Errors in blood pressure measurement are often the result of poor technique or faulty equipment. It is therefore important for all staff performing blood pressure measurements to be adequately trained and for equipment to be checked and calibrated on a regular basis. Errors occur for a variety of reasons including: The use of faulty equipment, use of an incorrectly sized cuff, Inadequate support of the arm, poor observer technique, deflating the cuff too quickly, rounding up readings to the nearest 5 or 10mmHg. Practical advice for accurate blood pressure measurement has been published by the BHS (2007b, 2007c) and MHRA (2006).
I immediately documented the observations on the vital signs chart (MEWS) so as not to forget and to reduce the risk of errors (Williams et al, 2004: C). My patient’s pulse was high and blood pressure low so I reported this abnormal reading to my mentor. She checked the knee where the patient had been operated on and noticed that the patient was bleeding profusely, leading to appropriate measures being taken to stop the bleeding.
When observations are carried out it is always important to minimize the risk of cross- infections by washing and drying hands (DH 2005: C), the person carrying out the observations must have enough knowledge on how the equipment works, how to use the equipment and also be able to record the accurate readings. Inaccurate reading may cause a lot of harm to the patient. It is important that a health care professional be aware that there is a wide range of normal values that can apply to persons of different ages.
It is standard practice for vital sign measurements to be taken upon admission of a new patient into a medical facility (British Journal of Nursing 2006). Each area of the hospital has guidelines which outline the intervals and the way in which the measurements should be taken. Sometimes it is up to the nurse which technique to use, depending on their experience and training. Assessment also depends on the patient’s age and gender. Nurses will face moments when they will be unable to perform the assessment. These circumstances may include aggressive behaviour of the patient or permission being declined by the patient. Some cultural / religious barriers might prevent the nurse going ahead with the assessment. The equipment available may also limit the ways in which the assessments can be done.
The nurse will need to think critically when making the decision to perform or not to perform certain assessments, depending on the characteristics of the presented patient i.e. patient’s age, gender, cultural/religious background, health status and cognitive ability. Some of the procedures can be invasive e.g. a rectal temperature measurement, therefore privacy and the level of comfort of the patient will need to be considered before performing certain assessments. Vital signs measurement is an essential clinical skill and nursing staff must be competent in undertaking the procedures. Accuracy is essential and nurses should be appropriately trained in the various methods of vital signs measurement and the correct use of equipment.
British Journal of Nursing (2000). The Importance of Measuring and Recording Vital Signs Correctly. 15(5)
Brown,S. (1990) Temperature taking-getting it right. Nurse Standard,5(12),4-5
Bogan, B., Kritzer, S. & Deane, D. (1993) Nursing Student Compliance to Standards for Blood Pressure Measurement. J Nurse Educ, 32(2), 90-2.
Campbell, N.R.et al. (1990) Accurate, reproducible measurement of blood pressure. Can Med Assoc J, 143(1), 19-24.
DH (2005) Saving Lives: a Delivery Programme to Reduce Healthcare Associated Infection Including MRSA: Skills for Implementation. Department of Health, London.