AMA Looks to Retrain Doctors on Taking Blood Pressures
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.
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.
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”.
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?
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.
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.
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!!!
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.
For years I only did b/p checks with a dinamap. I got confused listening to manual readings, the different korotcov/korotcoff sounds when I was required to start checking them this way. I did practices online thru Youtube to retrain myself. IF someone re-rechecks, and says something drastically different, I know what I heard.
I have seen cardiologists doing inpatient consults do their own BP measurements on both arms.
My dh's PCP requested daily bp measurements at home, specifically using the 2 step process (inflate then deflate the cuff while palpating the pulse, wait, then recheck using the stethoscope), so I think he knows his stuff.
CMA's are probably better at taking BP's than you would think. They do it all day long in most clinics, and manually at that. They are given this training in most good CMA school's, as they are replacing RN's now, because they work for less. As an EMT-B, in the field, our Paramedics rely on our accuracy in critical moments. You can bet you're * we do it correctly and train those coming in to do it correctly.
beckysue920
134 Posts
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.