.

PROCEDURE FOR BLOOD PRESSURE

MONITORING


First
Issued
Issue
Version
Purpose of Issue/Description of Change Planned Review
Date

One
To correctly identify abnormal blood pressure
measurements in patients own homes and
referral for treatment management by General
Practitioner

2010
Named Responsible Officer:- Approved by Date

Professional Development Nurse


Nursing Policy Group

April 2008

Section :- Diagnostics

D N
o
07
Impact Assessment Screening
Complete
Date: J anuary 2008

Full Impact
Assessment
Required Y/N









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












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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 auxilliaries
and assistant practitioners who have been trained and assessed to be competent
in 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 as
part 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 be
superseded at any time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), it
will be necessary to check the patients blood pressure on another two occasions at
monthly 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 <120 <80
Normal blood pressure <130 <85
High-normal blood
pressure
130-139 85-89
Grade 1 Hypertension
(mild)
140-159 90-99
Grade 2 (moderate) 160-179 100-109
Grade 3
Hypertension(severe)
180 110
Isolated Systolic
Hypertension(Grade 1)
140-159 <90
Isolated Systolic
Hypertension (Grade 2)
160 <90
(BHS Guidelines 2004)




PREPARATION OF EQUIPMENT

The accuracy of the blood pressure reading obtained is highly dependent upon
proper use of the equipment provided.

The circumference of the upper arm must be measured in order to determine which
size cuff should be used. See table below :


Arm Circumference Cuff Size
Less than 23cm Small Adult
Less than 33cm Standard Adult
Above 33cm Large Adult

Adapted from British Hypertension Society Guidelines (2004)





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MEASURING BLOOD PRESSURE

PROCEDURE RATIONALE
Explain procedure to patient and obtain informed
consent
Allows patient to make an informed
decision to proceed with BP monitoring
Ask the patient to remove tight arm clothing.
Assist the patient if required, ensuring that
privacy and dignity are maintained at all times.
Allows the cuff to be applied in the
correct position thus reducing the
potential for error.
Check skin condition of the upper arm. If the patient has oedema or breaks.
If necessary clean the arm to prevent
cross infection
Request patient not to eat, take alcohol, smoke
or exercise for 30 minutes before having their
blood pressure checked. The patient should also
be requested to empty their bladder if they need
to.
All these factors can effect the reading
the reading obtained (NICE 2006)
Seat the patient for a minimum of 5 minutes in a
warm quiet room (NICE 2006)
To minimise the effects of the
environment on the reading obtained.
Whilst the patient is seated, measure the
circumference of the upper arm measure at
the widest points
Allows the correct sized cuff to be used
Select the appropriate cuff from the
measurements obtained.
Using the wrong sized cuff can effect the
reading obtained (NICE 2006)
Support the patients arm out-stretched at heart
level.
If the arm is above or below heart level
and not relaxed the reading can be
effected (NICE 2006)
Apply the cuff and measure blood pressure,
following the procedure for the use of the
monitoring machine.
Note the reading in the patient records.
To maintain an accurate record of
readings.
Repeat procedure for other arm. Blood pressure readings can differ
between arms (Nice 2006)
Ask the patient to stand (if able) for 2 minutes
(BHS 2004) and then take a further blood
pressure reading from the arm from which the
highest reading was obtained. Document in
patients records.
Blood pressure readings can differ with
the patient sitting and standing.
Older people can often suffer from
postural hypotension ( blood pressure
dropping when they stand)
If any of the readings obtained exceed the
baseline reading or are above 140/90 mmHg,
then repeat the measurement using the arm
from which the highest reading was obtained
(NICE 2006). Document in patient records.

Inform General Practitioner on the day the
measurements were obtained.
Readings of 140/90 or above suggest
that the patient has hypertension. A
second reading is required to confirm that
the blood pressure is high (NICE 2006)

Patients GP to make timely clinical
decisions and adapt the patients
treatment, if required.




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SHARING RESULTS
Inform 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 care
assistants / auxiliaries / assistant practitoners need to have attended a PCT training
session and have had their competence assessed by a registered nurse.
A record of this is kept in their personal file. The Caseload Managers who support
this group of staff will be informed of any changes in guidance from British
Hypertension Society and NICE Guidance, via the professional Development Team.
Caseload managers will be expected to update their team. It is the responsibility of
the 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 remains
accountable for the appropriateness of that delegation and for providing the
appropriate level of supervision in order to ensure competence to carry out the
delegated 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 is
the responsibity of the team leader/ caseload manager to have a system in place to
monitor 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 a
clinical error or near miss must be reported following the PCT Incident Reporting
Policy

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, J une.

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

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