Blood Pressure Screening WHFHC 181st Clinic

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Blood Pressure ScreeningWHFHC181st Clinic
Emily Eida Dina Ferdman Anna Gay Carly Gomes
Faith Ihekweazu Ben Landis Ted Macnow Amy
Ost Sarah Richman Vanessa Salcedo Nefthi
Sandeep Kim Shams Sarah Szlam Kristen
Williams Jason Winkler
Annie Armstrong Carrie Bernstein Steve Caddle
Marina Catallozzi Melanie Gissen Adriana Matiz
Mary McCord Dodi Meyer Kim Noble John Rausch
Minna Saslaw Dana Sirota
Aurora Gomez Carmen Nicasio Petra Ortiz
Candida Rodriguez David Vawdrey

• Quality Improvement Project
• 2010-2011 Academic Year

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Aim Statement

• Improve blood pressure screening and
• documentation in children 3 years and above
• Identify discrepancies between BP readings done
  by MAs with the automatic Dinamap and BP
  readings done by providers via auscultation
• Successfully educate 90 of providers and MAs
  with most recent AAP guidelines for screening,
  measuring, defining, and managing hypertension
• Successfully screen and document BP in 90 of
  children aged 3 and above during their well child
  visits
• Successfully document, refer, and initiate
  medical therapy for 90 of children with
  confirmed stage II hypertension
• Improve MA accuracy in recording BPs and choosing
  appropriate cuff size

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Interventions - MAs

• PDSA cycle 1 intervention
• Redistribution of appropriate BP cuff sizes to
  each MAs dinamap machine
• MA education via power point presentation (Pre
  test 50/Post test 100)
• MAs encouraged to recheck any BP gt 120/80 and
  document both in flowsheet
• MINI CHART REVIEW RESULTS
• 60 patients seen had BP screen
• 13 had measurements gt120/80, 33 of whom had
  pressures that were re-checked by the MA
• PDSA cycle 2 intervention
• Recalibration of height scales every scale was
  examined and adjusted. Several scales were 1-2cm
  off
• Post-recalibration measurements
• 12/13 heights recorded were accurate
• 1/13 height was off by 3cm (one tile line)

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Interventions - Providers

• PDSA cycle 1 intervention
• Standard NHANES BP tables were placed on wall in
  examination rooms next to sphygmomanometers
• Up-to-date BP calculator for boys and girls was
  added as favorite website in Internet Explorer in
  all examination rooms
• Provider powerpoint tutorial all parameters
  close to 100 on post test
• PDSA cycle 2 intervention
• Tested the validity of the SmartPaste, F6, tool
  to determine whether it correlates accurately
  with the Standard Charts used to determine BP
  percentiles
• Emails sent to providers
• How to SmartPaste from the flowsheets
• How to enter a new measured BP into the flowsheet
  and then use SmartPaste a 2nd time
• Better to retain the MAs BP in addition to the
  newly measured BP

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Results (providers) chart review
Measurement phase PDSA cycle 1 Mid Year PDSA cycle 2
pts Screened 85 91 100 90
pre-HTN (repeated/noted in AP) 24 (8/0) 20 (27/11) 23 (29/8) 5 (0/0)
stage 1 (repeated/noted in AP) 10 (40/0) 9 (80/50) 11 (43/20) 17 (100/100)
stage 2 (repeated/noted in AP) 2 (100/0) 5 (66/50) 3 (0/0) 17 (100/100)
PDSA cycle 2 70 used smartpaste in PE
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SmartPaste Option F6
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Physician Reminder
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SmartPaste accuracy

• Purpose validate accuracy of SmartPaste F6
• Methods comparison of SmartPaste BP percentiles
  vs. uptodate (UTD) calculator for 21 pediatric
  patients (aged 3 to 17)
• Results Discrepancies between SP and UTD BP
  percentiles ranged from 0 to 7 iles
• Majority of differences (either systolic or
  diastolic) were small
• 13/21 pts 0 and 2 iles
• 5/21 pts 3 to 4iles
• 3/21 pts 5 and 7iles
• In 2 pts the discrepancy would have lead to a
  difference in HTN classification
• Ex. Smart paste estimated 95ile (stage I
  hypertension) while UTD estimated 93 or 94ile
  (prehypertension)
• Most of the larger differences (4 to 7 iles)
  occurred for lower BP iles (not clinically
  relevant)
• Conclusions Smart Paste BP percentiles generally
  correlate with the UTD BP percentiles, with the
  small differences trending towards Smart Paste
  overestimating the BP percentile
• As a screening tool, while this may lead to more
  false positives , it would avoid us missing any
  true hypertension.

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Conclusions - revisiting the AIM statement

• Improve blood pressure screening and
• documentation in children 3 years and above
• Identify discrepancies between BP readings done
  by MAs with the automatic Dinamap and BP
  readings done by providers via auscultation
• Successfully educate 90 of providers and MAs
  with most recent AAP guidelines for screening,
  measuring, defining, and managing hypertension
• Successfully screen and document BP in 90 of
  children aged 3 and above during their well child
  visits
• Successfully document, refer, and initiate
  medical therapy for 90 of children with
  confirmed stage II hypertension
• Improve MA accuracy in recording BPs and choosing
  appropriate cuff size

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Change Package - spreading our project to the ACN

• MA training on correct BP measurement, dinamaps
  for MA with appropriate cuff sizes
• Recalibration of height scales
• Train MDs in SmartPaste function
• Post cutoffs for preHTN, stage 1 and stage 2
  and SmartPaste signs in exam rooms