Identifying Targets to Improve the Management of Severe Hypertension in Pregnancy and Postpartum.

OBJECTIVES: To (1) define quality indicators, (2) describe care gaps, and (3) identify process issues in severe hypertension (sustained systolic blood pressure [BP] ≥160 mm Hg or diastolic BP ≥110 mm Hg) management at our tertiary care centre. METHODS: Pregnant and postpartum persons diagnosed with a hypertensive disorder of pregnancy from 2018 to 2019 were identified. A retrospective cohort of patients with severe hypertension was constructed, and data were collected through chart review. Severe hypertension management was assessed according to defined quality indicators. Clinical characteristics were compared between participants with and without time-to-target BP within 60 minutes. Process issues were examined for each severe hypertension occurrence. RESULTS: Of 608 participants with a hypertensive disorder of pregnancy, 90 (15%) experienced severe hypertension. Median time-to-target BP was 76 minutes (interquartile range 47-123 minutes), and target BP (<155/105 mm Hg) was achieved within 60 minutes in 31/90 (34%) participants. Appropriate antihypertensives for severe hypertension were used in 55/90 (61%), and time-to-treatment initiation was within 30 minutes in 42/54 (78%). Chronic hypertension and oral labetalol use were associated with delays in achieving target BP. Process issues related to severe hypertension management included inappropriate treatment (n = 35/90; 39%), failure to recognize severe hypertension as an emergency (n = 21/90; 23%), and delayed treatment initiation (n = 12/54; 22%). CONCLUSION: We defined quality indicators for severe hypertension management. Time-to-target BP within 60 minutes was achieved in a minority of patients, and chronic hypertension was associated with delayed severe hypertension resolution. Process issues in severe hypertension management were described.

Pharmacy Practice in Quebec Emergency Departments: A Survey Study.

Background: According to a Canadian survey conducted in 2013, 37 of the 67 Quebec emergency departments (EDs) in hospitals with more than 50 beds reported having a pharmacist within the department. However, based on the 17 responses to the survey, it was not possible to determine patient care services offered by Quebec ED pharmacists, because the data were aggregated across all Canadian respondents. A provincial survey was undertaken to further define ED pharmacy practice within Quebec. Objectives: To measure pharmacist involvement in EDs in the province of Quebec and to describe patient care services and interventions offered by these pharmacists. Methods: A 47-question survey was sent to 33 directors of pharmacy departments, representing 90 hospitals and institutes with EDs in the province of Quebec. The directors of pharmacy were asked to forward the survey to an ED pharmacist for completion or to partially answer the survey themselves if their facilities had no pharmacists practising in the ED. The survey evaluated the presence of pharmacists in the ED, their training, the interventions they performed, and their involvement within the department. The presence and role of ED pharmacy technical staff were also evaluated. Results: Of the 43 completed surveys received, 30 reported at least 1 pharmacist providing patient care within the facility's ED. The most common tasks performed by ED pharmacists were, in decreasing order of frequency, answering questions from the multidisciplinary team, adjusting medications according to patients' allergies or their renal or hepatic function, managing drug interactions, and clarifying prescriptions. Pharmacists also reported teaching pharmacy students and residents and supporting the team in the resuscitation area. Conclusions: The majority of respondents reported having at least 1 pharmacist in the ED. Compared with previous Canadian results, this survey had more respondents from Quebec with better representation of ED pharmacy practice in the province. Patient care services provided by pharmacists were variable, possibly because of a lack of standardized practice guidelines.

Contexte: Selon une enquête canadienne menée en 2013, 37 des 67 services des urgences dans des hôpitaux québécois de plus de 50 lits ont déclaré avoir un pharmacien au sein de leur service. Cependant, à partir des 17 réponses de cette enquête, il n'a pas été possible de déterminer les services de soins aux patients offerts par les pharmaciens des services des urgences du Québec, car les données étaient agrégées pour tous les répondants canadiens. Une enquête provinciale a été menée pour mieux définir la pratique de la pharmacie au sein des services des urgences au Québec. Objectifs: Mesurer l'implication des pharmaciens dans les services des urgences du Québec et décrire les services de soins aux patients et les interventions offerts par ces pharmaciens. Méthodes: Un sondage comportant 47 questions a été envoyé à 33 chefs de départements de pharmacie, représentant 90 hôpitaux et instituts ayant un service des urgences au Québec. Les chefs de départements de pharmacie ont été invités à transmettre le sondage à un pharmacien du service des urgences pour qu'il y réponde; ou, si leur établissement ne comptait aucun pharmacien exerçant en service des urgences, à y répondre partiellement eux-mêmes. L'enquête a permis d'évaluer la présence des pharmaciens dans les services des urgences, leur formation, leurs interventions et leur implication au sein du département. La présence et le rôle du personnel technique en pharmacie des urgences ont également été évalués. Résultats: Sur les 43 questionnaires remplis reçus, 30 indiquaient avoir au moins un pharmacien prodiguant des soins aux patients dans le service des urgences de l'établissement. Les tâches les plus courantes consistaient, par ordre décroissant de fréquence, à répondre aux questions de l'équipe multidisciplinaire, à adapter les médicaments selon les allergies des patients ou leur fonction rénale ou hépatique, à gérer les interactions médicamenteuses et à clarifier les ordonnances. Les pharmaciens ont également déclaré former les étudiants et les résidents en pharmacie et soutenir l'équipe dans la salle de réanimation. Conclusions: La majorité des répondants ont déclaré avoir au moins un pharmacien au service des urgences. Par rapport aux résultats canadiens antérieurs, cette enquête comptait plus de répondants du Québec et indiquait une meilleure représentation de la pratique de la pharmacie au service des urgences dans la province. Les services de soins aux patients fournis par les pharmaciens étaient variables, peut-être en raison d'un manque de directives de pratique normalisées.