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In this forum we explain and discuss various clinical pharmacy services and its practical approaches. Eg: Anticoagulant Management Therapy, Medical Reconciliation Service, Treatment Chart Review, Therapeutic Drug Monitoring, Patient Education and etc. NOTE: To read/reply any topics under this section members must spend 20 BB Points to get the access.
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#2421
Blood Pressure Monitoring

Introduction

Its one of the disease screening service done by the pharmacist in clinical or community setup.

Blood Pressure is defined as the pressure of the blood in the circulatory system, often measured for diagnosis since it is closely related to the force and rate of the heartbeat and the diameter and elasticity of the arterial walls.The control of blood pressure begins with an accurate measurement leading to a correct diagnosis, effective treatment, routine monitoring, and medication adherence. For more than a century, the mercury sphygmomanometer is the gold standard for measuring blood pressure. Nowadays digital blood pressure equipment’s are available for the ease of use by patients especially at home.

Common sources of error in blood pressure measurements include

-human errors (e.g., incorrect cuff size, improper body positioning, inadequate rest period, terminal digit preference, lack of repeat measurements),

-patient factors (e.g., recent caffeine, decongestant, or nicotine use; talking during the measurement), and

-device-related factors (e.g., failure to properly use, inspect, maintain, or calibrate a device validated by the American National Standards Institute, Association for the Advancement of Medical Instrumentation, or International Organization for Standardization).

Pharmacists should be aware of these problems and monitor BP carefully.

Objectives

To train the Doctor of Pharmacy students in the following areas:

+ To monitor the Blood Pressure using Sphygmomanometer.
+ To interpret the blood pressure findings and make necessary recommendations.
+ To understand the role of pharmacist in disease management.

Procedure

•Blood pressure monitoring equipment must be checked for calibration prior to the procedure
•Clean blood pressure machine and cuff with appropriate cleaning wipe
•The circumference of the upper arm must be measured at the widest point in order to determine which size cuff be used. See table below:-

Arm Circumference Cuff Size

Less than 23cm Small Adult
23cm to 33cm Standard Adult
33cm to 50cm Large Adult
51cm to 53cm Adult Thigh Cuff

Table-1 Details the Arm Circumference respect to the Cuff Size

•Valid consent must be given voluntarily by an appropriately informed person prior to any procedure or intervention.
•Prior to procedure, advice patient not to eat, take alcohol, smoke or exercise for 30 minutes before their blood pressure is measured, as these factors may affect the accuracy of the blood pressure reading.
•Verbally confirm the identity of the patient by asking for their full name and date of birth. If client unable to confirm, check identity with family/caregiver. This is done to avoid mistaken identity.
•Introduce yourself. This is to promote mutual respect and put client at ease.
•Wear identity badge which includes name status and designation. This is for patients to know who they are seeing and to promote mutual respect.
•Ensure verbal consent for the presence of any other third party is obtained (Students for example, as the client has the choice to refuse).
•Explain procedure to patient including risks and benefits and gain valid consent. This will enable patient to make an informed decision to proceed with blood pressure monitoring.
•Make sure you decontaminate hand, so that the risk of transfer of transient microorganisms on the healthcare workers hands is reduced.
•Ask patient to remove any tight arm clothing. Assist the patient if required, ensuring privacy and dignity at all times. This will allow the cuff to be applied in the correct position thus reducing the potential for error.
•Check skin condition of the upper arm. If patients arm is: - Swollen/edematous or has any breaks do not continue, seek advice. If necessary clean arm to prevent cross infection.
•Request the patient to empty their bladder if they need to, because full bladder can affect blood pressure reading.
•The patient should be seated in a temperate environment and relaxed for at least 5 minutes prior to procedure. Their legs should be uncrossed and flat on the floor. This can minimize the effects of the environment to ensure an accurate reading is obtained.
•Whilst patient is seated measure the circumference of the upper arm at the widest point and record in the health care record so that the correct sized cuff will be used.
•Select appropriate cuff from measurements obtained. Using the wrong sized cuff can affect the reading obtained.
•The Blood Pressure Tracker -Documentation form is enclosed for your reference

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