CORRECTLY MEASURING BLOOD PRESSURE

At handover, the outgoing nurse mentions that just prior to coming into handover, a patient had a high blood pressure (BP) reading.

She had taken the blood pressure only once.

Previously the patient’s blood pressure was within normal range.

In the middle of a busy round, the incoming nurse passes on the information that the patient had  a high blood pressure reading.

Without any further information and because the round was leaving the room, the patient is quickly written up for hypertensive medication.

Measurement of high blood pressure is among the first skills that nurses learn.

But how accurate are those readings?

A research letter in JAMA identified blood pressure measurement error as a major cause of poor BP control.

Errors that occur in taking blood pressure included inappropriate cuff size. talking during measurement, terminal digit preference and incorrect arm and body positioning.

The American Heart Association recommends repeating a BP measurement during a clinic visit.

There should be 1 minute separating the BP readings.

Yet this does not happen and in a busy environment,  BP is measured only once.

Taking a BP twice is a way of reducing measurement error and avoid over-treatment.

The research letter evaluated the effect of a second BP measurement.

It found that taking a BP for a second time when a reading was at least 140/90 mm Hg, there was a change of -8 mm Hg.

Taking it again resulted in 36% of patients having a final reading below 140/90 mm HG and this avoided a potential over treatment.

It can be hard when nurses are busy to do the necessary followup but the implications for not doing so has an impact on patient care.

A standard of nursing practice for consideration is that a high blood pressure reading should be confirmed a second time before it is reported upon.

To learn more about measuring high blood pressure:

Baron, Robert B. “Treating Blood Pressure Correctly by Measuring It Correctly.” JAMA Internal Medicine. (online)

Pickering, Thomas G., et al. “Recommendations for blood pressure measurement in humans: an AHA scientific statement from the Council on High Blood Pressure Research Professional and Public Education Subcommittee.” The Journal of Clinical Hypertension 7.2 (2005): 102-109.

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