AN AUDIT OF INPATIENT BLOOD PRESSURE MEASUREMENT FOCUSING ON ACCURATE TECHNIQUE

Objective: The accuracy of a blood pressure (BP) measurement depends on the quality of the measurement technique applied. Poor BP measurement technique is common in hospital settings and the resultant inaccurate readings risk inappropriate treatment changes, with implications for the immediate acute care setting and for longer term care. As there are no existing guidelines for the accurate measurement of BP in the inpatient setting, we sought to firstly generate a novel composite outcome measure and then assess the performance of a representative hospital by audit. Design and method: This was a comprehensive cross-sectional audit of selected admitted non-critical care wards (age care, acute surgical and haematology) in a 600-bed, tertiary public hospital. The method of BP measurement across three wards at St George Hospital was observed over three weeks. A ideal BP measurement was defined as one that included ten key variables determined by expert panel consensus. We detailed the observed BP measurements and their performance against our novel standard, as well as describing the characteristics of an average BP measurement. Results: A total of 278 BP measurements on 153 patients were observed in the audit period. Only 7% of BP measurements involved more than one reading, 77% used the correct cuff size, 23% had no talking during measurement, 65% had the cuff correctly positioned, and 85% had the limb at heart height. BP measurements were taken in a seated position 26%, legs uncrossed 82%, back supported 75% and arm bare 65% of the time. Conclusions: Prior to this study, there was no existing standard by which to measure the quality of BP measurement in admitted patients. We have piloted a composite method for inpatient BP measurement assessment derived by expert consensus and have found great variability in BP measurement technique in day to day care. These data provide a summation of standard practices in BP measurement at a representative hospital and a basis to develop studies to evaluate whether these variations correlate with patient outcomes.