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AMA Looks to Retrain Doctors on Taking Blood Pressures

Is There a Clear Need for Re-Training in Basic B/P Skills?

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Specializes in Clinical Leadership, Staff Development, Education.

Measuring blood pressure is thought of as a fundamental skill, but is it being performed correctly? The American Heart Association and American Medical Association has released an on-line refresher course for HCPs to brush up on their knowledge and technique. Continue reading to find out why physicians are being targeted for this training.

AMA Looks to Retrain Doctors on Taking Blood Pressures
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Like nurses, most physicians learn how to measure blood pressure while they are in medical school. It’s likely they don’t receive refreshers following their initial training over their professional careers. There’s concern that lack of training on this fundamental skill could lead to misdiagnosis of a patient symptoms, especially with high blood pressure being the leading risk factor for heart attacks and strokes.

On-line Course Launched

On November 18th, the American Medical Association (AMA) and the American Heart Association (AHA) released an on-line course to provide periodic retraining. The aim is to ensure health care professionals measure blood pressure accurately and consistently every time. The 30-minute course is based on the updated 2017 comprehensive clinical guidelines for the prevention, diagnosis and treatment of hypertension in adults. The guidelines were developed by several health organizations, including the AHA and the American College of Cardiology.

  • The course objectives include:
  • Reinforce guideline recommended blood pressure measurement techniques
  • Simulate proper BP measurement using a manual, semi-automatic, or automated device
  • Boost competency and confidence in BP measurement

The course also provides 0.5 Continuing Education (CE) credit and costs 25.00 for individual enrollment. The course can be accessed at Achieving Accuracy: BP Measurement.

Clear Need for Training

The module was developed after the AMA-AHA surveyed over 2,000 healthcare professionals and found they were not receiving ongoing blood pressure training. Specific findings include:

  • Half of physicians and physician assistants reported never receiving BP retraining after school
  • One-third of nurses and a quarter of medical assistants were not retrained
  • As much as 41% of BPs taken across all medical practices were probably less than 100% accurate
  • 50% medical assistants and three-quarters of nurses, physician assistants, primary-care physicians and pharmacists were not required to complete refresher training but felt it should be a regular part of their continuing medical education.

Campaigning for Accuracy

According to Dr. Michael Rakotz, a family physician and the vice president of health outcomes for the AMA, very few medical professionals, including nurses and doctors, perform the procedure correctly. The AMA sponsors an ongoing campaign to raise awareness around the correct technique for BP measurement. The campaign includes posters that are displayed in exam rooms and anywhere vital signs are taken. The posters also raise awareness among patients and Rakotz states, “once the patients learn how their blood pressure should be measured, they aren’t going to let anybody measure it incorrectly again”.

You can read the article Are Blood Pressure Mistakes Making You Chronically Ill.

Common Mistakes

Regardless if you are a student, nurse, physician or other healthcare provider, there are common mistakes we make when measuring blood pressure. Have you made any of these BP missteps?

Incorrect positioning

For someone able to maintain a sitting position, both feet should rest on the ground or a stool. The back and arms should be supported, with arms propped at heart level.

Activity before a measurement

Sitting quietly 5 minutes after activity for five minutes will help relax the body after activity.

Placing cuff over clothing

It is important to place the cuff on bare skin. Did you know placing a cuff over a sleeve can add up to 50mmHg to a reading depending on the clothing’s thickness?

Using the wrong sized cuff

Using a cuff that is too small can add between 2mmHg to 10mmHg to a BP reading.

Talking during the measurement

It is tempting to talk and ask questions while taking a BP, however, even active listening can add 10mmHg.

Heavy Consequences

Dr. Raymond Townsend, director of the hypertension program at the University of Pennsylvania Hospital points out the consequences of simple errors, “When you label someone as having hypertension you actually have given them a chronic disease label. That can be a downer on our outlook on life so getting it right is important”.

Dr. Townsend and Dr. Rakotz worked on a study to look at the accuracy of blood pressure measurement among medical students. During the 2015 annual AMA meeting, early 160 medical students participated in a “blood pressure check challenge”. The students were evaluated on 11 measurement elements and four was the average number performed correctly.

Townsend points out correct measurement and treatment of blood pressure is the single most important difference HCPs can make to “ help someone live longer and live free of target organ damage”.

Evaluating Effectiveness

The AMA and AHA have partnered with Advocate Aurora Health, the University of Pennsylvania, the University of Alabama and CVS Minuteclinic chain to evaluate if the on-line training meets the training needs of their clinical staff.

What do you think?

Is it important for physicians, as well as other HCPs, to retrain periodically on this fundamental skill?

J.Adderton RN, MSN has 25 years nursing experience in community health, leadership and education.

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How do you recommend we take BP in an ambulatory setting if it is important to have the cuff on bare skin? I am often in the position of a person coming in for a brief visit (med refills or flu shot, for example) and our facility policy is to always check BP. It does not seem appropriate to have the person disrobe and wear a gown for a simple BP check. I live in New England where people are almost always in long sleeves.

Hoosier_RN, MSN

Specializes in dialysis.

17 minutes ago, CommunityRNBSN said:

How do you recommend we take BP in an ambulatory setting if it is important to have the cuff on bare skin? I am often in the position of a person coming in for a brief visit (med refills or flu shot, for example) and our facility policy is to always check BP. It does not seem appropriate to have the person disrobe and wear a gown for a simple BP check. I live in New England where people are almost always in long sleeves.

Make sure that you add a note that this was taken over a sleeve

beachbabe86

Specializes in Oceanfront Living.

8 hours ago, J.Adderton said:

Is it important for physicians, as well as other HCPs, to retrain periodically on this fundamental skill?

Yes! My IM physician was surprised at the BP reading that the LPN took. So, she decided to check it herself. It was a manual cuff and I could hardly keep a straight face. Needless to say, she could use a retraining.

Such an excellent physician, though.

I think people in many different roles could use retraining on blood pressure measurement. It is often performed incorrectly right from the start with wrong size cuff selection and then just gets more ridiculous (patients waving/moving their arms around while talking/describing their problem, scooting themselves up on the stretcher, etc., etc., etc). These errors happen with automatic/machine and manual readings both.

TriciaJ, RN

Specializes in Psych, Corrections, Med-Surg, Ambulatory.

I often wonder if the MAs in some clinics even get trained in the first place, other than wrap the cuff somewhere on the arm and press the button. Then they get wigged out because my BP is significantly higher than 110/70. Well, yes, it is, but with such poor technique, all bets are off.

J.Adderton, BSN, MSN

Specializes in Clinical Leadership, Staff Development, Education.

16 hours ago, CommunityRNBSN said:

How do you recommend we take BP in an ambulatory setting if it is important to have the cuff on bare skin? I am often in the position of a person coming in for a brief visit (med refills or flu shot, for example) and our facility policy is to always check BP. It does not seem appropriate to have the person disrobe and wear a gown for a simple BP check. I live in New England where people are almost always in long sleeves.

Great question when you consider the practicality in certain situations. It would be less important to disrobe a person seeking care for flu, follow-up ect. vs. a person with alarming high/low readings, urgent medical condition or any other condition where accurate reading is priority.

I have never been to New England, but have always wanted to go. I always hear about the beautiful scenery.

LOL the pic with the BP taken over two (possibly three) sleeves

Snatchedwig, ADN, CNA, LPN, RN

Specializes in Medsurg.

1 hour ago, Daisy Joyce said:

LOL the pic with the BP taken over two (possibly three) sleeves

Lol stop

tenor (6).gif

The pic is the point of the article. Doctors* don’t know how to take blood pressure correctly.

*And everyone else.

OUxPhys, BSN, RN

Specializes in Cardiology.

I couldn't tell you the last time I saw a physician take a manual BP.

He also looks like hes ready to pump it up, but has no stethoscope in his ears. There is one hanging on the wall.

beckysue920

Specializes in Psych, HIV/AIDS.

My PMP always checks my BP with her own cuff...it's always amazed me.

When I was taught BPing, we were told never to put your thumb on the stethoscope hub because your own pulse may be what is being recorded. Has anyone ever been taught this? Countless people almost always put their thumb on it when they take mine.

6 hours ago, beckysue920 said:

When I was taught BPing, we were told never to put your thumb on the stethoscope hub because your own pulse may be what is being recorded.

No...because that makes absolutely zero sense.

It sounds like someone got confused and meant to advise you not to take someone's pulse with your own thumb (?)

13 hours ago, beckysue920 said:

When I was in school we were also taught to not hold our thumb over the ball for the same reason.

Placing a BP cuff on bare skin is very hard to accomplish in a busy IM office where the patient is wearing nothing but a long sleeve shirt. Especially when the patient is already late and cutting into your 15 minute appointments with the NP/MD.

Tenebrae, BSN, RN

Specializes in Mental Health, Gerontology, Palliative.

On 11/29/2019 at 1:42 AM, OUxPhys said:

I couldn't tell you the last time I saw a physician take a manual BP.

I struggle to remember last time I saw a nurse take a manual BP.

Electric machines are fine, however I think they make it too easy to loose skills

I’ve have had to be in a lot of different physicians offices and be seen by a lot of them over the last 6 years. I’ve noticed a trend in almost all of them except in PCP’s office. My B/P isn’t taken. Even sometimes in the ER? And when it is taken, especially in the ER, they don’t want to tell me. I have RSD/CRPS II, and a couple other diagnosis that have rendered me disabled. I was taught in nursing school that B/P has direct correlation with someone who is saying they are experiencing pain. With this disease/syndrome, flare ups are harsh and my blood pressure goes through the roof. 5 years after being diagnosed, I’ve researched this in every possible way, the disease/syndrome. I’ve learned a lot from medical journals, published medical articles etc. not just was posted online. So I’ve acquired some knowledge as to how to manage it. But it is insidious and sometimes i don’t even know what triggered the flare up. I do not take routine pain meds for the every day 24/7-365 pain, partly due to the fact I am lucky enough to have anaphylactic reactions to any and all opiates. While I was still working, I dispensed said narcotics using gloves. But it seems that this diagnosis has been deemed “rare.” And hard to diagnose. But a lot of what I’ve read, it isn’t really that “rare.” 1.5- 6 million people in the USA alone suffer from this, November is supposed to be RSD/CRPS month, but it hasn’t gained a lot of motion. They have nick named it the “Suicide Disease” due to the fact that it is under-diagnosed, and people give up. I’ve no plans to give up. But the fact that they are so reluctant to bring my pain down, and do not seem concerned about my severe increase in B/P during flare ups, causes me great concern. I am afraid of stroking out. I’m not talking a slight increase I am talking numbers like 244/138. I’ve been sent home from the hospital with my B/P like this. This terrifies me immensely. I am still licensed in 30 states, but I am unable to do the physical part and I do have some cognitive issues with this also. But the B/P issue bothers me a lot. I’m afraid one day I will have a stroke over something I’ve no control over. I think it should be done in every physicians office as well as the hospitals not discharging a patient with a B/P that high. And if I bring it up, I get schooled. Any ideas on how to change this?

I had a hypertensive patient rechecked by a MD. She came out of the room saying she got a much lower BP reading so she could let the patient go. Um, no. I know what I heard!!!

Tweety, BSN, RN

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

My doctor wanted to confirm a high reading the MA got and rechecked using excellent technique. The MA's reading matched his. Never knew this was an issue.

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