Quality Improvement of a Safe Home Blood Pressure Monitoring in Pregnancy Programme

 

Blood pressure disorders in pregnancy are one of the leading causes of maternal morbidity and mortality. Pregnant women with hypertension (either pre-existing or developed in pregnancy) need close surveillance throughout their pregnancy and often need to have their delivery expedited to minimize adverse maternal and fetal outcomes. During the Covid-19 pandemic, a home blood pressure monitoring programme was implemented for pregnant women at risk of or with confirmed blood pressure disorders with a dedicated team of 2 midwifes overseeing the program to closely monitor these women whilst reducing face to face interactions. However due to the national midwifery staffing crisis, the program was embedded within the Maternity Day Assessment Unit (DAU) team to manage together with their workload of walk-in patients.

 

A baseline audit had been carried out against the standard operating procedure with assessment of staff awareness, patient safety and patient satisfaction. During a 5 month period in 2021, the audit showed a long referral to initial appointment time, poor follow-up and 3 potentially avoidable adverse outcomes. Our staff survey showed that 87% of staff were aware of the home blood pressure monitoring system but much improvement in the referral procedure and education was needed. Only 1/3 of patients were regularly compliant with the app and 2/3 had not returned their machines. However, all women on the programme gave positive feedback and wanted a home monitoring system to be maintained. Our quality improvement project commenced in April 2022 and was designed to assess the safety of the program with the ongoing staffing challenges. Our overall aim was to reduce avoidable adverse events caused as a result of an inadequately implemented system and therefore improve the overall safety of the service.