Download procedure for blood pressure monitoring

CLINICAL PROCEDURE
PROCEDURE FOR BLOOD PRESSURE
MONITORING
Issue
History
Issue
Version
One
Purpose of Issue/Description of Change
To accurately perform and obtain a blood
pressure measurement in a community setting
Planned
Review Date
2016
Named Responsible Officer:-
Approved by
Date
Quality and Governance Service
Quality, Patient Experience and
Risk Group
December 2013
Section:- CP25
Target Audience
Multidisciplinary
UNLESS THIS VERSION HAS BEEN TAKEN DIRECTLY FROM TRUST WEB SITE THERE IS
NO ASSURANCE THIS IS THE CORRECT VERSION
PROCEDURE FOR BLOOD PRESSURE MONITORING
CONTROL RECORD
Title
Purpose
Author
Equality Assessment
Subject Experts
Document Librarian
Groups consulted with:Infection Control Approved
Date approved by Quality, Patient
Experience and Risk Group
Method of Distribution
Archived
Access
Procedure for Blood Pressure Monitoring
To accurately perform and obtain a
measurement in a community setting
Quality and Governance Service (QGS)
Integrated into procedure
Lorraine Adams
QGS
Clinical Policies and Procedures Group
2nd Review 13.11.13
December 2013
Email
Date
Via QGS
VERSION CONTROL RECORD
Version Number
Author
Version 1
L Adams
blood
Yes
Intranet:- Staff Zone
Location:- Datix Librarian
Status
N
Changes / Comments
New
Status – Revised
PROCEDURE FOR BLOOD PRESSURE MONITORING
2/12
pressure
No
PROCEDURE FOR BLOOD PRESSURE MONITORING
INTRODUCTION
To ensure the effective, co-ordinated management of blood pressure monitoring undertaken
by health professionals who have been trained and assessed to be competent when
delegated this procedure.
TARGET GROUP
This procedure is performed by all health professionals who are required to carry out this
procedure as part of their role.
TRAINING
All staff in the Trust are required to comply with mandatory training as specified in the Trusts
Mandatory Training Matrix. Clinical Staff are also required to comply with service specific
mandatory training as specified within their service training matrix.
Blood pressure monitoring is a core competency of a registered health professional. Health
care assistant, nursing auxiliaries and assistant practitioners need to have been trained and
have their competence assessed by a registered nurse. A record of this must be kept in their
personal file.
Assistant Practitioners and Nursing Auxiliaries are required to undertake training in the use of
the Omron Sphygmomanometer (or equivalent). A blood pressure competency must be
completed and updated every 2 years. A copy should be kept within their portfolio and
personal file.
REFERRAL
Accurate patient information regarding the indication for blood pressure (BP)
monitoring(please refer to indications) and relevant patient diagnosis is required from the
referring clinician to enable the registered nurse to appropriately delegate blood pressure
monitoring to a non- registered practitioner.
RELATED POLICIES
Please refer to relevant Trust policies and procedures
INDICATIONS
Patients who have been assessed by a registered health professional and have been
identified as requiring a blood pressure measurement.
Where medication requiring blood pressure monitoring
Patients who have the potential of Autonomic Dysreflexia
Screening patients who may have hypertension/hypotension
As indicated for initial nursing assessment
As indicated following nursing reassessment
PROCEDURE FOR BLOOD PRESSURE MONITORING
3/12
PROCEDURE FOR BLOOD PRESSURE MONITORING
CAUTIONS
Oscillometric blood pressure devices may not be accurate in those with weak or
thready pulse.
Patients with Atrial Fibrillation should have blood pressure taken using a aneroid
sphygmomanometer
In patients with heart beats below 50 beats/minutes, even if the rhythm is regular,
some of the semi-automatic devices are unable to reduce their deflation rate
sufficiently so that too rapid a fall in cuff pressure results in underestimation of systolic
blood pressure and overestimation of diastolic blood pressure
Patients who have had trauma to the upper arm, previous mastectomy, Arteriovenous
fistula or a forearm amputation should not have blood pressure measured from the
effected side or those at risk of lymphedema
In pregnancy diastolic blood pressure is best measured using the disappearance of the
Korotkoff V sounds.( Consider using aneroid monitoring device).
If the use of an aneroid sphygmomanometer is indicated the registered nurse or health
professional needs to consider the appropriateness of delegating this role to an
Assistant Practitioner and /or Nursing Auxiliary or Nurse Practitioner.
PREPARATION OF EQUIPMENT
The accuracy of the blood pressure reading obtained is highly dependent upon proper use of
the equipment provided
Blood pressure monitoring equipment must be recalibrated annually by Electronic Biomedical
Equipment (EBME) Department at Wirral University Teaching Hospital Trust. It is the
responsibility of the team leader/ case load manager to have a system in place to monitor and
maintain quality assurance with this standard.
Clean blood pressure machine and cuff with Trust approved cleaning wipe.
Use a single patient use cuff cover when a patient has a multi resistant organism
The circumference of the upper arm must be measured at the widest point in order to
determine which size cuff be used. See table below:Arm Circumference
Less than 23cm
Cuff Size
Small Adult
23cm to 33cm
33cm to 50cm
Standard Adult
Large Adult
51cm to 53cm
Adult Thigh Cuff
PROCEDURE FOR BLOOD PRESSURE MONITORING
4/12
PROCEDURE FOR BLOOD PRESSURE MONITORING
CONSENT
Valid consent must be given voluntarily by an appropriately informed person prior to any
procedure or intervention. No one can give consent on behalf of another adult who is deemed
to lack capacity regardless of whether the impairment is temporary or permanent. However
such patients can be treated if it is deemed to be within their best interest. This must be
recorded within the patient’s health records with a clear rationale stated at all times. Refer to
Trust Patient Information and Consent Policy for further information and guidance or the
Clinical Protocol for Assessing Mental Capacity and Best Interests.
EQUIPMENT –
Organisational recommended blood pressure device
Various cuff size
Tape measure
Relevant documentation
Spare batteries
single patient use cuff cover (if required)
Trust approved cleaning wipe
aneroid sphygmomanometer (if indicated)
Diagnostic and Screening Standards to Promote and Maintain Patient Safety
Description of how each step in the process
is undertaken
a. How the
Screening/Diagnostic
procedure is
requested
In line with individual doctors
surgeries. Requests are made Via
fax with patient history and the length
of time the patient requires their
blood pressure monitoring(ensure
this is a safe haven fax machine)
b. How the clinician
treating the patient is
informed of the
results
(including timescales)
The General practitioner will receive
the results the same day in written
format via (safe haven fax). If the
patient’s blood pressure is
180/110mmHg or above or their
pulse is less than 50 beats per
minute. The doctor needs to be
contacted immediately via telephone;
this should be documented within the
patient’s health records along with
recommendations from the doctor.
The results still need faxing to the
surgery
The patient is informed of the results
by the person performing the
c. How the patient is
informed of the
Additional comments:-
Individual surgeries have
specific ways of working.
Ensure you are aware of these.
In the event of fax down time,
paper request forms and patient
information can be collected
from individual doctor surgeries.
Urgent results are returned back
to the patient’s clinician
immediately via telephone.
However this must be explained
to receptionist staff that it is
important to speak to doctor
directly in order for them to
triage the telephone call.
Patient informed at time of
procedure.
PROCEDURE FOR BLOOD PRESSURE MONITORING
5/12
PROCEDURE FOR BLOOD PRESSURE MONITORING
results (including
timescales)
d. Taking action on
the result of
diagnostic /screening
tests (including
timescales) : documentation of
the result
procedure
 interpretation of
the result
 how patient is
followed up or
referred following a
screening
Which staff are
authorised to request
this test?
By the referring clinician.
For the GP or requesting clinician to
action the results
Filed within patients health records
along with treatment and course
Patient should be aware of
treatment plan if indicated and
the GP should action any further
treatment or changes,
depending on results
Please ensure any allergies are
kept up-to-date in records to
reduce risks to patients
By the referring clinician
All Trust staff who have a clinical
rationale as to why they are
requesting the proposed procedure
PROCEDURE
Prior to procedure, advise patient not to eat, take alcohol, smoke or exercise for 30 minutes
before their blood pressure is measured, as these factors may affect the accuracy of the blood
pressure reading.
ACTION
Verbally confirm the identity of the patient by
asking for their full name and date of birth. If
client unable to confirm, check identity with
family/carer
Introduce yourself as a staff member and any
colleagues involved at the contact
Wear identity badge which includes name
status and designation
Ensure verbal consent for the presence of any
other third party is obtained
Explain procedure to patient including risks
and benefits and gain valid consent
Decontaminate hands
Ask patient to remove any tight arm clothing.
Assist the patient if required, ensuring privacy
and dignity at all times
RATIONALE
To avoid mistaken identity
To promote mutual respect and put client at
ease
For patients to know who they are seeing and
to promote mutual respect
Students for example, as the client has the
choice to refuse
Enables patient to make an informed decision
to proceed with blood pressure monitoring
To reduce the risk of transfer of transient microorganisms on the healthcare workers hands
Allows the cuff to be applied in the correct
position thus reducing the potential for error.
PROCEDURE FOR BLOOD PRESSURE MONITORING
6/12
PROCEDURE FOR BLOOD PRESSURE MONITORING
Check skin condition of the upper arm
Request the patient to empty their bladder if
they need to.
If patients arm is:Swollen/oedematous or has any breaks do not
continue, seek advice.
If necessary clean arm to prevent cross
infection
Can effect blood pressure reading(NICE, 2006)
The patient should be seated in a temperate
environment and relaxed for at least 5 minutes
prior to procedure. Their legs should be
uncrossed and flat on the floor
Whilst patient is seated measure the
circumference of the upper arm at the widest
point and record in the health care record
Select appropriate cuff from measurements
obtained(NICE, 2011)
To minimize the effects of the environment to
ensure an accurate reading is obtained (NICE,
2006)
Support the patients arm out-stretched at
heart level and check the brachial pulse,
rhythm and pace.
If the arm is above or below heart level and not
relaxed the reading may be effected (NICE
2006) This is to ensure that the most
appropriate equipment is used e.g. a patient
with arterial fibrillation should have blood
pressure taken with aneroid
sphygmomanometer(NICE,2011)
To obtain an accurate blood pressure
measurement
Apply the cuff and measure blood pressure,
following the procedure for the use of the
monitoring device. Patient should not talk
during the procedure
Allows the correct sized cuff to be used
Using the wrong sized cuff can affect the
reading obtained
Note the reading in the patients records
To maintain an accurate record of readings
Repeat procedure for other arm (If indicated)
Blood pressure readings can differ between
arms (NICE 2006). The arm with the highest
reading should be used for all subsequent
readings (BHS 2006).
Performing sitting and standing BP monitoring
(If indicated or requested)
Ask the patient to Stand (If able)for 1-3
minutes(BHS 2006) and then take a further
blood pressure measurement with the arm
supported, from the arm that the highest
reading obtained
Document in patient’s health care records(see
appendix 1)
Decontaminate reusable equipment using
Trust approved cleaning wipe.
Blood pressure readings can differ
with the patient sitting or standing older people
can suffer from ‘postural hypotension’(blood
pressure dropping when they stand
Decontamination of medical equipment is
essential for the effective delivery of patient
care.
PROCEDURE FOR BLOOD PRESSURE MONITORING
7/12
PROCEDURE FOR BLOOD PRESSURE MONITORING
On completion of procedure, decontaminate
hands.
To remove any accumulation of transient
micro-organisms
Document blood pressure reading within
health records
Inform General Practitioner by fax on the day
the measurements were obtained(see
appendix 2)
Inform General practitioner by telephone and
fax if reading is above 180/110mmHG(see
appendix 2)
Inform General Practitioner by telephone and
fax if pulse rate is less than 50 beats/ per
minute
As per trust record keeping policy
Patient’s GP to make timely clinical decisions
and adapt the patient's treatment, if required.
May indicate that the patient has
accelerated(malignant)
hypertension(NICE,2006)
Blood pressure measurements may not be
accurate(BHS 2006)
WHERE TO GET ADVICE FROM
Team leader/line manager
INCIDENT REPORTING
Clinical incidents or near misses must be reported via the Trust’s Datix incident reporting
system.
SAFEGUARDING
In any situation where staff may consider the patient to be a vulnerable adult, they need to
follow the Trust Safeguarding Adult Policy and discuss with their line manager and document
outcomes.
REFERRALS
Any referrals to health professionals, therapists or other specialist services must be followed
up and all professional advice or guidance documented in the patients health records.
EQUALITY ASSESSMENT
During the development of this procedure the Trust has considered the clinical needs of
Each protected characteristic (age, disability, gender, gender reassignment, pregnancy and
maternity, race, religion or belief, sexual orientation). There is no evidence of exclusion of
these named groups.
If staff become aware of any clinical exclusions that impact on the delivery of care a Trust
Incident form would need to be completed and an appropriate action plan put in place.
PROCEDURE FOR BLOOD PRESSURE MONITORING
8/12
PROCEDURE FOR BLOOD PRESSURE MONITORING
REFERENCES –
British Hypertension Society (2006): Blood Pressure Measurement. Fact file.
http://www.bhsoc.org/files/6813/4398/9702/BHS_BP_Measurement_Factfile_2006.pdf
Nursing and Midwifery Council (2010): Advice on delegation for NMC registrants.
www.nmc-org
The Royal Marsden Hospital Manual of Clinical Nursing Procedures. Eighth Edition.(2011)
Edited by Lisa Dougherty and Sara Lister.
PROCEDURE FOR BLOOD PRESSURE MONITORING
9/12
APPENDIX 1
RISK ASSESSMENT FOR SCREENING/DIAGNOSTIC PROCEDURES
Name of Screening/Diagnostic Procedure:
Date risk assessed:
Risk assessed by:
Likelihood that process
Criteria
will fail
Low
Medium
High
a. Process for requesting
the screening/diagnostic
procedure
low
b. Process for informing
the clinician treating the
patient of the result
low
c. Process for informing the
patient of the result
low
d/e. Process for action
from a diagnostic test or
following-up or referring the
patient after a screening
test
low
Identify risks from the
‘process’ of conducting the
test if relevant
Risk identified in process
Mitigation/Controls
Staff need to ensure that they receive enough information
from the referrer to provide care for Patients. Also they are
aware of GP surgeries processes and if unsure clarify
these with the GP surgeries. This is to ensure patients
receive a timely response to their needs and avoid
delayed treatment/monitoring or lost results
Staff need to ensure that they follow individual
GP surgeries processes and if unsure clarify these with
GP surgeries. This is to ensure that results are not
delayed and results that are urgent are acted upon in a
timely manner and patient is kept full informed regarding
their treatment.
Patient is made aware of the process and is told the
reading after monitoring and advised that the doctor will
be informed of results.
All actions should be
documented within the
patient’s health records to
ensure continuity of care
Practitioner should inform patient directly of treatment or
further diagnostics required giving patient enough time to
ask question
Staff should be made aware of risks of cross infection and
follow this procedure to protect patients and themselves.
Auxiliary Nurse must be deemed competent and this is the
responsibility of the person delegating to ensure they are
aware of the process.
Staff should clarify this prior to
obtaining blood pressure
reading so that the procedure
is documented within the notes
so all parties are aware of the
process.
Patient should be made aware
of the results and how the GP
will be informed and will
contact patient if treatment or if
further monitoring required
Any treatments need to be
documented with in the
patient’s records this includes
medication, strength dose and
length the prescription is for .
Any allergies need to be kept
up to date within records.
Reduce the risks to patient and
ensure the process for
individual surgeries is followed
PROCEDURE FOR BLOOD PRESSURE MONITORING
Appendix 2
Blood Pressure Monitoring Record
Date
Time
Blood Pressure Left Arm
Blood Pressure Right Arm
Blood Pressure Standing
Any Further Measurements
Print Name
Signature
Designation
Date
Time
Blood Pressure Left Arm
Blood Pressure Right Arm
Blood Pressure Standing
Any Further Measurements
Print Name
Signature
Designation
PROCEDURE FOR BLOOD PRESSURE MONITORING
11/12
PROCEDURE FOR BLOOD PRESSURE MONITORING
Appendix 2
BLOOD PRESSURE MONITORING COMMUNICATION RECORD
Patient Details
Patient Name:
Address & Postcode:
Date of Birth:
Contact Number:
NHS No:
GP:
Referral Details
Referred By
Referred To:
Designation
Date:
Contact No:
Time:
Fax No
Fax No:
Blood Pressure Measurements
Date
Time
Left are blood pressure
Right arm Blood pressure
Standing blood pressure
Any further measurements
Print Name
Signature
Designation
Additional
Comments……………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
……………………………………………………
PROCEDURE FOR BLOOD PRESSURE MONITORING
12/12