Back to the Basics: A Quality Improvement Program to Enhance Clinical Staff Use of Evidence-Based Standard Blood Pressure Measurement Techniques

Learning objective: Evaluate the use of a skills-based education program to improve clinical staff (RNs, LPNs, and medical assistants) competence in providing an evidence-based technique for measuring BP and improving BP control in our primary care clinics.

Background: Uncontrolled hypertension is one of Kentucky’s leading health problems and contributes to poor patient outcomes. Accurate measurement of blood pressure (BP) is critically important in primary care, but ambulatory care BP measures are inherently problematic. Many experienced clinicians do not measure BP accurately because they either take shortcuts or lack knowledge regarding the appropriate technique. Inaccurate BP assessment can lead to inadequate diagnoses of hypertension (HTN). The standard evidence-based technique for measuring BP includes having the patient seated for 3-5 minutes in a quiet room with legs uncrossed, not talking, and back supported. BP should be re-checked after 5 minutes if elevated. In-office BP measurement using a correct size, upper-arm cuff constitutes the evidence-based reference method for current BP classification and treatment targets.

Methods: This quality improvement project will utilize the plan-do-study-act (PDSA) cycle to evaluate the use of a skills-based educational program to improve clinical staff competence in using an evidence-based technique for measuring BP and for improving BP control in primary care clinics. Controlled HTN was defined as the percentage of patients 18-85 years of age who have a diagnosis of HTN whose most recent BP was adequately controlled (