Improving Lying and Standing Blood Pressure Measurement Recording
Abstract
Introduction
Falls are a common hospital patient presentation. NICE falls assessment and prevention guideline (NG249) includes lying and standing (L&S) blood pressure (BP). The Royal College of Physicians (RCP) outlines a standardised approach for L&S BP measurement; involving lying BP, standing BP within 1 minute and after 3 minutes.
We aimed to improve postural BP recording on Cerner Electronic Patient Record (EPR) utilising Quality Improvement methodology to help clinicians make a correct diagnosis.
Method
Retrospective data was collected using EPR patient notes whereby 12 medical patients had L&S BPs recorded over three weeks and accuracy compared to RCP approach. A qualitative survey of 15 ward healthcare professionals (healthcare assistants and nurses) was conducted, assessing L&S BP understanding, skill technique and recording.
Multiple Plan-Do-Study-Act (PDSA) cycles were completed and areas for improvement identified. These included:
- Increasing staff awareness by using educational posters on wards, during nursing handovers and induction.
- Small group teaching sessions.
- Cerner EPR L&S BP recording modifications.
Results
Initial data demonstrated zero patients had L&S BP measurements recorded at 3 minutes. Staff survey highlighted poor understanding and minimal formal training. First and second PSDA cycles showed no improvement, with zero out of 11 and zero out of 12 medical patients respectively having correct L&S BP recorded at 3 minutes. EPR system interrogation found no option to record L&S BP after 3 minutes. Following EPR modification in PDSA cycle 3, a 14% improvement in accurate L&S BP recording was demonstrated.
Conclusion
L&S BP measurement is vital for falls assessments, guiding medical management. Despite promoting awareness and educating staff there was no improvement in accurate L&S BP recording. An identified barrier was Cerner EPR system and subsequent modifications demonstrated improvement. This project highlights issues regarding use of a nationwide EPR system with built-in errors, questioning patient record integrity.