Year of Publication

2016

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Lynne Jensen

Clinical Mentor

Dr. Ashley Guiliani

Committee Member

Dr. Sharon Lock

Abstract

Purpose: To evaluate provider adherence to the current hypertension management guideline, JNC 8, by assessing blood pressure control in individuals diagnosed with hypertension in an internal medicine clinic.

Methods: A retrospective chart review was conducted to assess the percentage of patients diagnosed with essential hypertension meeting the blood pressure goals set forth in JNC 8. In the absence of blood pressure control, provider intervention was assessed. Data collected included blood pressure, use of home blood pressure log, documentation of blood pressure medication compliance, and provider interventions in the absence of blood pressure control across three office visits. In addition, current blood pressure control in the clinic was compared to blood pressure control from Guiliani’s (2014) quality improvement (QI) project.

Results: This QI project demonstrated that 44% of patients across all three visits had blood pressure control, with greater control in patients who were age 60-89 as compared to those patients who were age 18-59. In the absence of blood pressure control, providers failed to document any type of intervention in 34.3-54.3% of patients. When compared to the Guiliani’s (2014) QI project, blood pressure control across all visits has appeared to increase, from 24% in 2013 to 44% in the current project.

Conclusion: The current project demonstrated an improvement in blood pressure control as compared to Guiliani’s (2014) project, but providers failed to document changes in hypertension management plans for patients in the absence of blood pressure control up to 50% of the time. This is indicative of the continued presence of clinical inertia. Ensuring providers understand the importance of documenting interventions in the absence of control is essential in the management of hypertension as well as reducing the morbidity and mortality associated with uncontrolled blood pressure.

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