Learning Objective #1: Use the Iowa Model of Evidence-Based Practice to Promote Quality Care to answer a clinical practice problem

Learning Objective #2: Develop evidence-based practice guidelines for blood pressure measurement based on research findings

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There is a growing trend among healthcare workers to use the forearm (FA) when obtaining NIBPs. Research on the use of the FA for BP measurement is extremely limited. The Iowa Model of Evidence-Based Practice to Promote Quality Care guided the decision to conduct research to compare NIBPs taken on the FA with those taken on the upper arm (UA) with patients seated, positioned supine, and upright 45 degrees. Two descriptive, correlational comparison studies were conducted. For the 1st study, 204 patients admitted to the ED were recruited. UA and FA circumferences were measured and cuff size was determined. NIBPs were taken on the FA and then on the UA with the subject seated and the arm at heart level. For the 2nd study, 215 inpatients were recruited. Patients' arm circumferences were measured and proper cuff size was determined. NIBPs were taken on the FA and then on the UA with subject supine and arm resting at the side. Patients were then repositioned (HOB 45 degrees) and NIBPs were taken on the UA and then on the FA. The Bland-Altman procedure was used to calculate the amount of agreement between the UA and FA SBPs, DBPs, and MAPs. In the first study, distances between the mean values and limits of agreement ranged from 15 mm Hg (MAPs) to 18.4 mm Hg (SBPs). In the second study, distances between the mean values and limits of agreement ranged from 11.9 mm Hg (MAPs) to 19.3 mm Hg (SBPs) with subjects supine and from 2.2 mm Hg (MAPs) to 33.4 mm Hg (SBPs) with subjects HOB 45 degrees. These findings indicate that despite strict attention to cuff size, UA and FA NIBPs are not interchangeable. Findings from both studies will be used to develop an evidence-based clinical practice guideline for NIBP measurement.