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Enhancing the Process of Medication Titration in the Ambulatory Pulmonary Hypertension Population

S. Rodman

Diane Bray

S. Tointon

M. Asche

A. Loth

N. Ou

T. Wallerich

Robert Frantz


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Conference: 2015 PH Professional Network Symposium

Release Date: 09.17.2015

Presentation Type: Abstracts

File Download: 2015 Symposium Abstract - 1024

File Size: (240 kb)

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The purpose of this quality improvement initiative was to standardize the process of medication management based on response to therapy while maintaining high levels of patient and staff satisfaction.


Pulmonary hypertension (PH) treatment, including medication management, necessitates a multidisciplinary approach. Care teams are challenged with formulating a standardized process that allows all members of the team to practice at the top of their licensure and within the scope of their practice. Standardized protocols are helpful to streamline the process across multiple providers. In addition to this directive, patient safety and overall staff and patient satisfaction are imperative. Our overall patient and staff satisfaction was high prior to starting this enhancement process. Our goal was to maintain an acceptable level of satisfaction among staff and patients, while assuring safety and efficiency of practice. Providers in the PH clinic frequently prescribe medications to manage the unique symptoms of their patients. These medications require titration to the highest tolerated dose. The speed and amount at which the dose can be titrated varies from patient to patient and depends to a large extent on how well the drug is tolerated. One of the roles of the nurses is to contact the patients at pre-determined intervals to assess their tolerance of the medication(s) and complete a symptom assessment. The assessment process is essential to determine the response to therapy from the patient’s baseline. Although this process has been in place for some time it lacked clear and specific direction from the prescriber. We have developed protocols to assist with the baseline assessment of pulmonary hypertension symptoms and to provide objective measures of side effects during the titration process. Surveys were used to measure patient satisfaction and nursing and physician staff satisfaction. No adverse events related to patient safety were reported.


Order sets and protocols were developed and surveys utilized.


Our process enhancements have streamlined individualized care of the patient with pulmonary hypertension by the multidisciplinary team.


Medication protocols may be developed and safely utilized to assist with medication titration across the pulmonary hypertension disease management continuum.