Developing Systems to Improve Hypertension Monitoring at a Primary Care Clinic

Tuesday, 23 July 2013: 1:50 PM

Theresa Marie Holsan, DNP, RN, FNP-C
Village Family Practice, Centennial, CO

Learning Objective 1: The learner will be able to identify one way to improve blood pressure measurements in hypertensive patients.

Learning Objective 2: The learner will be able to describe the standard way to measure blood pressure.

Scope and Significance

Primary care clinics are responsible for evaluation of patients with hypertension (HTN) and reporting care to effectively treat this disease.  Despite  recommended guidelines about 59% of the adult  patients in the United States with HTN are being treated and only 34% of those treated have well-controlled blood pressure (BP).

Specific objectives of the project  were to: 1. Increase the percentage of adult hypertensive patients with adequately controlled BP(<140/90 mm Hg); 2. Standardize BP techniques by ancillary staff and providers and to improve BP documentation; and 3. Evaluate and accurately use the patient reminder system for follow-up care.

Review of the Literature

A comprehensive review of original studies published in English from all countries beginning 2000 to January 2012 was performed.  Relevant literature was identified through CINAHL, PubMed, and OVID using the search terms hypertension, quality improvement, follow-up, BP methods, and BP control. 


A pre-post design was used over a 15 month project period.  Multiple plan-do-study-act (PDSA) cycles were initiated and three practice outcomes evaluated.  Descriptive statistics and Pearson Chi-square were used to evaluate the effectiveness of the interventions.


BP was entered in the vital sign section of the chart 100% and variation in BP measurement was reduced.  Changes to patient follow up resulted in 93% of patients with HTN having a follow-up visit entered into the electronic medical record (EMR).  Adult hypertensive patients with adequately controlled BP improved from 56.8% to 75.3%.   χ2 (1, N=958) =36.36, p<.0001, v=.195.

Implications for Nursing

A combination of chart review and quality improvement methodology offered a powerful way to improve practice. The interventions provided measurable and sustainable improvements through collective efforts. Communication was strengthened and use of the EMR was augmented. Hypertension is a global health issue, without accurate BP data clinicians cannot make decisions to improve patient outcomes.