Abstract Body: Background and Purpose
2022 Intracerebral Hemorrhage (ICH) guidelines encourage treatment of blood pressure (BP) as soon as possible following identification of ICH. Our academic comprehensive stroke center (CSC) evaluated the initiation of antihypertensive medications and target systolic BP goals for ICH patients.
In patients with acute spontaneous ICH, we aimed to improve timeliness of BP treatment through education of nurses provide providing hyperacute ICH care.
Methods
A retrospective chart review was conducted on patients presenting to the CSC from May 2023 - November 2023 & December 2023 - May 2024, utilizing Get With The Guidelines® data. BP timepoints included the time to antihypertensive medication (Door to Initiation), and time to reaching BP goal (Door to Systolic Goal). In addition, we analyzed barriers to implementation.
Education was developed by the CSC core stroke team and provided to nurses who care for patients with ICH in the hyperacute phase. Nurses were provided education in orientation and in-real-time about BP goals for ICH, and education was adjusted to address barriers.
Results
Door to initiation of antihypertensive medication administration decreased from 53 minutes (52.38%) to 33 minutes (90.91%). There was noted Improvement in Door to Systolic Goal from 109 minutes (55.0%) to 99 minutes (57.14%). Barriers to implementation included time constraints on staff in the Emergency Department (ED) to titrate continuous drips. Staff needed additional coaching on antihypertensive drips and rapid titration to reduce BP. Patients with airway compromise, staffing models, and high acuity assignments factored in the prioritization for reducing BP.
Conclusion
Nursing education improved door to antihypertensive administration in patients with ICH from 53 minutes to 33 minutes. Following the intervention, 90.9% of patients had an initiation of an antihypertensive under one hour. However, only 57% met the systolic BP goal within 90 minutes. Additional focus is needed to identify time goals to achieve systolic BP.
“This work represents the author’s independent analysis of local or multicenter data gathered using the AHA Get With The Guidelines® (GWTG) Patient Management Tool/IQVIA Registry Platform but is not an analysis of the national GWTG dataset and does not represent findings from the AHA GWTG National Program.”