 health care professionals including nurses, midwifes, PA’s, and local physicians  A 10 question pretest and post test was given  Employees were instructed to read up on hypertension  Due to time constraints, the 1 week followup post-test was unable to be administered

Methods

 On April 23, 2014 an hour workshop was held  Attended by 29 health care professionals including nurses, midwifes, PA’s, and local physicians  A 10 question pretest and post test was given  Answers to the post-test were reviewed following the lecture  The following week, the same test was given to assess knowledge retention rates  Due to holidays and varying work schedules, only 10 exams were administered

Methods

 Lecture Objectives

 Review basic cardiac physiology and hypertension definitions  4 objectives of managing high blood pressure  Stratify patients into 4 treatment categories based on their blood pressure and risk factors  Describe elements of lifestyle modification (including health education and behavioral change strategies)  Formulate basic management plans for the longitudinal care of patients with HPT  Highlight the most common hypertensive emergencies where emergent blood pressure reduction is warranted

Lecture Footage

Results

 Axim  Attendance: 36  Administered Quizzes: N=21  Incomplete Post-Test: N=3  Pretest Avg: 57.1%  Post Test Avg: 73.8  Apam  Attendance: 29  Administered Quizzes: N=20  Incomplete 1wk Post- Test: N=9  Pretest Avg: 69.6%  Post-Test Avg: 77%  1 Wk Follow up Post- Test: 100%

Results (Axim)

57.1% N = 21 73.8% N = 18

10 20 30 40 50 60 70 80 Group Average Pre-Test Post- Test

Results (Apam)

69.5% N=20 77% N=20

100%

N=11

20 40 60 80 100 120 Group Average

Pre-Test Post-Test 1 Wk Post- Test

Limitations

 Axim Limitations

 Not enough tests available due to unexpected turnout  Inability to identify people due to instructions to put initials instead of full name  No Post-Test review of answers  Difficulty in administering post test post site visit  Not as many data points as Apam (ward, 1wk exam, etc)

 Apam Limitations

 Smaller sample size of 1 wk follow up

Future Directions

 Appoint the employees with the highest scores who have demonstrated enthusiasm as continuing medical education liaisons

 This person will be responsible for creating clinical vignettes to be administered to hospital staff  Ensuring patient safety and adherence to protocols  Brainstorm incentives for high performing health care professionals

 Monitor the management logs to ensure appropriate treatment  Data analysis: Stratify questions by concept to highlight areas of improvement

Case

 58F w/ a PMH of chronic HTN who has been noncompliant with medications presents to the A&E complaining of new

• nset palpitations and mild intermittent substernal chest

pain that started around 8am. She reports dizziness, visual changes, nausea, oliguria, and headache, but denies dyspnea, diaphoresis, pleuritc chest pain, and lower extremity edema  Physical Exam revealed a blood pressure of 220/108 and a tachycardic HR of 106. She had bounding carotid pulses, a 3/6 systolic murmur, and a displaced PMI. She was clear to auscultation bilaterally. No cyanosis, clubbing or edema

Case

 This clinical scenario is most likely consistent with

• A. Hypertensive Urgency
• B. Hypertensive Emergency
• C. Acute Pulmonary Edema
• D. None of the above

Case

 What is the next best step in management?

• A. Administer STAT Lasix 80mg IV q2hr until symptoms resolve
• B. Administer Hydralazine 5mg IV STAT followed by 5-10mg

q10mins until BP is stabilized at a SBP of 180mmHg

• C. Administer Lisinopril 40mg PO AND Nifedipine 90mg PO and

monitor patient in the A&E until his blood pressure improves before discharging him on oral medications.

• D. Start patent on Dobutamine 20mcg/kg/min to optimize

cardiac contractility

• E. None of the above

Case

 The patient given a hypertensive urgency diagnosis and was given Lasix 160mg IV, Diazepam 20mg and 500cc of DNS. She was transferred to the female ward and was discharged overnight.

Questions????