PROCEDURE FOR BLOOD PRESSURE MONITORING

Transcription

1 PROCEDURE FOR BLOOD PRESSURE MONITORING Issue History April 08 June 10 Aug 10 Issue Version Four Purpose of Issue/Description of Change Planned Review Date To accurately perform and obtain a blood pressure measurement in a community setting 2013 Named Responsible Officer:- Approved by Date Service Improvement Unit Clinical Policy and Procedures Group November 2010 Section :- Diagnostics NPD N o 07 Impact Assessment Screening Complete Date: June2010 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

2 AIM To ensure the effective, co-ordinated management of blood pressure monitoring undertaken by registered nurses, also nursing auxilliaries and assistant practitioner s who have been trained and assessed to be competent when delegated this procedure. TARGET GROUP All staff employed by Provider Services who are required to carry out this procedure as part of their role and job description. RELATED POLICIES Please refer to relevant organisational policies and procedures RELATED DOCUMENTS Please use the most current versions printed from the community nursing documentation section of intranet TRAINING / SUPERVISION Blood pressure monitoring is a core competency of a registered nurse. Health care assistant, nursing auxiliaries and assistant practitoners need to have been trained and have had their competence assessed by a registered nurse. A record of this is kept in their personal file. A registrant with the Nursing and Midwifery Council (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. TRAINING Assistant Practitioners and Nursing Auxilliaries are required to undertake training in the use of the Omron sphygmomanometer (or equivalent) A blood pressure competency must be completed and updated every two years. A copy to be kept in their portfolio and personal file REFERRAL Accurate patient information regarding the indication for blood pressure (BP) monitoring (see below) and relevant patient diagnosis is required from the referring clinician to enable the registered nurse to appropriately delegate blood pressure monitoring to a non registered practitioner. 2/8

3 INDICATIONS Patients who have been assessed by a Registered Nurse or General Practitioner and have been identified as requiring a blood pressure measurement in their home environment. Where medication indicates e.g. Epoetin Patients who have the potential of Autonomic Dysreflexia Screening patients who may have hypertension/hypotension As indicated, following nursing assessment CAUTIONS Rhythm disturbances, especially atrial fibrillation affect BP measurement using a Omron (or equivilant) digital blood pressure device. Refer to the manufacturers user manual for further advice. In patients with heart rates below 50 beats/min, even if the rhythm is regular, some of the semi-automatic devices are unable to reduce their deflation rate sufficiently so that too rapid a fall in cuff pressure results in underestimation of systolic blood pressure and overestimation of diastolic blood pressure. In pregnancy diastolic blood pressure is best measured using the disappearance of Korotkoff V sounds. (Consider using aneroid monitoring device). If the use of an aneroid sphygmomanometer is indicated the registered nurse needs to consider the appropriateness of delegating this role to an Assistant Practitioner and/or Nursing Auxiliary to ensure they competent PREPARATION OF EQUIPMENT The accuracy of the blood pressure reading obtained is highly dependent upon proper use of the equipment provided. 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. Clean blood pressure machine and cuff in line with Cleaning and Disinfection Policy using a detergent wipe and pat dry. Consider use of single patient use disposable cuff cover if infection risk 3/8

4 The circumference of the upper arm must be measured at the widest point in order to determine which size cuff to be used. See table below : Arm Circumference Less than 23cm 23cm to 33cm 33cm to 50cm 51cm to 53cm Cuff Size Small Adult Standard Adult Large Adult Adult Thigh Cuff Adapted from British Hyperetension Society Guidelines 01/2006 MEASURING BLOOD PRESSURE EQUIPMENT Organisational recommended blood pressure device Various cuff sizes Tape measure Relevant documentation Spare batterires Disposable single patient use cuff cover Prior to procedure advise patient not to eat, take alcohol, smoke or exercise for 30 minutes before having their blood pressure measured. PROCEDURE Introduce yourself and any colleagues involved at the contact. Verbally confirm the identity of the patient by asking for their full name and date of birth. If patient unable to confirm, check identity with family/ carer Explain procedure to patient and gain informed consent Decontaminate hands prior to procedure Ask the patient to remove any tight arm clothing. Assist the patient if required, ensuring that privacy and dignity are maintained at all times. Check skin condition of the upper arm. Request the patient to empty their bladder if they need to. RATIONALE To be courteous and respectful To avoid mistaken identity Allows patient to make an informed decision to proceed with BP monitoring To reduce the risk of transfer of transient micro-organisms on the healthcare workers hands Allows the cuff to be applied in the correct position thus reducing the potential for error. If the patient s arm is swollen/oedematous or has any breaks do not continue, seek advice. If necessary clean the arm to prevent cross infection Can effect blood pressure readings (NICE 2006) 4/8

5 PROCEDURE The patient should be seated in a temperate environment and relaxed for at least 5 minutes prior to taking measurement. Whilst the patient is seated, measure the circumference of the upper arm at the widest point and record in the health care record. Select the appropriate cuff from the measurements obtained. Support the patient s arm out-stretched at heart level. Apply the cuff and measure blood pressure, following the procedure for the use of the monitoring device. Patients should not talk during the procedure. Note the reading in the patient health records (see appendix 1) Repeat procedure for other arm. Ask the patient to stand (if able) for 1-3 minutes (BHS 2006) and then take a further blood pressure measurement with the arm supported, from the arm that the highest reading was obtained. Document in patients records (see appendix1) Decontaminate equipment in line with policy Decontaminate hands on completion of procedure Inform General Practitioner by fax on the day the measurements were obtained (see appendix 2) Inform General Practitioner by telephone and fax if readings above 180/110mmHg (see appendix 2) Inform General Practitioner by telephone and fax if pulse rate is less that 50 beats /min RATIONALE To minimise the effects of the environment on the reading obtained (NICE 2006). Allows the correct sized cuff to be used Using the wrong sized cuff can effect the reading obtained (NICE 2006) If the arm is above or below heart level and not relaxed the reading can be effected (NICE 2006) To obtain an accurate blood pressure measurement To maintain an accurate record of readings. Blood pressure readings can differ between arms (NICE 2006). The arm with the highest reading should be used for all subsequent readings (BHS 2006). Blood pressure readings can differ with the patient sitting and standing. Older people can suffer from postural hypotension (blood pressure dropping when they stand) Cleaning of equipment minimises the risk of cross infection To remove the accumulation of transient micro organisms Patient s GP to make timely clinical decisions and adapt the patient s treatment, if required. May indicate that the patient has accelerated (malignant) hypertension (NICE 2006) Blood Pressure measurements may not be accurate (BHS 2006) CLINICAL INCIDENTS Any related incidents arising from measuring blood pressure which may involve a clinical error or near miss must be reported following the Incident Reporting Policy 5/8

6 REFERENCES British Hypertension Society (2006) Blood pressure measurement. Fact file National Institute for Health and Clinical Excellence 2006 (Quick Reference Guide) Hypertension: Management of hypertension in adults in primary care, June. Nursing and Midwifery Council (2007) Advice on delegation for NMC registrants NHS Litigation Authority (2008) Risk Management Standards for PCT s. April CONSULATION Clinical Policy and Procedures Group Infection Control Heart Support Service Manager 6/8

7 Appendix 1 Blood Pressure Monitoring Record Patients Full Name: Date of Birth: NHS Number: DIAGNOSIS :- Date Time Blood Pressure Left Arm Blood Pressure Right Arm Blood Pressure Standing Any Further Measurement Print Name Signature Designation Date Time Blood Pressure Left Arm Blood Pressure Right Arm Blood Pressure Standing Any Further Measurement Print Name Signature Designation November 2010 Service Improvement Unit

8 Appendix 2 BLOOD PRESSURE MONITORING COMMUNICATION RECORD Patient Details Patients Name: Date of Birth: NHS No: Address & Postcode: Contact Number: GP: Referral Details Referred By: Designation: Date: Time: Contact No: Fax No: Referred To: Fax No: Blood Pressure Measurements Date Time Left arm blood pressure Right arm blood pressure Standing blood pressure Any further measurements Print Name Signature Designation Additional Comments November 2010 Service Improvement Unit