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Policy for Screening, Monitoring and Management of Hypertension

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					Policy Type:     Clinical
Definition:      Policy                                 C li
Owner Group:     Operations                             n ic




                                                        Clinical Policy
                                                        al
                                                        Gu
                                                        id e
                                                        lin
                                                        e



   Policy for Screening, Monitoring and
       Management of Hypertension




Applicable To:                  Nursing and Therapy Staff
Communication Method:           Line Manager
Consequence of Non Adherence:   Disciplinary

Policy Author/Source:           CHD Facilitator
Trust Policy Index Number:      8.3
Version Number:                 2

Approval Body:                  Clinical Policy and Procedure
                                EBPCT September 2006
Date Approved:                  Adopted by BENPCT October
                                2006
Review Date:                    September 2008



                                                   Page 1 of 21
                                   CONTENTS

                                               Page No



Diversity Statement                                  2

Introduction                                         3

Rationale:                                           4
      Inclusion Criteria
      Exclusion Criteria

Specific Responsibilities and Accountability         5
      The Trust
      The Staff

The Health Care Assistant                            6

The Hypertension Link Nurse                          6
     Team Leaders
     The Manager

Equipment                                            7

Training                                             8

Audit and reporting standards                        8

Guidelines/Procedures                                8

Outcome                                              10

Indications for specialist referral                  11

Criteria for not proceeding with this policy         11

Monitoring and evaluation                            12

References                                           13

Appendices




BENPCT Hypertension policy 2006.               Page 2 of 21
                     Diversity Statement for Clinical Policies


This policy endeavours to deliver care in such a way as to treat patients fairly
and respectfully regardless of age, gender, race, ethnicity, religion/belief,
sexual orientation and/or disability.

The care and treatment provided will respect the individuality of each patient.

BEN PCT is caring, committed and competent in its core values and these will
be developed to ensure equality and fairness becomes the working culture.

In line with the PCT’s strategy and plans for race and equality all clinical
policies and protocols are reviewed against the values, standards and targets
contained within the strategy for fairness and equality.




BENPCT Hypertension policy 2006.                                        Page 3 of 21
1.0      INTRODUCTION

1.1      This policy is aimed at standardising the practice of community nurses in
         the monitoring and management of hypertension, adopting the NICE
         guidelines (National Institute for Clinical Effectiveness) and British
         Hypertension Society guidelines and targets set in the National Service
         Framework for Coronary Heart Disease.

1.2      The purpose of this policy is to provide a blood pressure assessment,
         monitoring and management service to housebound patients with
         hypertension in the community, ensuring an equal access to service for
         these patients as compared to those that attend the practice nurse. For
         the purpose of this document the definition on housebound is where the
         patient is only able to leave home by ambulance (RCN 2002).

1.3      Community health Practitioners (CHP) are in a prime position to provide
         a service for hypertensive patients, offering access to holistic care, with
         a focus on non-pharmacological interventions to lower blood pressure
         and prevent coronary heart disease / cardiovascular disease (CHD /
         CVD).

2.0      RATIONALE

                  To detect undiagnosed hypertension, advise on non-
                   pharmacological interventions and refer to GP for appropriate
                   investigations and interventions.

                  To achieve and maintain acceptable blood pressure levels in
                   identified medicated hypertensive patients, based on current
                   evidence, in line with the British Hypertensive Society (BHS) /
                   NICE recommendations. However the society recognise that
                   target blood pressure may not be achievable in all patients.

                  To use non-pharmacological interventions to lower blood pressure
                   and support drug therapy in reducing risk of CHD / CVD.

                  Earlier detection of hypertension, leading to earlier treatment and
                   interventions.

                  Provision of evidence based, quality standardised service.

                  Provision of equitable service for housebound patients

                  Promotion of patient concordance through patient empowerment

                  Referral and access to local agency / community support e.g.
                   exercise on prescription, dietician service.
                   Inclusion Criteria

                  All patients 16 years and upwards unable to attend surgery.


BENPCT Hypertension policy 2006.                                            Page 4 of 21
                  Potentially any patient the Health Care Practitioner comes into
                   contact with over the age of 18 years e.g. on health promotion
                   awareness days

Exclusion Criteria

                  Suspected malignant hypertension

                  Secondary hypertension

                  Paediatrics (under 16 years)

                  Pregnancy

                  In exceptional cases patients are to be assessed and dealt with
                   on an individual basis


3.0      SPECIFIC RESPONSIBILITIES AND ACCOUNTABILITY

3.1      The Trust

         All staff to have access to an updated evidence policy document.

         To ensure that appropriate training and updates are provided to all
         relevant staff groups.

         Staff are made aware of any policy changes and new skills update
         followed by the appropriate training.

         All relevant staff groups to have access to appropriate equipment that
         complies with safety and maintenance requirements according to trust
         policies.

3.2      The Staff

         To practice within their scope of professional practice and competency.

         To read and adhere to Trust policy.

         To identify any areas for skill update and training requirement.

         To ensure that the patients care actively promotes their privacy and
         dignity and protects their modesty.

         To obtain informed consent from the patient prior to any procedure being
         carried out.

         To ensure systems are in place to communicate blood pressure readings
         to the GP.

         To ensure their equipment is maintained and calibrated according to
         Trust policies.
BENPCT Hypertension policy 2006.                                            Page 5 of 21
         Qualified staff to ensure continued review and appraisal of competency
         of unqualified staff who carry out the hypertension monitoring.
         To ensure that health promotion advice is up to date and specific to
         individual needs.

         To ensure any operational concerns are discussed with their manager.


3.3      The Manager

         Managers need to ensure that staff are aware and have access to the
         policy and that appropriate education; supervision and mechanisms are
         in place to ensure safe practice. Areas of training need must be
         highlighted and addressed through appraisal or supervision and a record
         of competencies kept for audit and standard purposes.


4.0      THE HEALTH CARE ASSISTANT

4.1      The Health Care Assistant will be authorised to perform blood pressure
         monitoring, following Trust training, on patients whose blood pressure
         has reached acceptable control levels as deemed appropriate by their
         GP.

4.2      Patients for monitoring will be allocated following the initial assessment
         of the patient by a qualified Health Practitioner.

4.3      Patients being monitored by HCAs will be reviewed at least annually by
         a qualified Health Practitioner.

4.4      The HCA will compare past and present blood pressure readings and
         any changes will be brought to the attention of a qualified Health
         Practitioner in their team. All relevant documentation will be completed.

4.5      Whilst with the patient/client the HCA will check whether the
         patient/client is experiencing any problems taking their medication. If any
         problems taking medication are identified the HCA will report findings
         back to the qualified Health Practitioner in their team. The HCA will
         advise of any lifestyle advice as per patient/client care plan.




BENPCT Hypertension policy 2006.                                          Page 6 of 21
5.0      THE HYPERTENSION LINK NURSE

                  Will act as a resource in their clinical area.

                  Will liase between their community team, manager and other
                   clinical nurse specialists, and CHD facilitators.

                  Will attend BHS approved study days and appropriate updates as
                   necessary .

                  Participate in writing, reviewing and updating policies, procedures
                   and standards in relation to hypertension prevention and
                   management.

                  Measure and monitor effectiveness of policy through audits,
                   questionnaires and other tools.

                  Attend relevant link nurse meetings, e.g. hypertension clinical
                   action team and CVD update.

                  To take on optional role in training groups of nurses. This optional
                   role will require the participant to hold a teaching certificate e.g.
                   mentors and assessor’s course or equivalent.

3.4      Team Leaders

         Ensure the team has an identified link nurse in the team or in a sister
         team that they can link into.

         In the absence of a link nurse inform their clinical leader.


6.0      EQUIPMENT

6.1      Automatic sphygmomanometers recommended and validated by BHS
         should be used according to manufacturers instructions.
         See          BHS          monitors/devices          for updates:
         http://www.hyp.ac.uk/bhs/bp_monitors/automatic.htm

6.2      At present the mercury sphygmomanometer remains the gold standard
         BHS (1999), however, these will eventually be phased out due to health
         and safety standards regarding mercury.
         Check mercury sphygmomanometer is in good working order i.e.
         Clean mercury
         Sound rubber tubing
         Airtight connections
         Clean control valves

6.3      Stethoscopes should be in good working order; the bell or diaphragm
         can be used according to personal choice.



BENPCT Hypertension policy 2006.                                              Page 7 of 21
         Cuff sizes:
         The bladder within the cuff should encircle the upper arm by approx.
         80% (3/4 of the arm circumference)
         Adult:              12cm by 23cm – for small arms
         Alternative cuff:   12cm by 36cm – will cover 98% of arms
         Large cuff:         15cm by 36cm – for arm circumference over 42cm

         All equipment should be maintained and calibrated via medical devices
         department annually.

7.0      TRAINING

7.1      Competencies: All grades of qualified health practitioners must
         undertake trust training or have evidence of other appropriate/relevant
         hypertension training in order to provide this service.

7.2      Health Care Assistants (HCA) or support workers need to have
         undertaken trust training on hypertension management and have been
         assessed as competent, on three consecutive occasions, performed on
         three different patients, by a qualified member of staff using the
         assessment form (appendix 7). A qualified member of staff will reassess
         their practice annually.

7.3      New starters to the trust will receive, where necessary, training on
         hypertension management as part of their induction provided by the
         hypertension link worker in their team.
         All health practitioners involved in hypertension management will be
         updated of any changes or new recommendations by their hypertension
         link worker.

8.0      AUDIT AND REPORTING STANDARDS

8.1      The hypertension link workers will be responsible for ensuring audit and
         reporting on hypertension monitoring and referral is carried out on an
         annual basis.
         Any untoward incidents or near misses should be reported to line
         managers using the IR1 form.

9.0      GUIDELINES/PROCEDURE

9.1      Diagnosis of Hypertension

         All patients/clients should have their blood pressure assessed as part of
         the holistic or Single Assessment Process (SAP). Health interventions
         should be discussed with patients at this stage and guidance for any
         agreed modifications in lifestyle.
         Thresholds for Intervention guidelines (appendix 1) offer guidelines for
         follow up and also offers guidance as to when to refer to their general
         practitioner for treatment in accordance with the British Hypertension
         Society / NICE guidelines.
         To confirm diagnosis 2 readings must be taken on at least 3 separate
         occasions.

BENPCT Hypertension policy 2006.                                        Page 8 of 21
9.2      Health Assessment

         Assessment of lifestyle risk factors performed and health promotion on
         modifiable risk factors will be discussed in order to empower patients
         who are ready to make lifestyle changes. Support literature should be
         provided e.g. BHF booklet entitled ‘Blood Pressure’ and any changes
         negotiated should be reviewed at follow-up. Management and action will
         be recorded in the patient’s handheld documentation (appendix 2&3)
         and their general practitioner informed by agreed localised method.

9.3      Health screening

9.3.1 Blood tests

         Annual blood tests relating to specific medication will be taken as
         recommended in the British National Formulary (BNF),and in discussion
         with the GP and practice recall system. Additional blood tests identified
         during the health assessment may also need to be taken in agreement
         with the patient’s general practitioner (appendix 4). Nurses taking blood
         will have undertaken venepuncture training and will obtain samples and
         dispose of sharps in accordance with the trust policy for venepuncture.
         Patients with abnormal blood results will be discussed with the GP and
         action negotiated. Any action taken or planned should be documented in
         the care plan, along with reasons for deviating from BHS / NICE
         guidelines.

9.3.2 Blood glucose

         A random BM test should be performed on all patients with a high blood
         pressure to screen for diabetes. If BM is 7.0 mmols or above liaise with
         their general practitioner and arrange for a venous fasting glucose to aid
         diagnosis. It may be necessary for a glucose tolerance test to be
         undertaken for final diagnosis.
         If the patient is diagnosed diabetic, monitoring is to be carried out in
         accordance with trust management guidelines for Diabetes.

9.3.3 Urinalysis

         Urine will be tested annually for blood and protein. If proteinuria or
         haematuria present send mid-steam urine sample to laboratory for
         testing for multi-culture and sensitivity, and discuss with GP to arrange
         blood test for urea and electrolytes and creatinin.
         Patients with abnormal results will be discussed with the GP and action
         negotiated. Action taken to be documented in the care plan.




BENPCT Hypertension policy 2006.                                         Page 9 of 21
9.4      Blood pressure: (see appendix 5)

         Blood pressure will be measured using equipment recommended by the
         British Hypertension Society – the mercury sphygmomanometer as gold
         standard or alternatively, an automatic digital sphygmomanometer
         validated and recommended by the BHS.
         Do not crease cuff or air tube and do not fold cuff or air tube together too
         tightly. Instruction manual should be read and followed.
         Immediately before measuring blood pressure the patient should avoid
         eating, drinking alcohol, smoking or exercise. Explain procedure to the
         patient.

         Blood pressure will be measured according to current recommendations
         for accurate measurement of blood pressure (appendix 5).
         Blood pressure measurement should be taken in both arms on initial
         measurement, if blood pressure is raised, refer to appendix 5 for further
         details. Use clinical judgement and contact link worker if there are any
         concerns.

9.5      Blood Pressure Service


10.0     OUTCOME
         (See appendix 6)

                  Normotensive patient not on treatment, with no risk factors
                   identified by patient or nurse – routine follow up in 5 years.

                  Normotensive patient not on treatment with known risk factors to
                   CVD.- Follow up in one year.

                  Hypertensive patient on medication, with no problems or concerns
                   identified by patient or nurse – routine follow up 3-6 months.

                  Hypertensive patient on medication (BP >150/90 and <199/109)
                   advice on modifiable risk factors if appropriate and follow up
                   weekly for 1 month. If still hypertensive but BP reducing, continue
                   advice to allow patient time to modify lifestyle risks over 12
                   weeks. If no reduction in BP – refer to GP. See appendix 1 BHS
                   flow chart.

                  Blood pressure = to or > 199 systolic or > 109 diastolic – refer to
                   GP same day.

                  Normotensive but drug incompatibility or side effects – refer to
                   GP.


                  Normotensive and no drug therapy problems, but patient
                   complains of other symptoms / condition / concerns – refer to GP.

BENPCT Hypertension policy 2006.                                            Page 10 of 21
11.0     INDICATIONS FOR SPECIALIST REFERRAL
            In the following conditions the nurse will need to notify the GP for
            assessment and referral as appropriate,

                  Suspected malignant hypertension.

                  Secondary hypertension.

                  Impending implications, TIA (transient ishaemic attack)

                  Resistance to anti-hypertensive therapy – uncontrolled on 3 or
                   more drugs.

                  To evaluate therapeutic problems or failures.

                  Unusually variable blood pressure.

                  Women of child bearing age / on contraceptive pill.

                  Pregnancy.

                  Elevated serum creatinine/potassium/sodium.

                  Proteinuria or haematurea.

                  Possible white coat hypertension.

                  Young <30 years.


12.0     CRITERIA FOR NOT PROCEEDING WITH THIS POLICY

                  Suspected malignant hypertension.

                  Secondary hypertension.

                  Paediatrics (under 16).

                  Pregnancy.




BENPCT Hypertension policy 2006.                                             Page 11 of 21
13.0     MONITORING AND EVALUATION

This policy will be reviewed annually to ensure it is up to date with current
evidence.


Date of ratification……………………………………………

Name(s)………………………………………………………

Signature(s)…………………………………………………..

Designation…………………………………………………..


Date of ratification……………………………………………

Name(s)………………………………………………………

Signature(s)…………………………………………………..

Designation…………………………………………………..


Date of ratification……………………………………………

Name(s)………………………………………………………

Signature(s)…………………………………………………..

Designation…………………………………………………..




BENPCT Hypertension policy 2006.                                   Page 12 of 21
REFERENCES
BNF, British National Formulary.

BRITISH HEART FOUNDATION (1999) Coronary heart disease statistics.
London: British Heart Foundation.

DEPARTMENT OF HEALTH (2000) National Service Framework for Coronary
Heart Disease. London: DOH

NICE, National Institute for Clinical Excellence.

O’BRIEN, ET et al. (2000) Blood Pressure Measurement: Recommendations of
the British Hypertension Society. 4th edition, London: BMJ Publishing group.

Royal College of Nursing. (2002). Developing Referral Criteria for District
Nursing Services. Royal College of Nursing: London.

SMITH,WC. LEE,AJ. CROMBIE,IK. TUNSTALL-PEDOE,H. (1990) Control of
blood pressure in scotland: the rule of halves. British Medical Journal,
300(6730),pp981-983.

WILHELMSEN,L.      STRASSER,T.         (1993)  WHO-WHL          Hypertension
management audit project. Journal of Human Hypertension, 7(3), pp257-263.

WILLIAMS, B. et al. (2004) Guidelines for the management of hypertension:
report of the fourth working party of the British Hypertension Society. Journal of
Human Hypertension, (18) pp.139-185.

WOOD, D. et al. (1998) Joint British recommendations on prevention of
coronary heart disease in clinical practice. Heart, vol 80 supplement 2




Website References

         For further information
         http://www.prodigy.nhs.uk/guidance.asp?gt=hypertension
         http://www.hyp.ac.uk/bhs/resources/guidelines.htm
         www.nice.org.uk




BENPCT Hypertension policy 2006.                                       Page 13 of 21
Hypertension policy 2006.
                            Page 14 of 21
                                                                                              Appendix 2

                                      Hypertension Card
Patients Name………………DOB:……………….Gender: ………… Ethnicity………
                                  Patient History / Family History

                                                                      Patient        Family
Unknown
                                                                      Y   N          Y   N

          Hypertension (high blood pressure)

          Hyperlipidaemia (high cholesterol levels in blood)

          Coronary heart disease

          Cerebral vascular accident (stroke)

          Transient ischaemic attack (mini-strokes)

          Diabetes

          Peripheral vascular disease

          Renal disease (kidney disease)

Cardiovascular Drugs e.g. Diuretics, Beta Blockers, Calcium Channel
Blockers, ACEI, Alpha Blockers

             Type / Name                      Dose              Number of times per day




Nurses Signature:…………..………… Date:…………………
                               Initial Blood Pressure Readings
 Visits        Blood         Average        Sitting (s)        Arm            Date     Nurses
              Pressure       Reading        Standing           Used                   Signature
                                                (st)
  1st        1.
 Visit       2.
  2nd        1.
 Visit       2.
  3rd        1.
 Visit       2.




                                                                                      Page 15 of 21
                                                                                                                                                           Appendix 3

                                                    Risk Factors And Recommendations.

           Weight               *Alcohol              Diabetes                     Exercise
                                                                                                 Patient      Comments, recommendations,
            (body     Blood      units                                                        compliance     risk factors & aims. (with respect to                 Review
Date                                       Smoking    glucose      Cholesterol       Type                                                                Signed
             mass    Pressure     per                                                              to         risk factors, note patients readiness to              date
            index)                                     HBAIC                      Frequency                     change relative to cycle of change).
                                 week                                                          treatment




                                                                                                Normal Blood Ranges;-
                                                                   Physiological Details
                                                                                                Urea + electrolytes: 2.4 – 7.5
Investigations         Date                Result           Action                 Signed       Sodium:              133 – 147
    Urea &                                                                                      Potassium:            3.5 – 5.0
  electrolytes                                            *Alcohol units per week:-
   Creatinin                                                                                    Liver function test – AST less than 35
 (kidney test)                                            14 for women, 21 for men
                                                                                                AIK phos:             30 – 200
Liver function                                            1 unit     = one glass of wine,       Bilirubin:             1 – 25
     test                                                              one shot of spirits,     Albumin:              35 – 48
                                                                       half pint of beer.       Total Protien:        60 – 80
  Urinalysis                                                                                    Cholesterol:         3.6 – 6.5
 (urine test)                                                                                   High Density lipids (HDL)
                                                                                                CVD Score



                                                                                                                                                         Page 16 of 21
                                                                               Appendix 4


                       BLOOD TESTS SPECIFIC TO MEDICATION.



Class of drug.                        Investigation required.


Diuretics                             Urea and electrolytes, and creatinine annually and
                                      following titration according to BNF. (British National
                                      Formulary)

Statins                               Liver function test, lipids annually and following
                                      titration according to the BNF.

ACE inhibitors                        Creatinine, U+E, annually and following titration
                                      according to the BNF.




                                ADDITIONAL BLOOD TESTS



To Determine statin treatment         Lipid studies according to the Joint British Society
                                      guidelines.

Proteinuria                           Urea and electrolytes, and creatinine

History of increased CHD              Full blood count
Symptoms

Diabetes                              HBA1c




                                                                                  Page 17 of 21
                                                                   Appendix 5

CLINICAL PRACTICE FOR
ACCURATE MEASUREMENT OF BLOOD PRESSURE


DEFINITON OF ACTIVITY

Preparation of patient for measurement of blood pressure as recommended by
the British Hypertension Society (O’Brien et al. 1997). Assessment of modifiable
lifestyle risk factors for CHD/CVD and health education re: non-pharmacological
intervention in reduction of blood pressure.

THE PATIENT

The patient should be seated and relaxed (with an empty bladder) for at least 5
minutes, remove any tight cumbersome clothing around the upper arm to avoid
interference with blood flow. Make sure the arm is supported and not hyper-
extended, hyperextension results in isometric exercise and will raise the blood
pressure.

EQUIPMENT

Automatic sphygmomanometers recommended and validated by BHS should be
used according to manufacturers instructions.
See            BHS           monitors/devices      for        updates:
http://www.hyp.ac.uk/bhs/bp_monitors/automatic.htm


At present the mercury sphygmomanometer remains the gold standard BHS
(1999), however, these will eventually be phased out due to health and safety
standards regarding mercury.
Check mercury sphygmomanometer is in good working order i.e.
Clean mercury
Sound rubber tubing
Airtight connections
Clean control valves

The mercury sphygmomanometer should be placed on a level surface, level with
the observer’s eyes.


STETHOSCOPE

This should be of good quality; the bell or diaphragm may be used according to
personal choice.



Hypertension policy 2006.
                                                                       Page 18 of 21
CUFF SIZES
The bladder within the cuff should encircle the upper arm by approx. 80% (3/4 of
the arm circumference)
Adult:              12cm by 23cm – for small arms
Alternative cuff:   12cm by 36cm – will cover 98% of arms
Large cuff:         15cm by 36cm – for arm circumference over 42cm maybe
                    required.


MEASUREMENT OF BLOOD PRESSURE USING MERCURY
SPHYGMOMANOMETER

Place the centre of the cuff over the brachial artery, tubing directed up towards
the shoulder to avoid interfering with the stethoscope. The cuff should be level
with the heart and the arm supported.

Initially measure blood pressure on both arms, if there is a difference of more
than 20mmHg systolic or 10mmHg diastolic repeat on three separate occasions.
Use highest arm measurement and record in notes the arm to be used
subsequently, refer to secondary care for simultaneous measurement of BP on
both arms.

Feeling the radial or brachial pulse inflate the cuff rapidly to 30mmHg above the
occlusion of the pulse to allow for any auscultatory gap and time to adjust the
valve. Deflate the cuff at 2-3mm per second, using Koroptkof sounds record
phase 1(K1) systolic pressure and phase 5 (K5 disappearance of sound) diastolic
pressure, if muffling continues use phase 4 (K4) to record diastolic pressure and
K5 as disappearance of sound, record in notes.

Two measurements should be taken at each visit and the mean average
recorded

Standing blood pressures to identify postural hypotension should be measured in
the elderly and diabetics when the patient has stood for at least one minute and
recorded in the medical records.




Hypertension policy 2006.
                                                                        Page 19 of 21
                                                                              Appendix 6


        Blood Pressure Monitoring Guidelines for all Health care
                           Support Staff.

Target blood pressure (BP):-      less than 140/85 or the maximum BP
                        reduction tolerated.


                                                              BP more than 150/90
                            BP 140/85 or less
                                                              and less than 180/110




                                                              Advise on modifiable
     No problems /                              Problems /       risk factors if
       concerns                                  concerns         appropriate.
      identified.                               identified.


     Advise on                              Advise on
    modifiable risk                        modifiable risk
      factors if                             factors if
                                                                Check patient is
                                                               taking medication.
  Check patient is                        Check patient is
      taking                                  taking
    medication.                             medication.

 Routine follow-up                          Inform district
  in 3-6 months.                                nurse.        Inform a qualified
                                                                nurse if patient
                                                               has a history of
                                                              CHD/Stroke/TIA/P
                                                              VD/renal disease




Hypertension policy 2006.
                                                                       Page 20 of 21
                                                                                            Appendix 7


                 Blood Pressure Monitoring Assessment Tool.
          The students must achieve YES to all questions to pass
       competency. The student must also be observed monitoring at
               least three different patients blood pressure.

                                                                                            YES         NO


1.                Did the student explain the procedure to the patient?

2.                Did the student allow the patient to be seated and relaxed for at
                  least five minutes prior to measuring blood pressure?

3.                Did the student use equipment recommended for use by the
                  trust, which has been serviced as recommended by the
                  manufacturer?

4.                Did the student use the correct size cuff for the arm?

5.                Did the student center the cuff 2cm above the brachial artery?

6.                Did the student support the arm so that it was level with the
                  heart?

7.                Did the student measure the blood pressure to the nearest
                  2mmhg?

         8.       Did the student advise the patient on modifying risk factors as
                  appropriate (identified in patient care plan)?

9.                Did the student check if patient is taking medication or
                  experiencing problems with medication?

10.               Did the student correctly document the blood pressure and
                  action taken?

11.               Did the student take appropriate action following identification of
                  blood pressure?


Date …………………Students Name ……………Students Signature…………….

Assessors Name ……………………...…Assessors Signature………………….......



     Hypertension policy 2006.
                                                                                        Page 21 of 21

				
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