Year of Publication

2017

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Sharon E. Lock

Clinical Mentor

Dr. Christopher M. Yost

Committee Member

Dr. Lynne Jensen

Abstract

Purpose: A quality improvement project was undertaken in an internal medicine clinic to evaluate provider adherence with the Eighth Joint National Committee (JNC 8) hypertension (HTN) medication management guidelines for adult patients diagnosed with HTN, evaluate characteristics associated with clinical inertia (CI) in patients with uncontrolled HTN, and evaluate the utility of a brief educational intervention to decrease CI.

Methods: The project used the plan-do-study-act method to assess JNC 8 prescribing guideline adherence by consenting providers. Medical records were randomly selected from patients with HTN seen at provider visits 10 days before (January 31-February 13, 2017) and 10 days after (February 15-28, 2017) a brief provider intervention. A random sample of 100 patient records from each time point were reviewed. Records were examined for demographic data, antihypertensive medications, blood pressure measurements, and documentation of distribution of patient hypertension (HTN) education handouts. Blood pressure readings at the most recent visit were examined for evidence of HTN control per JNC 8. Patients with lack of HTN control had their record further examined for documentation of interventions to determine CI.

Results: There was no significant difference between the demographics of the pre-intervention and post-intervention groups. HTN control was 65% in the pre-intervention group and 64% post-intervention group (p > .05). The percent CI was 23.5% pre-intervention group and 45.7% post-intervention group (p > .05).

Conclusion: A quality improvement project using a brief educational intervention in an internal medicine clinic showed no effect, but improvements were seen when comparing HTN control and CI to past observations. Suggestions for clinical improvement are to address HTN at acute visits, increase use and documentation of non-pharmacological interventions, documenting formal HTN patient education handouts, multi-stage quality improvement projects for greater impact, increased use of patient adherence assessments, or larger implementations such as team based care models.

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