Debunking 7 myths associated with BP measurement training

Not all blood pressure measurements are created equal. Accurate measurement is vital to confirm diagnosis of high BP in patients and provide proper treatment. But why should doctors care about being retrained to measure BP accurately?

To help address the gap in BP measurement accuracy, the AMA and American Heart Association launched an online module that provides an engaging and interactive opportunity to refresh skills. Powered by Target: BP™, the online module, “Achieving Accuracy: BP Measurement,” creates a comprehensive and standardized training approach to help ensure that every health professional in the U.S. is competently trained to measure BP consistently and accurately—every time.

Kate Kirley, MD, a family physician and director of chronic disease prevention at the AMA, recently took time to debunk some myths around BP measurement training and the importance of standardized training across the care team.

“There are plenty of guidelines saying that we should be screening all adults for high blood pressure,” said Dr. Kirley. “Even a young, healthy person who looks like their blood pressure should be fine can—and sometimes does—have hypertension.

“Accuracy really matters in all people—for screening reasons, for obtaining an accurate diagnosis, and for making sure your treatment is working appropriately,” she added.

BP retraining is not only important for those who take blood pressure measurements every day, such as medical assistants, but for the entire care team, including doctors and physician assistants.

“What we saw when we did retrain all of these health care professionals is that everyone came out of the training saying, ‘It was good that I did this. I needed that,’” said Dr. Kirley. She added that many health professionals also greatly appreciated the training as a reminder about things they felt they already knew.

A common assumption is that recommendations about proper BP measurement technique have remained the same. However, new guidelines exist to provide further guidance for how to properly measure blood pressure.

“Studies have been done over the course of many decades that have caused us to refine what the important steps are, and our understanding of how doing a step wrong impacts blood pressure,” said Dr. Kirley.

It is recommended that health professionals take more than one BP measurement and average them. However, there is a concern that this will add more time to an already busy schedule.

“When the team measures properly, it might add a couple minutes,” said Dr. Kirley. But when implemented properly, the practice of taking multiple BP readings probably saves time. We waste time when a doctor reviews a BP measurement and thinks it can’t be accurate, then they are taking time out of their visit to remeasure. In turn, this can cause the white coat effect, which leads to unnecessary medication adjustments.

“Doing it right the first time can save time—or at least not add time—while improving trust inaccuracy of the measurement,” she said.

“People really believe that manual blood pressure measurement is the gold standard. But that is only true with research nurses trained to conduct research-quality blood pressures,” said Dr. Kirley. “Using calibrated and validated automated machines can cut down on some of the user error that happens.”

Many people might also assume that if you’re using an automated machine you don’t have to worry about any errors in BP measurements.

“All of those positioning steps and preparing the patient matter enormously. That is why retraining still is really important no matter what type of measurement device you use in your office,” she said.

A medical assistant or nurse will typically check the patient’s BP and a primary care physician or physician assistant will retake it if the reading seems “off” or if there is a critical diagnosis associated with the measurement.

“All of that really points to the importance of everyone on the team knowing what the standard of accurate blood pressure measurement is and being able to perform to that standard equally,” said Dr. Kirley. “Medical assistants and nurses do tend to be the people taking blood pressure most often in the office and that is what we want. That’s because when doctors take blood pressure, we are much more likely to cause a stronger alerting response or cause the white coat effect because we make people nervous.”

When physicians understand that their fellow team members are following the standard, they can trust the measurement being taken and won’t feel the need to retake it.