Measuring the Quality of In-Office Blood Pressure Measurements in Different Specialties

Background: In-office blood pressure measurements may be done routinely, or standardized. Both ACC/AHA and KDIGO recommend standardized in-office blood pressure measurements. Staffing issues, time constraints, and lack of widespread education of medical professionals may be barriers to proper measurements according to these guidelines. This study evaluated the technique of in-office BP measurements across internal medicine and nephrology specialties. Methods: We conducted a quality improvement project collecting data by direct observation. The technique was scored by a ten-point checklist derived from ACC/AHA and KDIGO guidelines. Nephrology and Internal Medicine outpatient practices affiliated with Ascension St. John Hospital were observed and graded. Results: Among nephrology offices, the overall checklist was followed correctly with a mean of 61% and 62% of the time, and an internal medicine clinic 46% of the time. The highest adherences were of patients with uncrossed legs (83%), correct cuff size (90%), and cuff over bare arm (73%).The lowest results were arm raised to level of sternum (13%), and sitting more than five minutes (3.3%). There were significant discrepancies between clinics among these data, with internal medicine clinic accounting for 4/5 of the patients with crossed legs, and having feet on the floor only 13% of the time. Conclusion: Barriers to standardized blood pressure measurements are increased burden on medical professionals and time needed for proper measurement. This may be due to barriers of staffing, time constraints, and education. The concern for over or under-treatment is of significantly higher concern and therefore urges the need for updating clinic procedures of this standardized method. Home blood pressure monitoring (HBPM) has not been studied in the setting of chronic kidney disease, and although it likely has significant utility, needs to be used in addition to proper in-office measurements to guide appropriate therapy. Given the high recommendation for standardized BP measurement and its use in several clinical trials, the use of this method is of utmost importance to upkeep in general clinical settings in order to follow the recommendations made by clinical findings.