Our participating teams increased the percentage of birthing people with severe hypertension who were treated within 60 minutes from 55% to 71%. The shift in the data seen on the Shewhart chart above represents a relative improvement of 30% and demonstrates the change ideas implemented by our teams created an impactful improvement.
MNPQC concluded the first phase of a statewide quality improvement initiative to improve the identification, treatment, and follow up of hypertension in pregnancy and the postpartum period. Eight hospitals have been engaged on different levels of participation. Information/resources on this work is found here.
Blue Band Project
To identify gaps across systems providing care on maternal HTN and reach our communities across urban and rural regions, the MNPQC is introducing The Blue Band Project: an innovative system approach to implement across the continuum of care, including clinics, hospitals, homecare and community.
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.
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.
6. To increase early recognition and intervention with multiple teaching and education methodologies to engage patients and the community.
Congratulations to Astera Health, CentraCare, MHealth Fairview, Northfield Hospital, North Memorial Health and Riverwood Healthcare Center for completing our Hypertension in Pregnancy Initiative!
Hypertension Initiative Faculty Lead, MHealth Fairview
Dr. Sabol received her Obstetrics & Gynecology training at Oregon Health & Science University and completed her Maternal-Fetal Medicine training at Washington University in St. Louis. She is now full-time faculty at the University of Minnesota/MHealth Fairview. Her career focus is centered on hypertensive disorders of pregnancy and quality improvement and implementation science in obstetrics. She is currently receiving her Master’s in Patient Safety and Healthcare Quality from Johns Hopkins Bloomberg School of Public Health. 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 postpartum home blood pressure monitoring system for all hypertensive patients delivered at that institution. She is eager and excited to work towards improving access, quality, and healthcare equity for birthing people in our state.
HTN Faculty Lead, CentraCare
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.
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.
MPO/MNPQC Executive 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.
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.
Jane Taylor is an Improvement Advisor and Learning Designer. She supports learning collaboratives and innovation projects by providing expertise in improvement approaches and measurement. Since 2016, Jane has provided quality improvement expertise for MN Perinatal Association and MNPQC on Preventing Preterm Births, Hypertension in
Pregnancy and Postpartum Care, The Early Hearing Diagnosis Initiatives, and the MOSTaRE Opioid Project. Currently she severs on the Data Committee and the Steering Committee.
Jane has dedicated the last 22 years of her profession career to improving lives for newborns, infants, children and birthing people. For fun she is an amateur violinist and ballroom competitor. She enjoys sailing on Lake Pepin in the summer with her husband and their dog, Pepper.
No bio at this time.
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.
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.
No bio at this time.
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.
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.
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.
MD, MNPQC Board President, MHealth Fairview
Dr. Jessica L. Nyholm is an obstetrician-gynecologist in Minneapolis and is affiliated with multiple hospitals in the area, including M Health Fairview, University of Minnesota Medical Center, and Maple Grove Hospital. She began as a specialist in Maternal-Fetal Medicine at the University of Minnesota. Jessica is passionate about Quality Improvement in Obstetrics, with involvement in both the OB Clinical Practice Council through North Memorial Health and Zero Birth Injury (ZBI) through M Health. Additionally, she has an interest in perinatal infections, with a focus on cytomegalovirus infection in pregnancy.
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.
The Mother Baby Center • Abbott Northwestern Hospital MSN, RNC, C-ONQS, PHN
Clinical Program Specialist
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.
No bio at this time.
Black Nurses Association
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.
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, 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.
1. Citation: Ford ND, Cox S, Ko JY, Ouyang L, Romero L, Colarusso T, Ferre CD, Kroelinger CD, Hayes DK, Barfield WD. Hypertensive Disorders in Pregnancy and Mortality at Delivery Hospitalization – United States, 2017-MMWR Morb Mortal Wkly Rep. 2022;71:585-591. DOI: 10.15585/mmwr.mm7117a1.
2. Citation: Ford ND, Cox S, Ko JY, Ouyang L, Romero L, Colarusso T, Ferre CD, Kroelinger CD, Hayes DK, Barfield WD. Hypertensive Disorders in Pregnancy and Mortality at Delivery Hospitalization – United States, 2017-MMWR Morb Mortal Wkly Rep. 2022;71:585-591. DOI: 10.15585/mmwr.mm7117a1.
3. Citation: Preeclampsia Foundation – Answers to our most frequently asked questions. https://www.preeclampsia.org/
faqs. May 1, 2023.
4. Citation: CDC – Pregnancy Mortality Surveillance System. https://www.cdc.gov/
reproductivehealth/maternal- mortality/pregnancy-mortality- surveillance-system.htm. May 1, 2023.