How Accurate Is Inpatient Blood Pressure Measurement?

BACKGROUND

Accuracy of blood pressure (BP) measurement depends on quality technique, yet there are no existing guidelines for accurate measurement of inpatient BP. We assessed the performance of BP measurements in a major teaching hospital by comparison with consensus criteria.

METHODS

Routine BP measurement methods were observed across 3 noncritical care wards (aged care, acute surgical, and hematology) at St George Hospital, Sydney, over a 3-week period. Aspects of BP measurement were compared for concordance with an ideal BP measurement technique, consisting of 10 consensus criteria, as determined by an expert panel.

RESULTS

A total of 278 BP measurements were observed in 153 patients. Concordance with the consensus criteria was high for device calibration (92%), uncrossed legs (82%), using the correct cuff size (77%), and back support (75%). Concordance was moderate for the criteria of correctly positioned cuff on a bare arm (both 65%), and poor for the remaining criteria (seated position [26%], no talking [23%], cuff at heart height [15%], and taking at least 2 measurements [7%]). No observed measurement met all 10 of the consensus criteria for BP measurement quality.

CONCLUSIONS

Our findings indicate considerable discordance between routine BP measurement and optimal technique (as determined by an expert panel) in an Australian hospital setting. The lowest concordance was observed for the 3 highest-ranked consensus criteria for accurate BP measurement. This variability may result in inaccurate and biased readings. Standardized, hospital-specific BP measurement guidelines and training are needed to improve BP measurement accuracy.