Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Cathy Koetting, PhD, DNP, APRN, CPNP-PC, PMHS, FNP-C


Cathy Koetting, PhD, DNP, APRN, CPNP-PC, PMHS, FNP-C

Charity Galgani, DNP, APRN, WHNP-BC

Jennifer Kowal, MSN, CNM, WHNP-BC


Problem: Hypertensive disorders of pregnancy are a leading cause of morbidity and mortality. An area of concern is the lack of women and infant departments that have a standardized approach for treatment of severe hypertension congruent with the American College of Obstetricians and Gynecologists (ACOG) recommendations.

Methods: A department with approximately 4,000 deliveries per year was the site for this quality improvement project. A descriptive observational design was used to evaluate the effect of an updated protocol on treating hypertensive events within 30-60 minutes. The protocol was updated by a maternal fetal medicine physician and a certified nurse midwife. Data was evaluated 3 months prior to and 3 months after implementation of the updated protocol.

Results: One hundred fifty-five patients met eligibility criteria and participated in the project. The relationships between program change and meeting the time to treatment goal was significant, x2 (1, N = 155) = 8.8, p = 0.003. Variables shown to not have a significant relationship between program change were the average number of blood pressure readings to normalize per patient, the number of times the repeat blood pressure was met, and magnesium utilization.

Implications for Practice: Implementation of the updated protocol increased knowledge to staff and clarified notification to the house provider along with decreasing the percentage of severe maternal hypertensive events not treated within 30-60 minutes over a 3-month period. Updating the maternal severe hypertension recognition and response protocol resulted in improved practice to align with ACOG guidelines.