Concordance of blood pressure measurement between the nursing staff and the doctor

Concordancia de la toma de presión arterial entre el personal de enfermería y el médico

Introduction: blood pressure (BP) is one of the parameters used to determine the hemodynamic status of a patient. When we find it altered we are forced to take behaviors that can be erroneous and economically significant if the measurement was incorrect. This work wants to highlight the importance of taking the TA with a precise technique and clarify if the differences in the measurements made by the doctor and the nurse correspond to technical problems by the tensiometers, or if on the contrary our staff does not apply the proper techniques.
Methods: A total of 592 patients older than 18 years, hospitalized in the different pavilions of the San José Hospital, entered the study, regardless of their clinical condition or gender. The TA was determined by the nursing staff and then, with the same blood pressure monitor, by the internal doctors. Then the resident of Internal Medicine did it with a calibrated standard tensiometer. For the statistical analysis, the concordance method was used, through the Pearson correlation coefficient. In addition, the point estimate was obtained with its respective confidence interval.
Results: a 592 patient was taken every 10 minutes the TA on three occasions and it was shown that the figures varied according to who executed the measurement. The difference was more noticeable when comparing the figures of the resident and the nurse, obtaining a difference of more than 10 mm Hg in the systolic BP in 29% of the cases (IC 0.260 - 0.334) and in the diastolic one in 30% (IC 0.267 - 0.341), with a coefficient of agreement between 0.78 and 0.91.
Conclusions: taking into account that the resident used the technique accurately and given the marked differences in the figures obtained, it follows that the way in which the TA was measured is not adequate. Therefore, it is imperative to review the procedure and instruct medical and paramedical personnel on the correct way to take it.

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