Purpose: The purpose of this initiative is to improve the quality of care for patients with hypertension by enhancing clinical staff knowledge of blood pressure measurement technique, increasing awareness of the quality metric for hypertension, and implementing a standardized protocol for repeat measurements including post-visit follow-up on a system-wide scale in ambulatory care clinics.

Background: While blood pressure measurement techniques are taught in nursing and medical assistant schools, these methods are rarely reinforced in clinical practice. A review of the organization’s quality metric data demonstrated the need for a standardized process for blood pressure measurement.

Methods: We searched PubMed for current best practices in “blood pressure determination” and refined the results to 34 articles to answer our question: In adult patients with a hypertension diagnosis aged 18-85 years in an ambulatory care setting who have a most recent blood pressure greater than 139/89, does system-wide online caregiver education and implementation of a standardized protocol improve the number of patients with a most recent blood pressure under control? The research confirmed the importance of ongoing education and the use of standardized procedures for blood pressure measurement technique. Interventions were developed to improve blood pressure measurement technique, including a micro-learning educational pathway and standardized protocol. To encourage participation and improvement, our team has created a competition-based approach, measuring percentage of improvement, where the winning clinic in each region will receive a celebratory event for their efforts and a spotlight article in our communications channel.

Results: Each participant will complete both a pre-test and a post-test that will assess their knowledge of blood pressure measurement skills, the hypertension quality metric, and perceived barriers or enablers to accurately measuring blood pressure in the clinic setting. A baseline data assessment will be performed, measuring performance during a 3-month period prior to implementation, and intermittent progress data will be completed during the competition period. At the completion of the competition, our goal is to see an overall improvement in blood pressure measurement technique, an increased number of repeat blood pressure measurements when a patient is not at goal, an increased number of follow-up blood pressure check appointments if indicated, and an overall increase of patients whose most recent in clinic blood pressure is under control.

Conclusions/implications: This initiative has not yet been implemented. We anticipate the first cycle of this implementation will be completed prior to the conference, with post-data available for success measures at that time.

Nicole Stuart-Pesevic MSN, RN, AMB-BC

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