FACTORS AFFECTING HOSPITAL INPATIENT BLOOD PRESSURE MEASUREMENT AS RANKED BY A DELPHI SURVEY

Objective: Current guidelines do not address the appropriate technique for accurate blood pressure (BP) measurement for inpatients. Data from community-based measures suggest that technique in BP assessment matters for accurate readings. Given the substantial impact that diagnosis and treatment decisions can have based on hospital BP measurements, this study sought to explore the relative importance of various factors for the accurate measurement of BP in inpatients. Design and method: This was a Ranking-type Delphi Survey. A guideline review of current evidence for the determinants of accurate BP measurement was used to inform a preliminary list of variables for the procedure of BP measurement. A Delphi panel of experts in the field of hypertension were surveyed across 4 rounds of anonymous interviews to determine the appropriate list of variables and their ranked order of importance in the accurate measurement of inpatient BP. Binary decisions required >80% agreement to reach consensus. Consensus on the ranked order of variables required a Kendall’s coefficient of >0.7. Results: A panel of 9 international experts in hypertension ratified the selected source documents. Over a further 3 rounds of anonymised surveys with interval feedback and 100% retention, the panel agreed with a high degree of consensus on the need for the following 10 variables in the accurate measurement of inpatient BP in order of importance: (1) at least two measurements, (2) correct cuff size, (3) not talking during measurement, (4) a correctly fitted cuff on the upper arm, (5) cuff at heart level, (6) the patient in a seated position, (7) up to date calibration of device, (8) legs uncrossed, (9) bare arm below the cuff and, (10) a supported back (Kendall’s 0.97). Conclusions: An understanding of the true determinants of accurate inpatient BP measurement and the magnitude effect of each component of the procedure is still required. In the interim, expert consensus provides a ranked list of factors to prioritise in the measurement of inpatient BP which can be used to assess the performance of clinicians measuring BP in an inpatient setting.