Implementing an Evidence-Based Blood Pressure Technique in an Oncology Clinic

Background:Hypertension (HTN) continues to be a leading risk factor for cardiovascular disease, stroke, and death, with an estimated cost in the United States of 131 billion dollars annually (Kirkland et al., 2018). Accurate blood pressure (BP) measurements are essential in the prevention, detection, evaluation, diagnosis, and management of HTN. Research has shown BP's are often taken inaccurately due to poor technique, human error, and manual measurements, which results in a missed or inappropriate diagnosis of HTN. New BP techniques called automated office blood pressure (AOBP) have been shown to reduce improper BP readings in an office setting. The purpose of this study was twofold: 1) to implement an evidence-based BP technique in an oncology clinic and 2), to improve the clinical staff's knowledge of proper AOBP techniques to reduce inappropriate BP readings and identify HTN more appropriately.Methods:The quality improvement project (QI) observed workflow in two oncology clinics, developed educational materials, used a pre and post-survey to assess staff knowledge on proper BP techniques, and taught the AOBP technique. All BP's greater than 140/90 mmHg were collected and recorded using paper slips over nine weeks. These values were placed in an Excel spreadsheet to determine the average, then initial BP and AOBP numbers were compared. If a patient's BP was 140/90 mmHg, the AOBP technique was done in an exam room with medical staff outside. At the end of the QI project, an end survey was distributed to assess if knowledge was retained and overall satisfaction of the project. Results:Of the patients that were initially diagnosed with HTN using traditional BP technique, the AOBP method confirmed HTN in 76% of patients for an overall reduction of 24% (p-<0.05). Thirty-two patients were no longer considered hypertensive (<135/85 mmHg) after the AOPB technique was completed. There were potentially 108 patients who were misidentified as being hypertensive from not having AOBP protocol completed. The average difference in systolic BP from initial reading to AOBP was 11 mmHg (p-<0.01) and in diastolic BP from initial reading to AOBP was 2 mmHg (p-< 0.06). One hundred twelve patients had a decrease of at least 5 mmHg on systolic reading with the AOBP technique. A significant difference was found in the results of 3 out of 10 questions on the post-survey. Discussion:The AOBP technique showed a 24 % reduction in BP measurements from initial BP measurement and should be used in oncology settings for better identification of HTN. An additional 449 patients were identified as being hypertensive that did not receive the AOBP protocol. From the results associated with this project, the HAC purchased a validated AOBP machine to help take BP's more accurately. The educational presentation appeared to be a valuable resource to help educate staff on appropriate BP and AOBP techniques to reduce inappropriate BP measurements. Replication of this QI project is necessary to see if a validated AOBP machine would show similar results or perhaps even better results than with the current vitals machines used.