An audit and suggested guidelines for in-patient blood pressure measurement

There is a lack of standardization of automated IPBPM technique including a failure to adhere to principles of measurement already established for office BP in a majority (97%) of patients. This may lead to potentially erroneous BP readings, which are an unreliable basis for clinical interpretation and decision making. There is a need for universal hospital-specific guidelines for IPBPM and programmes to train and monitor staff for adherence to these. Particular attention should be given to those factors well known to affect blood pressure measurement, including correct cuff size and placement, arm position and absence of talking during measurement as well as only using validated machines. Additional recommendations might include the routine use of manual BP readings where appropriate (such as with very low or irregular heart rates), BP measured in both arms on admission and the arm with the highest BP used thereafter and recording the side of IPBPM and patient position. We recommend that a task force is commissioned to develop universal guidelines for this important part of clinical assessment.