procedure for 24 hour ambulatory blood pressure monitoring
Contents
1. potential for error Check skin condition of the upper arm If the patient s arm is swollen oedematous or has any breaks do not continue seek advice The patient should be seated in a temperate environment and relaxed for at least 5 minutes prior to taking measurement To minimise the effects of the environment on the reading obtained NICE 2006 Apply single use disposable cuff cover To increase patient comfort and reduce potential risk of cross infection as cuffs are material and non wipeable Apply the cuff on the appropriate arm Thread the tubing around the back of the patient s neck down the front of their body underneath their clothes and connect to the monitor at waist level The monitor should then be placed in the pouch and secured on a belt provide if required around the waist To ensure the tubing is as unobtrusive as possible for the patient The monitor is secure To prevent damage and to enable accurate readings to be taken Patient clothing can then be re applied fitting loosely around the cuff area To allow the cuff to inflate sufficiently to obtain correct blood pressure readings Decontaminate hands on completion of procedure To remove the accumulation of transient micro organisms Instruct patient to keep a relaxed arm and not to talk whilst readings are being taken and that if a reading is not obtained the machine will take it again after 5 minutes2. Inform the patient that if they are driving and the cuff inflates to ignore it until they can pull over safely If the monitor does not obtain the reading then it will repeat the process after 5 minutes Instruct the patient not to get the monitor wet To ensure the optimum amount of readings are obtained and they are accurate To ensure patient safety To prevent monitor malfunction PROCEDURE FOR 24 HOUR AMBULATORY BLOOD PRESSURE MONITORING 6 12 Instruct patient to put the monitor under the To ensure patient safetv pillow or on the bedside table when sleeping To keep the tubing intact but remove it from around their neck Instruct the patient to remove the cuff and To stop the monitor inflating the cuff switch off the monitor at an agreed time unnecessarily Once the 24 hour monitoring period is complete Instruct the patient to place the monitor Ensures the monitor is returned in a timely pouch belt if provided and cuff in the manner for use in the next clinic envelope provided and returned to the department on the date and time agreed Supply the patient with a written copy of the For patient to refer to and in the event of instructions including a contact number diary any problems enables them to contact the sheet and envelope dept for advice The diary sheet allows comparison of any events or symptoms with the blood pressure readings taken at that time The envelope is to enable
3. Wirral Community LVL NHS Trust PROCEDURE FOR 24 HOUR AMBULATORY BLOOD PRESSURE MONITORING ABPM Issue Issue Purpose of Issue Description of Change Planned History Version Review Date To accurately perform and obtain a 24 hour Lal ambulatory blood pressure measurement in a community setting NamedResponsibleOfficer LI Officer Approvedby pens Patient Experience and Soe Soe Lead Risk pens Penn Penn 3 Target Audience Clinical staff employed within Wirral Heart Support who carry out this procedure as part of their role and job description Section CP19 UNLESS THIS VERSION HAS BEEN TAKEN DIRECTLY FROM TRUST WEB SITE THERE IS NO ASSURANCE THIS IS THE CORRECT VERSION CONTROL RECORD Title Procedure for 24 hour Ambulatorv Blood Pressure Purpose This procedure is to ensure the effective co ordinated management of ambulatory blood pressure monitoring undertaken by all clinical staff within the department who have been trained and assessed to be competent when undertaking this procedure Author Quality and Governance Service QGS Equality Assessment Integrated into procedure Yes No Subject Experts Heart Support Lead Document Librarian QGS Groups consulted with Clinical Policies and Procedures Group Infection Control Approved February 2013 Date formally approved by February 2013 Quality Patient Experience and Risk Group Metho
4. ar misses must be reported and a Trust Incident Form must be completed via the Trust s incident reporting system SAFEGUARDING In any situation where staff may consider the patient to be a vulnerable adult they need to follow the Trust Safeguarding Adult Policy and discuss with their line manager and document outcomes REFERRALS Any referrals to health professionals therapists or other specialist services must be followed up and all professional advice or guidance documented in the patients health records EQUALITY ASSESSMENT During the development of this procedure the Trust has considered the clinical needs of each protected characteristic age disability gender gender reassignment pregnancy and maternity race religion or belief sexual orientation There is no evidence of exclusion of these named groups If staff become aware of any clinical exclusions that impact on the delivery of care a Trust Incident form would need to be completed and an appropriate action plan put in place REFERENCES NICE CG127 August 2011 Hypertension Clinical management of primary hypertension in adults PROCEDURE FOR 24 HOUR AMBULATORY BLOOD PRESSURE MONITORING 8 12 8 9 APPENDIX 1 Space Lab 24 Hour Blood Pressure Monitor How to Initialise the Monitor Place new batteries in the monitor Switch monitor on Attach the Monitor to the interface cable place connection arrow to arrow On the PC double click on the ABP Report Manageme
5. can give consent on behalf of another adult who is deemed to lack capacity regardless of whether the impairment is temporary or permanent However such patients can be treated if it is deemed to be within their best interest This must be recorded within the patient s health records with a clear rationale stated at all times Refer to Trust Patient Information and Consent Policy for further information and guidance Diagnostic and Screening Standards to Promote and Maintain Patient Safety Description of how each step in the process is undertaken Additional comments a How the Screening Diagnostic procedure is requested Service Specific referral form b How the clinician treating the patient is informed of the results including timescales Fax result to GP with a copy of the Hypertension Guidelines for diagnosis and treatment Within 5 working days from result to fax c How the patient is informed of the results including timescales Via GP within 10 working days Patient informed at fitting to contact GP after 10 working days Confirmed by patient Information Leaflet d Taking action on the result of diagnostic screening tests including timescales For GP or requesting clinician to action the result gt documentation of the result Filed in WICC clinical notes gt interpretation of the result By referring clinician gt how patient is followed up or referred follo
6. d of distribution Email y Intranet N Archived Date 26 February 2013 Location S Drive QGS Access Via QGS VERSION CONTROL RECORD Version Number Author Status Changes Comments Version 1 Quality and N First version Governance Service PROCEDURE FOR 24 HOUR AMBULATORY BLOOD PRESSURE MONITORING 2 12 PROCEDURE FOR 24 HOUR AMBULATORY BLOOD PRESSURE MONITORING INTRODUCTION Hypertension is one of the most important preventable causes of premature morbidity and mortality in the UK Ambulatory Blood Pressure monitoring ABPM involves a cuff and bladder connected to electronic sensors which detect changes in cuff pressure and allow blood pressure to be measured oscillometrically The cuff is inflated by a battery powered compressor and sensors within the cuff detect changes in pressure oscillations during cuff deflation Thus a patient s blood pressure can be automatically measured at repeated intervals commonly every 30 minutes throughout the day and night while they continue routine activities TARGET GROUP The procedure applies to all clinical staff employed within Wirral Heart Support who carry out this procedure as part of their role and job description TRAINING All staff in the Trust are required to comply with mandatory training as specified in the Trusts Mandatory Training Matrix Clinical Staff are also required to comply with service specific mandatory training as specified within
7. ensure client understands procedure and relevant risks Initialise the ambulatory blood pressure monitor using the installed Spacelabs software This allows patient data and correct monitoring details to be entered onto the monitor using compatible software Blood pressure readings will be taken every 30 minutes until 23 00hrs and hourly overnight until 7 00hrs Then readings will be taken every 30 minutes until removal of the monitor and cuff Times can be adjusted for nightshift workers to account for nocturnal dip in BP To ensure accuracy of results PROCEDURE FOR 24 HOUR AMBULATORY BLOOD PRESSURE MONITORING 5 12 Decontaminate hands prior to procedure To reduce the risk of transfer of transient micro organisms on the healthcare workers hands Ascertain which arm the cuff is to be applied to and visuallv assess the size of the cuff required If the patient is right handed the cuff is applied to the left arm and vice versa unless contra indicated Select the appropriate cuff size To ensure the cuff placement is as unobtrusive as possible to the patient as they will be wearing it for 24 hours Using the wrong sized cuff can effect the readings obtained NICE 2006 Ask the patient to remove any tight arm clothing Assist the patient if required ensuring that privacy and dignity are maintained at all times Allows the cuff to be applied in the correct position thus reducing the
8. nt Icon Input User I D Input Password Ensure Caps lock is on and input patient data NHS Number is used as the patients I D number Click Next 10 Click Initialise Monitor 11 Click Finish NB If monitor contains unprocessed data appears and the previous patients data has not been downloaded click on cancel and download the data first Now you can start the initialising procedure again if you do not require the data click on OK How to Download the Readings Switch the monitor on Attach the monitor to the interface cable place connection arrow to arrow On the PC double click on the ABP Management Report icon Input user I D and Password see initializing monitor above If the same computer is used as for the initialising process then the patient data should already be available If not then you should input it as for initialisation see above Click download data Click print icon PROCEDURE FOR 24 HOUR AMBULATORY BLOOD PRESSURE MONITORING 9 12 8 Patient information should appear Fill in anv additional patient information e g age sex medication and GP details 9 Toview patient results click on Review and choose what vou would like to look at 10 Click on the printer icon and the Report Components menu will appear 11 Select Patient Information Raw data graph Statistical Summary and Caliper data 3 sheets will print out 12 Place all paperwork including the pa
9. s at follow up appt or via GP As above d e Process for action if Casenotes results mislaid Clinical outcome sheets completed referral required after a X by GPwSI and booked on the day of screening test appointment Or referred via GP Identify risks from the BP cuff inflation whilst driving Discussed at appointment advised to process of conducting the X Entanglement in the cuff and tubing during sleep ignore whilst driving and pull over test if relevant when safe to do so Also to remove tubing from around the neck during sleep and place the monitor next to the bed Written information also given to patient PROCEDURE FOR 24 HOUR AMBULATORV BLOOD PRESSURE MONITORING 12 12
10. the return of the equipment Obtain patient signature on equipment receipt To ensure patient compliance with and check understanding of procedure procedure in order to obtain accurate requirements Answer any questions and re results and safe return of equipment iterate the date time of monitor return Clean equipment upon return using trust Decontamination of medical equipment is approved cleaning wipe essential for the effective delivery of patient care Upload monitor onto computer using In order to acquire patient results Spacelabs software and print Fax results to the Referring Practitioner with Patient s GP to make timely clinical accompanying NICE guidelines on decisions and adapt the patient s treatment hypertension treatment options if required EQUIPMENT The accuracy of the ambulatory blood pressure reading obtained is highly dependent upon proper use of the equipment provided ABPM pressure monitoring equipment once past it s manufacturers Warranty is calibrated annually by the manufacturer via an annual maintenance contract It is the responsibility of the Service Lead to have a system in place to monitor and maintain quality assurance with this standard PROCEDURE FOR 24 HOUR AMBULATORY BLOOD PRESSURE MONITORING 7 12 WERE TO GET ADVICE FROM Specialist advice may be sought from the technical clinical assistant or clinic coordinator INCIDENT REPORTING Clinical incidents or ne
11. their service training matrix Ambulatory Blood pressure monitoring is an extended competency of a registered nurse or Clinical technician All appropriate staff need to have been trained and have had their competence assessed by a registered nurse A record of this is kept in their personal file RELATED POLICIES Please refer to relevant Trust policies and procedures REFERRAL Accurate patient information is required using the appropriate referral form Information should include the indication for ABPM monitoring see below and any other relevant information deemed appropriate by the referring clinician This will enable the correct triage and application of the appropriate monitor in the most timely manner INDICATIONS Patients who have been assessed by a Registered Nurse or General Practitioner and have been identified as requiring ambulatory blood pressure measurement as per the NICE Guidelines 2011 PROCEDURE FOR 24 HOUR AMBULATORY BLOOD PRESSURE MONITORING 3 12 Patients who displav sporadic or drug resistant hvpertension or other reason deemed appropriate bv the General practitioner CAUTIONS Rhythm disturbances especially atrial fibrillation can affect BP measurement using an Omron or equivalent digital blood pressure device Refer to the manufacturers user manual for further advice CONSENT Valid consent must be given voluntarily by an appropriately informed person prior to any procedure or intervention No one
12. tient diary and receipt for equipment in the patients file ready for review by specialist GP PROCEDURE FOR 24 HOUR AMBULATORY BLOOD PRESSURE MONITORING 10 12 RISK ASSESSMENT FOR SCREENING PROCEDURE Name of Screening Procedure 24 hour ambulatorv blood pressure monitoring Date risk assessed 4 December 2012 Risk assessed bv Heart Support Lead Likelihood that process Risk identified in process Mitigation Controls Criteria will fail Low Medium High a Process for requesting Fax machine malfunction Maintenance of fax machine and the screening diagnostic X checked regularly throughout the procedure day b Process for informing Fax machine malfunction Mislaid Fax machine checked regularly the clinician treating the X casenotes results throughout the day patient of the result GP practices do not process faxes immediately Casenotes results placed and there is a delay in the GP seeing the scanned immediately into GPwSl s in tray or results on screen Multiple requests to service faxing tray IM7T Board aware and from GP practice for previously faxed result that have a planned migration in place for sits in process pile at practice phasing out faxed results and move to electronic communication only by end of 2013 c Process for informing the BP monitor malfunction If monitor malfunctions we can refit patient of the result X Delays from GP surgery as above Patient can request copies of clinic letters or discus
13. wing a screening By referring clinician Which staff are authorised to request this test GPs Heart failure Specialist Nurses GPWSIs and cardiac rehab clinicians PROCEDURE FOR 24 HOUR AMBULATORY BLOOD PRESSURE MONITORING 4 12 EQUIPMENT Installed Spacelabs software Ambulatorv Blood Pressure Monitors Monitor pouches Belts Various cuff sizes Relevant documentation Envelopes Spare batteries Single use disposable cuff cover Trust approved cleaning wipe PROCEDURE ACTION RATIONALE Ensure patient notes and all required equipment and documentation is available prior to the start of the clinic To ensure good time management and smooth running of the clinic Verbally confirm the identity of the patient by asking for their full name and date of birth If client unable to confirm check identity with family carer To avoid mistaken identity Introduce yourself as a staff member and any colleagues involved at the contact To promote mutual respect and put client at their ease Wear identity badge which includes name status and designation So client knows who they are seeing and to promote mutual respect Ensure verbal consent for the presence of any other third party is obtained e g students To respect the rights of the client and enable them to decline if they wish to do so Explain procedure to patient including risks and benefits and gain valid consent To
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