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Measuring BP: Are You Doing It Right?

are you correctly measuring BP?

Accurate blood pressure measurement is crucial for patient care, but there are 27 potential sources of error that can either falsely raise or lower a patient’s blood pressure reading. While eight of these errors are patient-related, including caffeine use and bladder distension, the remaining 19 can be managed by the care team.

The challenges and errors

The primary challenge lies in the fact that many healthcare professionals receive training in blood pressure measurement only once, typically during medical or nursing school, and are not provided with subsequent retraining. However, it is a complex skill, and proficiency can decay over time, necessitating periodic retraining every six months to one year, according to clinical guidelines. To address this issue, the Target: BP™ initiative, co-led by the AMA and the American Heart Association, offers accessible resources for training clinical staff in accurate blood pressure measurement. They also provide tools for training patients in self-measured blood pressure (SMBP).

One of the most common measurement errors is using an incorrectly sized cuff. The right-sized cuff is essential for accurate measurement, and a template for BP-measurement policies and procedures is provided to guide health care organizations in implementing comprehensive approaches to accurate BP measurement. These policies encompass aspects like device procurement and maintenance, team training and testing, and clinical procedures and workflows.

Key factors to take care

Key points to ensure accurate blood pressure measurement include the use of devices validated for accuracy, preferably automated, oscillometric devices, which reduce operator errors and require less frequent calibration. Proper positioning of the patient and cuff is critical, as is allowing time for the patient to empty their bladder and rest for three to five minutes before measurement.

The “alerting response,” where patients’ blood pressure temporarily increases due to the stress of measurement, is another factor to consider. To mitigate this response, having a different care team member perform the measurement can help. It is recommended to measure blood pressure in both arms initially and continue with the arm that yields higher readings. Averaging multiple measurements provides a more accurate representation of a patient’s daily mean blood pressure, whether in a clinical setting or with SMBP.

AMA MAP™ Hypertension Program

The AMA is committed to improving health outcomes related to cardiovascular disease. The AMA MAP™ Hypertension program is one such initiative focused on enhancing BP-measurement accuracy, promoting evidence-based treatment, and empowering patients in self-managing their blood pressure. In an environment where accurate blood pressure measurement is paramount, the collaboration between healthcare professionals and initiatives like Target: BP plays a pivotal role in ensuring patient health and well-being.

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