Perinatal Blood Pressure Measurement: A Critical Need for Accuracy - Implementation of an Evidence Based Protocol

Purpose for the program:

Hypertension in pregnancy is a leading cause of maternal and perinatal morbidity and mortality. Blood pressure measurement is primary assessment in diagnosis and treatment planning for these high risk patients. Inconsistent practices in technique can lead to inconsistent and inaccurate measurements. In order to improve safety and accuracy when providing nursing care, an evidence based blood pressure measurement protocol was developed.

Proposed change:

The Hypertensive Obstetric Blood Pressure Measurement Evidence Review Team was formed and included representation from nursing staff, nursing research, nursing education, and nursing management. A literature review was performed and a summary of recommendations was written for dissemination.  These recommendations included the positioning of the patient for measurement, use of auscultated manual blood pressures, cuff placement, sizes of cuffs, and using the 5^thKorotkoff sound. The recommendations also included that the manual measurements would be used for any suspected or actual hypertensive patient on admission and discharge for accurate baseline measurements, and at any time a treatment change would be indicated based on blood pressure determinations or when clinical judgment suggested it.    

Implementation, outcomes and evaluation:

A specific protocol was written based on the recommendations of the review team and all staff were informed of the new practice change. We then developed a computer based learning program which was required education for all staff, and was completed prior to the change. All residents, faculty and department chairs reviewed the recommendations at department meetings. The equipment was purchased and the biomedical team provided preventive maintenance for the equipment per standards.

A build of the documentation fields in the clinical information systems was completed and data for manual blood pressures, position of patient, and time and date were collected. Ongoing evaluations of the compliance data identified that  improvement initiatives were still needed. Further improvement was implemented to highlight each patient needing a manual blood pressure assessment at morning team rounds each day and to reinforce staff education.

Implications for nursing practice:

Inconsistent blood pressure measurement can lead to inaccurate assessments and lead to delays in or missed treatment for high risk patients. Improving practices to follow evidence based research and recommendations can improve safety and excellence of nursing care

Keywords: Hypertenion, pregnancy, blood pressure, protocol