Develop and Implement a Best Practice in Blood Pressure Measurement at the Great Falls

OBJECTIVE

Develop and implement a Best Practice in Blood Pressure Measurement at the Great Falls Clinic which will provide both accuracy and continuity in patient care

Due to improper technique in blood pressure (BP) measurement Providers may not make a hypertension (HTN) diagnosis in the borderline patient or they may inappropriately diagnose and subsequently start treatment on a patient who does not have HTN. A critical component to diagnosing and treating HTN is accurate BP measurement at each patient encounter. The purpose of this Best Practice initiative is to ensure that all nursing staff are trained and follow proper procedure when obtaining a patient’s BP.

Through out the Clinic, there is no consistency on how a BP is obtained and no assurance that staff are hearing and recording accurate BPs. Patients are not asked about their use of caffeine, alcohol or nicotine 30 minutes prior to their appointment. Once in the room, they are not sitting appropriately and their arm is not positioned at heart level. BP cuffs size and placement is often incorrect and sometimes it is placed over clothing. The nurse often releases the air too quickly and the manometer is not at eye level. Any one of these can lead to an inaccurate measurement which can effect the treatment plan.

PURPOSED PLAN OF ACTION

The purposed plan of action is to develop a standard protocol for BP measurement in the Great Falls Clinic. Once developed and approved, a vigorous education plan and skills check off will be implemented to assure all nursing and nursing assisted staff are competent in proper BP measurement.

The attached procedural checklist has been developed based on internet research of current Best Practices in other medical facilities that have already collected and analyzed data regarding proper BP measurement. An intensive education plan will need to be implemented. This will involve multiple educational classes and skills assessment opportunities at all Great Falls Clinic locations so that all clinical personal can be properly trained and insure competency.

The skills assessment should be performed on a BP simulator arm. This devise is life-like arm that can be programmed with different BP readings. The clinical staff would be asked to demonstrate proper patient positioning, cuff placement and then they would use the simulator to actually obtain a BP reading. The simulator is the only way to insure that the staff person can accurately auscultate a BP.