Blood pressure

Paula Telford measures as she selects a blood pressure cuff Monday at Mercy Medical Center in Clinton.

Elise Loyola/Clinton Herald
Clinton Herald Staff

Mercy Medical Center announced a significant organization-wide change in its standard blood pressure equipment and procedures last week, which will allow care-givers to obtain more accurate blood pressure readings and support quality patient care.

This follows the center’s extensive, two-year research demonstrating the importance of selecting optimally-sized blood pressure cuffs for each patient, as well as positioning the patient and limb correctly to obtain accurate readings.

“As treatment decisions are made based on blood pressure readings, we felt that it was important to follow evidence-based standards,” said Amy Berentes, VP of Patient Care at Mercy Medical Center. “By measuring a patient’s arm size every time he or she comes to the hospital, and finding one of the five different sized cuffs that is appropriate for that patient, we are improving the quality and safety of care.”

In light of the growing trends in obesity, the findings are catching the attention of state and national healthcare professionals. The rate of obesity continues to climb nationwide, with approximately one-third of the U.S. adult population considered obese, increasing the incidence of health-related conditions and the costs associated with providing care.

“We are committed to collaborating with leading hospitals, such as Mercy Medical Center, to support accurate blood pressure measurements,” said Ellen Street, general manager for U.S. Sales and Marketing, GE Healthcare Patient Care Solutions. “Mercy’s focus on standardizing BP cuff selection based on patient size is fundamental to enabling accurate blood pressure readings, and subsequent care decisions for patients.”

GE Healthcare manufactures the GE CRITIKON Blood Pressure cuffs.

Extensive research in support of patient safety, quality care

As early as 2009, Jill Iben, RN, and Paula Telford, RN, BSN, of Mercy Medical Center, started evaluating women in their last trimester of pregnancy who were being admitted to the hospital to rule out preeclampsia, a condition characterized by high blood pressure. These patients were hospitalized due to elevated blood pressure readings, but were within a normal range after being monitored with the correct blood pressure equipment and technique at Mercy’s Obstetrics unit.

After two years of comprehensive research, study findings indicated that using a standard cuff size, rather than the appropriate cuff size related to arm circumference, gave inappropriate blood pressure readings.

“A total of 45 percent of women in our study would have had the wrong size cuff,” said Telford. “That was significant to us since treatment decisions for the mother and the baby are made based on these readings.”

Comparing appropriate cuff size versus standard cuff usage, data showed systolic readings with a maximum difference of +40 mm Hg and a minimum difference of -7 mm Hg. Diastolic readings showed a maximum difference of +20 mm Hg and a minimum difference of -7 mm Hg. Results indicated that using an inappropriate size cuff yielded inaccurate blood pressure readings in the sample group.

“Blood pressure equipment has generally consisted of a pediatric cuff, a standard adult cuff, and a ‘large’ cuff not only at the physician office, but in the hospital,” said Berentes. “As we continue to see obesity rates increase, it becomes more apparent that one, two, or even three cuffs do not fit all our patients. This is a case of two OB nurses taking a clinical question, making appropriate practice changes, and having a huge impact on patients both in OB and beyond.”

With the research and evidence to improve the quality of care, combined with the determination of two dedicated nurses, the organization’s active nursing shared governance and the advanced and progressive culture of their parent organization, Trinity Health of Novi, Mich., Mercy made a sweeping organization-wide change to all its equipment and the procedure of obtaining blood pressure readings.

Assisted by GE Healthcare, the medical center conducted an on-site analysis of blood pressure equipment in every patient care location, including Mercy’s two Living Centers and Home Care and Hospice service. In two days, GE Healthcare representatives helped with the conversion of all the blood pressure equipment in every location of Mercy Medical Center as the facility implemented the new practice earlier this year.

In addition, all care-givers were trained on the procedure, which included obtaining an upper arm measurement in centimeters, selecting the appropriate-size blood pressure cuff from five different sizes based on the manufacturer guidelines, and issuing each patient their own cuff that stays with the patient throughout the entire visit and can even be taken home after their stay. By limiting the sharing of cuffs, this approach may also help prevent healthcare-associated infections.

The research project and resulting change in nursing practice was featured at the 18th National Evidence-Based Practice Conference held in April in Iowa City.  In addition, for her support of the project, Colleen Meggers, Director of Mercy’s Maternal Child Services won the Innovations for Patient Care Award presented by the Iowa Organization of Nurse Leaders at their spring conference in June of this year. The research project has also been submitted for consideration by the National Database for Nursing Quality Initiatives.

“All of us at Mercy are so proud to have played a small part in supporting this groundbreaking work,” said Sean Williams, President and CEO of Mercy Medical Center. “When healthcare decisions are made based on a blood pressure reading, one of the most basic measures of an individual’s health, it’s vitally important that it is done accurately. At Mercy, we are dedicated to providing the highest quality of patient care and this is just one example of our commitment in action – we are so proud of everyone involved.”

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