Procedure for Blood Pressure Measurement - NHS Wirrell

8/11/2019 Procedure for Blood Pressure Measurement - NHS Wirrell

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PROCEDURE FOR BLOOD PRESSUREMONITORING

FirstIssued

IssueVersion

Purpose of Issue/Description of Change Planned ReviewDate

OneTo correctly identify abnormal blood pressuremeasurements in patients own homes andreferral for treatment management by GeneralPractitioner

2010

Named Responsible Officer:- Approved by Date

Professional Development Nurse Nursing Policy Group April 2008

Section :- Diagnostics

D No 07

Impact Assessment ScreeningCompleteDate: January 2008

Full ImpactAssessmentRequired Y/N

UNLESS THIS VERSION HAS BEEN TAKEN DIRECTLY FROM THE NHS WIRRALWEB SITE THERE IS NO ASSURANCE THIS IS THE CORRECT VERSION


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PROCEDURE FOR BLOOD PRESSURE MONITORING2/5

PROCEDURE FOR BLOOD PRESSURE MONITORING

AIM

To ensure the effective, co-ordinated management of blood pressure monitoring

undertaken by registered nurses employed by Wirral PCT, also nursing auxilliariesand assistant practitioners who have been trained and assessed to be competentin this procedure.

Procedure complies with NHS Litigation Authority Risk Management Standards(2008) for PCTs for clinical diagnostic tests.

TARGET GROUP

All staff employed by Wirral PCT who are required to carry out this procedure aspart of their role and job description.

RELATED POLICIES

PCT Health Records Policy

Nursing and Midwifery Council (2007) Record Keeping

NMC (2008) Standards of conduct, performance and ethics

PCT Record Keeping for Community Nursing

Incident Reporting Policy

Consent Policy

NB Always use most current versions of PCT and NMC policies as may besuperseded at any time

INDICATIONS

Housebound patients who have been referred for blood pressure monitoring

Where medication dictates e.g. Epoetin

Patients who have the potential of Autonomic Dysreflexia

As indicated, following nursing assessment

DEFINING HYPERTENSION

To identify hypertension (persistent raised blood pressure, above 140/90 mmHg), itwill be necessary to check the patients blood pressure on another two occasions atmonthly intervals, twice on each occasion. If the patient has severe hypertension re-evaluate the patient earlier.


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BRITISH HYPERTENSION SOCIETY (BHS) CLASSIFICATION OF BLOOD

PRESSURE LEVELS

Category Systolic blood pressure(mmHg)

Diastolic blood pressure

Optimal blood pressure


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MEASURING BLOOD PRESSURE

PROCEDURE RATIONALE

Explain procedure to patient and obtain informedconsent

Allows patient to make an informeddecision to proceed with BP monitoring

Ask the patient to remove tight arm clothing.Assist the patient if required, ensuring thatprivacy and dignity are maintained at all times.

Allows the cuff to be applied in thecorrect position thus reducing thepotential for error.

Check skin condition of the upper arm. If the patient has oedema or breaks.

If necessary clean the arm to preventcross infection

Request patient not to eat, take alcohol, smokeor exercise for 30 minutes before having theirblood pressure checked. The patient should alsobe requested to empty their bladder if they needto.

All these factors can effect the readingthe reading obtained (NICE 2006)

Seat the patient for a minimum of 5 minutes in awarm quiet room (NICE 2006)

To minimise the effects of theenvironment on the reading obtained.

Whilst the patient is seated, measure thecircumference of the upper arm measure atthe widest points

Allows the correct sized cuff to be used

Select the appropriate cuff from themeasurements obtained.

Using the wrong sized cuff can effect thereading obtained (NICE 2006)

Support the patients arm out-stretched at heartlevel.

If the arm is above or below heart leveland not relaxed the reading can be

effected (NICE 2006)Apply the cuff and measure blood pressure,following the procedure for the use of themonitoring machine.

Note the reading in the patient records.

To maintain an accurate record ofreadings.

Repeat procedure for other arm. Blood pressure readings can differbetween arms (Nice 2006)

Ask the patient to stand (if able) for 2 minutes(BHS 2004) and then take a further bloodpressure reading from the arm from which thehighest reading was obtained. Document inpatients records.

Blood pressure readings can differ withthe patient sitting and standing.

Older people can often suffer from

postural hypotension ( blood pressuredropping when they stand)

If any of the readings obtained exceed thebaseline reading or are above 140/90 mmHg,then repeat the measurement using the armfrom which the highest reading was obtained(NICE 2006). Document in patient records.

Inform General Practitioner on the day themeasurements were obtained.

Readings of 140/90 or above suggestthat the patient has hypertension. Asecond reading is required to confirm thatthe blood pressure is high (NICE 2006)

Patients GP to make timely clinicaldecisions and adapt the patientstreatment, if required.


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SHARING RESULTSInform GP of measurements the same day and document in patients records.

TRAINING / SUPERVISION

Blood pressure monitoring is a core competency of a registered nurse. Health careassistants / auxiliaries / assistant practitoners need to have attended a PCT trainingsession and have had their competence assessed by a registered nurse.A record of this is kept in their personal file. The Caseload Managers who supportthis group of staff will be informed of any changes in guidance from BritishHypertension Society and NICE Guidance, via the professional Development Team.Caseload managers will be expected to update their team. It is the responsibility ofthe practitioner to identify further training / update needs.

For non -registered staff, this competency needs to have be highlighted in their job

description as a specific aspect of their role.

A registrant with the NMC who delegates apsects of care to another remainsaccountable for the appropriateness of that delegation and for providing theappropriate level of supervision in order to ensure competence to carry out thedelegated task ( NMC 2007)

EQUIPMENT

Blood pressure monitoring eqipment must be recalibrated annually by the Electronic

Biomedical Equipment ( EBME) Department at Wirral University Hospital Trust. It isthe responsibity of the team leader/ caseload manager to have a system in place tomonitor and maintain quality assurance with this standard.

Following each use, clean machine and cuff with Tuffie wipe and allow to dry.

CLINICAL INCIDENTS

Any related incidents arising from measuring blood pressure which may involve aclinical error or near miss must be reported following the PCT Incident ReportingPolicy

REFERENCES

British Hypertension Society Guidelines 2004

National Institute for Health and Clinical Excellence 2006 (Quick Reference Guide)Hypertension: management of hypertension in adults in primary care, June.

Nursing and Midwifery Council (2007) Advice on delegation for NMC registrants

NHS Litigation Authority (2008) Risk Management Standards for PCTs. April.

Procedure for Blood Pressure Measurement - NHS Wirrell

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