Obtaining Accurate Blood Pressure Measurements in the Cardiac Intensive Care Unit

Monday, 30 October 2017: 1:15 PM

Emily Rebecca Lange, BSN
School of Nursing, Rush University, Chicago, IL, USA

Background: According to the American Heart Association (AHA), blood pressure (BP) measurements are one of the most important measurements in medicine, yet they are often inaccurately measured (Pickering et al., 2005). In 2005, the AHA created specific guidelines on accurate BP measurement techniques (Pickering et al., 2005). In one study, 97% of blood pressure measurements did not follow all of the AHA guidelines and 36% of patients had the wrong cuff size on (Holland & Lewis, 2014). An initial audit of the Cardiac Intensive Care Unit (CICU) showed that 50% of the cuff sizes were incorrect.

Problem: The problem is that nurses do not always follow the AHA guidelines regarding BP measurement techniques leading to inaccurate BP measurements and decreased patient safety.

Purpose: The purpose of this project was to improve patient safety by determining how frequently and why BP measurements did not follow all of the AHA guidelines, identify barriers preventing staff from taking accurate BPs, and create interventions to improve BP accuracy.

Scope: This quality improvement project occurred from April to August 2016 in the CICU. Participation was voluntary by all Registered Nurses, Patient Care Technicians, and Nursing Assistants on the unit, which totals about 110 nursing staff members. Ten guidelines were chosen from the AHA and were used to guide this project: the BP cuff should be placed 2-3 cm above the antecubital fossa, the cuff should be the correct cuff, the BP cuff should be aligned with the brachial artery, the BP cuff should be level with the right atrium, the arm should be still, the patient should be silent, the patient should be supine or seated, the patient’s back should be supported, the patient’s arm should be supported, and the BP cuff should be on the patient’s skin (Pickering et al., 2005).

Implementation: To improve BP measurement accuracy, staff members participated in a quality improvement project including a short educational session with the goal of increasing CICU staff knowledge of utilizing correct BP techniques according to the AHA guidelines. Additionally, poster reminders were placed on patient monitors reminding staff to use the correct sized BP cuff with a list of the AHA guidelines. The guidelines were also placed in bedside clinical reference binders outside of each patient room. Multiple sizes of BP cuffs were stocked in each patient room. Also, all manual BP monitors were fixed and one was placed in every patient room.

Methods: Initial and final audits were done before and after the interventions were implemented. Pre-tests and post-tests were given before and after the educational sessions. Initial and final surveys were completed to assess barriers to taking accurate BP measurements and use of the interventions.

Evaluation: The initial audit and final audit included 46 patients each. The initial survey had 43 nurses participate, while the final survey had 39 nurses participate. The pre-test was taken by 71 nurses, compared to the post-test was taken by 72 nurses.

Results: The initial audit showed that staff followed an average of 5.20 out of the 10 AHA guidelines used for this project with a range from 2 to 10. The final audit showed an increase in the average of AHA guidelines followed to 8.54 with a range from 5 to 10. The posttest scores improved dramatically with 6 out of the 9 questions showing statistical significance. The final survey showed that most staff members agreed or strongly agreed with statements that they utilize the interventions from this project. There was a significant improvement from pre to post surveys of the extent to which people said that they were using AHA guidelines. There was also a significant increase in the number of staff who stated that they have all of the supplies at the bedside to take accurate BPs after the interventions.

Limitations: This was a quality improvement project in the CICU, so the interventions and results may not be relevant to other units or settings and are limited to this particular unit.

Significance: If inaccurate BP measurements are taken and recorded, patients can potentially receive inappropriate medications and treatments. Nurses do not always follow all of the AHA guidelines, so it is imperative that they are reminded of the proper techniques and given tools to remember and implement the guidelines.


Holland, M., & Lewis, P. S. (2014). An audit and suggested guidelines for in-patient blood pressure measurement. Journal Of Hypertension32(11), 2166-2170 5p. doi:10.1097/HJH.0000000000000306

Pickering, T.G., Hall, J.E., Appel, L.J., Falkner, B.E., Graves, J., Hill, M.N., et al. (2005). Recommendations for blood pressure measurement in humans and experimental animals. Hypertension, 45, 142-161.