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Abstract
Background Despite previous studies demonstrating accelerated deterioration in kidney function due to hypertension in paediatric patients with chronic kidney disease, there are significant discrepancies in the identification and management of elevated blood pressure in this high-risk population. Recognition of hypertension during childhood is hampered by the need for gender, age and height adjustment in calculations. We developed the Surveillance Target Outpatient blood Pressure (STOP) decision support tool to prompt team members to communicate BP percentile to identify hypertensive patients.
Objectives Improve recognition and intervention for elevated BP in ages 2–17 in a paediatric nephrology clinic. 1.) 90% of visits utilise STOP form 2.) 90% of elevated BP percentiles have documented intervention
Methods Model for Improvement framework was employed for this paediatric resident initiated QI project including rapid cycle PDSA testing beginning January through August 2017. Multidisciplinary teammates included receptionists, CMAs, nurses, and physicians. Daily data collection included quantitative measures analysed using run charts and control charts.
Results STOP form usage increased from an average of 69% to 92% (n=1498) using rapid cycle improvement by calculating and communicating BP percentile. Significant improvement was achieved in elevated BP management from an average of 74% to 100% of patients (n=483) with decreased variability occurring over the span of the project.
Conclusions We successfully used QI methods and tools to develop and implement a team–focused decision support tool to standardise and improve identification and management of elevated BP percentiles. The STOP form can be adopted and utilised in numerous clinical settings to identify those at risk for hypertension
Percentage of clinic visits with STOP forms (p chart)
Elevated BP percentile with intervention (p chart)