Perinatal Blood Pressure Measurement: A Critical Need for Accuracy. Implementation of an Evidence-Based Protocol
Article first published online: 11 JUN 2013
© 2013 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses
Journal of Obstetric, Gynecologic, & Neonatal Nursing
Special Issue: 2013 Convention Proceedings
Volume 42, Issue s1, page S63, June 2013
How to Cite
Young, R. (2013), Perinatal Blood Pressure Measurement: A Critical Need for Accuracy. Implementation of an Evidence-Based Protocol. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 42: S63. doi: 10.1111/1552-6909.12144
- Issue published online: 11 JUN 2013
- Article first published online: 11 JUN 2013
- blood pressure;
Purpose for the Program
Hypertension in pregnancy is a leading cause of maternal and perinatal morbidity and mortality. Blood pressure measurement is the primary assessment in diagnosis and treatment planning for these high-risk patients. Inconsistent practices in technique can lead to inconsistent and inaccurate measurements. To improve safety and accuracy when providing nursing care, an evidence-based blood pressure measurement protocol was developed.
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 positioning of the patient for measurement, use of auscultated manual blood pressures, cuff placement, sizes of cuffs, and use of the fifth Korotkoff sound. The recommendations also specified that manual measurements 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 before 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, 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.