Hypertension in Pregnancy

MNPQC is hosting a statewide quality improvement initiative to improve the identification, treatment, and follow up of hypertension in pregnancy and the postpartum period.

4-10%

US pregnancies affected by hypertensive disorders.

9%

of maternal deaths in the US are attributed to severe maternal hypertension

1/3

of severe obstetric complications from Preeclampsia/Eclampsia

6% & 19%

(preterm births & medically indicated induced preterm births)

are the result of severe maternal hypertension

Charter

Hypertensive disorders of pregnancy are increasing in incidence and are a leading cause of severe maternal morbidity(SMM). Timely treatment of hypertensive urgency is a well-understood best practice but can be challenging to operationalize consistently:

  • Hypertensive disorders of pregnancy affect 3-11% of all pregnancies.
  • Minnesota and national data demonstrate Black and Native American women are disproportionately impacted.
  • Other risk factors include hypertension prior to pregnancy, advanced maternal age, Type 1 or 2 diabetes, obesity, multiple gestations, and prior preeclampsia.
  • Hypertensive disorders of pregnancy are responsible for up to 17% of all maternal mortality in the US.
  • Neonatal outcomes are impacted.
  • The American College of Obstetrics and Gynecology endorses treating a hypertensive crisis within 60 minutes to reduce the risk for stroke and other adverse outcomes.

Aim: By Feb. 2023, we will develop reliable processes of  recognition and treatment of obstetric hypertension (HTN) during pregnancy and up to six weeks postpartum to reduce severe maternal morbidity (SMM) by 25% and achieve 80% or higher compliance of the HTN recognition tool and OB HTN emergency pathway.

Objectives

  • 1. Assess individual health system barriers and facilitate solutions to implement hypertension treatment strategies.

  • 2. Assess provider knowledge of interventions to reduce hypertension including treatment disparities for Black and Native American women and offer education opportunities to increase provider knowledge.

  • 3. Introduce a standardized process for treatment of hypertension including standardized order set, medication treatment kit and/or discharge planning protocol.

  • 4. Identify methods to incorporate anti-racism into individual practice and organizational guidelines.

  • 5. Identify various methodologies to enhance patient education and engagement to increase early recognition and intervention.

Resources





Faculty

Working Group

Abby Stoffel

MHA

Abby is a Quality and Process Improvement Specialist at the Minnesota Hospital Association (MHA) and is the staff lead for the MHA Perinatal Committee. She attended the University of Minnesota Twin Cities and graduated with a Bachelor’s Degree in Health Services Management.

Anne Walaszek

MNPQC Executive Branch

Anne Walaszek, MPH (Anishinaabe) is the Maternal and Child Health Quality Improvement Specialist in the Women and Infant Health Unit at the Minnesota Department of Health. In her role, she leads two quality improvement grants, the Perinatal Quality Collaborative and the Communities Collaborating to Prevent Girls Opioid Abuse. Ms. Walaszek has experience working at a national non-profit addressing cancer inequities within American Indian and Alaska Native communities. In this role, she provided leadership for a clinic and community health approach to develop and implement culturally tailored evidence-based interventions to effectively build capacity in health systems across Indian Country. Her public health experience reflects grant writing, program development, research and data management throughout her experiences at the Minnesota Department of Health Diabetes Program, Institute of Child Development at the University of Minnesota, and SAMHSA for their Child, Adolescent and Family Branch. She is a 2017 recipient of the Lou Fuller Award for Distinguished Service in Eliminating Health Disparities.

 

Beth Sabol

Hypertension Initiative Co-Chair, MHealth Fairview

Beth received her Obstetrics & Gynecology training at Oregon Health & Science University and completed her Maternal-Fetal Medicine training at Washington University in St. Louis. Her experience with quality improvement started as a resident working on a multidisciplinary effort to improve communication and patient outcomes in the setting of unplanned cesarean deliveries. During her fellowship, to combat high postpartum readmission rates and to improve maternal outcomes, she implemented a home blood pressure monitoring system for all patients delivering at that hospital. She is eager and excited to work with patients and providers across the state to improve access, quality, and healthcare equity in our state.

Melissa Bray-Erickson

CentraCare / AWHONN MN Section

Melissa has been working in obstetrical nursing for the past 20 years at a variety of facilities, from the small community hospital, to a large urban obstetrical care unit. She has worked as a Charge RN, a circulator, scrub and assist in the OR. Her current work as a Nurse Clinician began in August of 2013 at CentraCare Health, St. Cloud Hospital. Melissa is a part of the Molnlycke Speaker’s Bureau. She is a former Perinatal Expert Consultant with the Minnesota Hospital Association (MHA), and serves on the MHA Perinatal Safety Committee. Melissa serves on the Minnesota Perinatal Quality Collaborative and the Maternal Mortality Review Committee through the Minnesota Department of Health. Melissa is a 2012 Graduate of Western Governors University with a Master’s in Nursing Education. She is a present member of ANA, AWHONN, MOLN, AORN, ASPAN and Sigma Theta Tau professional nursing organizations, and serves as the current AWHONN Minnesota state chair. She was featured in “The Call of Nursing” written by William Patrick.

Phillip Rauk

MNPQC Executive Branch

Dr Rauk lead quality for Fairview System in OB for 10 years and serves at MHA as lead of their Perinatal Committee. He is the Vice Chair of Quality and Safety Department and an OB GYN at University of Minnesota.

Susan Boehm

MPO Executive Director/Treasurer, MNPQC Co-Director


Susan has been a Clinical Nurse Specialist in Women’s Health for over 30 years. She has a long history with MPO as a volunteer, conference presenter, planning committee member, and has served on the Board of Directors. She is currently the MPO Executive Director and Co-Director of the Minnesota Perinatal Quality Collaborative (MNPQC).

She enjoys the outdoors, hiking and kayaking, and loves the solitude of their cabin in the Boundary Waters.

Todd Stanhope

MNPQC Faculty

Dr. Stanhope is a full-time OB/GYN hospitalist and medical director of Women and Children’s services at North Memorial Health Hospital. His clinical interests include hypertension, complex deliveries, and postoperative opioid prescribing. Prior to his current position, he provided contracted OB coverage at a number of facilities, high and low volume, in several states and completed two missions to South Sudan with Doctors Without Borders from which he gained invaluable experience learning the myriad needs and challenges different facilities and systems face.

Alina Kraynak

MDH

No bio at this time.

Angie Thompson

Mayo Clinic

Angela has been an OBGYN with full scope speciality practice for many years, and is now primarily in laborist/OB hospitalist practice. She has experience practicing in both low and high resource settings both in the United States and in countries outside of the U.S. She has an MPH and her professional interests lie in optimizing maternal care from both the levels of individualized patient care while in the larger context of improving population health.

Arielle Skalisky

MN ACNM

Ari is an experienced labor and delivery nurse and newly Certified Nurse Midwife. She was born in Addis Ababa, Ethiopia and grew up in Hermantown, Minnesota. She graduated from The College of Saint Scholastica (BSN) in 2016, and most recently, The University of Minnesota (DNP) in 2020. Ari was involved in the Improvement of Neonatal Abstinence Syndrome Outcomes project and her interests include health disparities among minority women; adolescent health; perinatal mood disorders.

Becky Gams

MHealth Fairview / AWHONN MN Section

Becky obtained a BSN at the University of Wisconsin Eau Claire and a Masters of Science from the University of Minnesota. She has over 30 years of obstetrical nursing experience at the bedside, as an education specialist and is currently an Advanced Practice Nurse Leader for the Women’s and Children’s Service Line at MHealth Fairview. She is certified as a Women’s Health Nurse Practitioner. Becky is one of the founding members of the Zero Birth Injury Initiative at MHealth Fairview, a perinatal safety initiative aimed at reducing preventable birth injuries to both mothers and newborns. She is the co-lead the ZBI Steering Committee and the ZBI leadership team for MHealth Fairview with Dr. Phillip Rauk. She is the recipient of the University of Minnesota Medical Center Visionary Nurse Leader Award in 2016.

Beth Elfstrand

MN-ACOG

Dr Elfstrand has been a practicing physician in Minneapolis for 26 years. She has served in leadership roles at Abbott Northwestern Hospital for over a decade and served on Alina pregnancy care council for many years and worked on multiple quality projects. She is serving as chair of ACOG in MN and go to several district and national meetings each year.

Cameron Berg

North Memorial

No bio at this time.

Cara Carter

MHealth Fairview

Cara is a current Master of Public Health- Maternal Child Health student at University of Minnesota who has a Doctor of Pharmacy and completed residency at University of Missouri Women’s and Children’s Hospital. She is a licensed pharmacist in Missouri, Arizona, North Carolina, and Texas. She has led quality improvement projects during residency in the neonatal intensive care unit regarding Synagis and the pediatric intensive care unit regarding pediatric delirium. Cara completed a teaching certificate program from the University of Missouri-Kansas City and has experience teaching pharmacists, pharmacy students, physicians, residents, nurse practitioners, and medical students.

Carrie Neerland

MHealth Fairview / MN ACNM

Carrie Neerland is an Assistant Professor in the University of Minnesota’s Nurse-Midwifery program and practices full-scope midwifery. Dr. Neerland has experience with quality improvement projects in maternity care, especially around reducing primary cesarean births. Dr. Neerland represents the Minnesota Affiliate of the American College of Nurse-Midwives.

Charles Snow

CentraCare Health

CJ is a board certified OB/GYN with broad experience in both rural and urban practice settings. He is currently employed as a OB laborist at St. Cloud Hospital and recently completed an MBA from St. Thomas.

Marijo Aguilera

Health Partners

Dr Aguielera is a maternal fetal medicine specialist at Health Partners in St. Paul.

Heather Brusegard

Family Advocate

Heather Brusegard, Special Assistant, US Federal Government. Heather grew up in St. Paul, Minnesota and graduated from the University of Minnesota with a degree in Child Psychology. Heather and her husband Derek reside in Brooklyn Park, Minnesota with their two children, Eleanor (5.5) and Scarlett (3). Heather delivered Scarlett twelve weeks early and has been actively involved with the NICU & antepartum community since.

Jaime Slaughter-Acey

MHealth Fairview

Jamie’s research primarily focuses on environmental (social and physical) and psychosocial factors that contribute to women’s health across the life course, with emphasis on the maternal and child health (MCH) of marginalized/underserved populations. In particular, she seeks to improve our understanding of the social meaning of race and skin color and how they intersect with other aspects of social identity to affect health. Her goal is to utilize the knowledge gained from her research to apprise the development of novel and interdisciplinary community-based solutions focused on building healthier and more equitable communities that help us to achieve MCH equity for all.

Julie Shelton

Essentia Health

Julie Shelton DNP, APRN, CNS for the Birthplace/NICU at Essentia Health St. Mary’s Medical Center Duluth, MN. She has worked for 33 years as an RN at this facility. She has been the Education Coordinator at a critical access hospital, the Coordinator for our High Risk OB Clinic and our NICU Follow-Up Clinic. She is responsible for system initiatives and quality metrics. She provides education for staff surrounding High Risk OB and Critical Care Obstetrics.

Katie Linde

MDH

No bio at this time.

Shalana Bolton

CentraCare

Shalana represents the St. Cloud ETC as a nurse educator. She has been an ED RN for 15 years and an educator for the past 3. She has a passion for the OB population.

Melanie Dixon

MHealth Fairview

Melanie is a OB GYN practicing with M Health Fairview Women’s Clinic in Burnsville, MN at Ridges Hospital. She attended medical school at the University of N.C.-Chapel Hill, and completed residency training at Mayo Clinic Graduate School of Medicine in Rochester, MN.

Michael Kassing

Essentia

No bio at this time.

Sara Wiggins

Black Nurses Association

Sara has over 27 years of experience in the health care field. Her experience includes OB/GYN, and currently, work for a health plan and help navigate members through policies, claims, utilization processes, and coverage.

Summer Johnson

Open Cities Health Center

Summer is the Chief of Strategic Development at an FQHC in St. Paul. Her background is in public health working with marginalized and minority groups as well as individuals with developmental disabilities. She continually works to provide accessible, affordable care to high-risk populations.

Tanya Melnik

MHealth Fairview

Tanya has worked in Obstetric Medicine since 2004. Her interest in hypertensive disorders of pregnancy resulted in collaboration with Preeclampsia Foundation and the first White Paper on preeclampsia and future cardiovascular risk. She holds Master’s degree in Patient Safety and has worked on several quality improvement projects in her organization.

Tony Pelzel

MHealth Fairview

Tony Pelzel, M.D. is a family medicine physician and the director of family medicine with obstetrics at HealthEast. He has over ten year’s experience providing maternity care and practicing primary care medicine in St. Paul.

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