Unveiling the Impact: Training Transforms Rechecked Blood Pressure Rates

Objective: The technique to obtain blood pressure using a manual method has been updated, thus leading to a knowledge gap among medical assistants, nurses, and pharmacists in the ambulatory care setting. This gap, along with the lack of standard process for obtaining rechecked blood pressures, led to unnecessary diagnosis of hypertension, inappropriate antihypertensive medication initiation, and/or adjustments.
Learning outcome: The learning outcome of this quality improvement project was to increase the rate of elevated blood pressures being rechecked by 10%. Medical assistants, nurses, and pharmacists completed training on updated manual blood pressure techniques. Organizational thresholds define elevated blood pressure as systolic: >140 and diastolic: >90.
Methods: The affected population included patients 18 years and older in the ambulatory care setting. Practice locations identified medical assistants, nurses, and pharmacists to function as “blood pressure trainers.” Trainers completed in-person training sessions led by the nursing professional development practitioners and training materials from the American Medical Association and the American Heart Association M.A.P. BP program. This program included an online learning module, infographics for patient positioning, and forms to document training. Trainers then provided live, in-person training to their practice location using return demonstration and teach-back methods and documented completion of the in-person training and online module. Each practice location defined a process for completing blood pressure rechecks for patients experiencing elevated blood pressure.
Results: Blood pressure recheck quality improvement timeline: Between April 1-30, 2023: Rate of rechecked elevated blood pressures was 29.34% (3,713 of 12,656 patients). June 30, 2023: Training sessions were completed at each practice location. Between July 1 - September 30, 2023: Rate of rechecked blood pressure was 43.51% (5,049 patients), a 14.17% improvement. Since training implementation, the rate of rechecked elevated blood pressure has improved by 28.28%, totaling 57.62% rechecks. 49% of patients with an initially elevated blood pressure were below threshold upon recheck.
Conclusions: Completion of training and implementation of a standard blood pressure recheck process have led to a reduction of patients identified as having hypertension, prevention of unnecessary antihypertensive medication initiation, and modifications from inaccurate readings. Using evidence-based practices, the team was able to increase team member knowledge, skill, and engagement in the management of hypertension in the ambulatory care setting.