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From 20% to 80% adherence: a pre–post intervention audit of NICE guideline implementation for hypertensive emergencies in Pakistan

Year: 2025

Type: article

Abstract: Background Hypertensive emergencies require prompt, guideline-based management to prevent life-threatening complications. Despite established protocols like those from the UK’s National Institute for Health and Care Excellence (NICE), adherence remains suboptimal in low-resource settings. This audit evaluated the impact of targeted interventions on compliance with NICE guidelines in a Pakistani emergency department. Methods A pre–post intervention study was conducted at District Headquarters Hospital, Nankana Sahib. Fifty patients with hypertensive emergencies (systolic blood pressure >180 mmHg and/or diastolic blood pressure >120 mmHg) were audited pre-intervention (December 2023). Interventions included staff training, standardized treatment protocols, and real-time monitoring. A reaudit of 50 patients post-intervention (September 2024) (audit standard: 100% adherence) assessed compliance. Chi-square tests compared pre/post-adherence rates; P < .05 was significant. Results Pre-intervention, only 20% (10/50) of cases adhered to NICE guidelines. Post-intervention, adherence rose to 80% (40/50; P < .001). Median time to blood pressure control decreased from 5.2 h [interquartile range (IQR): 3.8–6.5] to 2.1 h (IQR: 1.5–3.0; P = .003). No strokes or myocardial infarctions occurred post-intervention. Conclusions Simple, low-cost interventions (training, protocols, and feedback) significantly improved guideline adherence and reduced time to BP control in a resource-limited setting. Sustained efforts are needed to bridge the remaining 20% gap. These findings support scalable strategies for low- and middle-income countries to enhance hypertensive emergency care.

Source: IJQHC Communications

DOI: 10.1093/ijcoms/lyaf021

Authors: Sakshi Kumari, Muhammad Adnan Wattoo, Abdullah Imtiaz, Muhammad Raheel Raza

Institution: Wah Medical College

Language: English

Topic: Clinical practice guidelines implementation

Subfield: Public Health, Environmental and Occupational Health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,500