Abstract: SA-PO526
Why We Treat Asymptomatic Blood Pressure Elevations in the Hospital
Session Information
- Hypertension and CVD: Clinical - II
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Canales, Muna T., VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
- Citty, Sandra W., VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
- Winchester, David E., VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
- Freytes, I. Magaly, VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
Background
In the hospital, asymptomatic blood pressure elevations (ABPE) are often treated with Pro Re Nata blood pressure medications (PRNBP). There is no evidence to support this practice, and recent literature suggests it may be harmful. Provider and nursing rationale and motivations for treating ABPE are not well understood.
Methods
We recruited clinical providers and nurses from inpatient non-ICU settings for 1 on 1 semi-structured interviews. Based on the Theoretical Domain Framework Interviews were coded in a rolling fashion by a multidisciplinary group until theme saturation was achieved.
Results
We interviewed 10 providers (years in role): 5 internal medicine/hospitalist physicians (10-22), 1 midlevel provider (8), 4 housestaff (2-7); and 6 nurses (1.7-4 years). Definitions for HTN “emergency” vs “urgency” varied within each group with respect to threshold for definition and for treatment. Providers and nurses felt that treatment varied by patient factors and nursing experience or stress level, while nurses felt there was variability by provider. All noted hospital factors that could affect BP including pain, stress, measurement technique, diet, substance abuse, and missed medications. Most providers felt that using PRNBP would lead to more harm than good, though some noted benefit to titrate scheduled medications, quick nursing response and less calls to doctor. Some providers feared being viewed as negligent by nursing or patients if they did not treat. Factors related to rapid response thresholds and need for MD to push IV medications at the bedside also influence provider and nursing actions. Nurses cited goal of keeping vitals in the normal range using PRNBP. Some providers felt guidelines needed regarding thresholds for treatment of inpatient ABPE. For buy in from providers, education of providers and nursing regarding new literature to support guidelines would be helpful to change practice. A few providers stated that adding alerts in the medical record or penalties to change practice is not desirable while another said alerts would be helpful. Nurses did not feel a need for any change to practice save to make PRNBP more accessible in the computer system.
Conclusion
Education of providers, nursing and patients regarding goals for ABPE with an algorithm for an approach to management may be helpful to optimize treatment of ABPE in the hospital.
Funding
- Veterans Affairs Support