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AMA Looks to Retrain Doctors on Taking Blood Pressures

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J.Adderton has 26 years experience as a BSN, MSN .

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

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

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.

7 Followers; 96 Articles; 31,001 Profile Views; 345 Posts

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150 Posts; 885 Profile Views

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. 

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Hoosier_RN has 20 years experience as a MSN and specializes in LTC, home health, hospice, ICU, ER, dialysis.

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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

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beachbabe86 specializes in Oceanfront Living.

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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.

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12 Followers; 3,690 Posts; 27,525 Profile Views

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.

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TriciaJ has 38 years experience as a RN and specializes in Psych, Corrections, Med-Surg, Ambulatory.

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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.

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J.Adderton has 26 years experience as a BSN, MSN.

7 Followers; 96 Articles; 345 Posts; 31,001 Profile Views

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.

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210 Posts; 2,823 Profile Views

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

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Snatchedwig has 11 years experience as a ADN, CNA, LPN, RN and specializes in Medsurg.

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1 hour ago, Daisy Joyce said:

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

Lol stop 

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12 Followers; 3,690 Posts; 27,525 Profile Views

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

*And everyone else. 

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OUxPhys has 4 years experience as a BSN, RN and specializes in Cardiology.

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

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9 Posts; 91 Profile Views

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

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