Project leads to improved blood pressure devices

MD Anderson is home to the most sophisticated technologies in the world, but for David Conlon, it’s all about the simple blood pressure cuff.

Conlon, a clinical nurse, has worked in MD Anderson’s Nursing Resource Pool since he joined the institution 12 years ago. He had confidence in his and his colleagues’ abilities when it came to taking the all-important blood pressure measurement, but he sometimes doubted the equipment.

On occasion, the machine wobbled on the wall or didn’t act properly when the bulb was pumped. Portable blood pressure machines were available, but it often was difficult to step away from a patient’s bedside to retrieve one.

When he wrapped the cuffs around patients’ arms, Conlon saw they sometimes were the wrong size and also wondered if they could potentially be a source of infection.

What concerned him most was getting an accurate reading of patients’ blood pressures, which were literally and figuratively, vital.

BP is de rigueur, until equipment falters

“Taking a patient’s blood pressure is something all nurses do every day, but for those of us on the inpatient units, we may take vitals several times during a shift or even every hour,” Conlon says.

“We must have proper readings so we can properly monitor patients. They may be getting chemotherapy, new immunotherapies or other IVs, recovering from surgery or experiencing complications.”

Carlos Aboytes, clinical engineering manager in Facilities Management,
worked with Linda Shank (center), operations manager, and Kevina
Othieno, inpatient business manager, both in Nursing Administration,
in the institutional initiative to improve blood pressure equipment.
Photo: John Everett

Conlon took his concerns — and initial research consisting of a literature review and two evidence tables — to the Nursing Practice Congress in 2006. He hoped it would assign a Professional Action Coordinating Team (PACT) and consider advocating a policy change.

The congress had just formed as MD Anderson’s formal shared governance structure, and the PACT addressing the blood pressure equipment issues was among the first appointed; Conlon was the chair.

A year later, the PACT answered all four of the original research questions and worked to establish these new standards and procedures to:

• change clinical practice to single-use cuffs and reduce the risk of infection;
• ensure that all hospital rooms have properly calibrated wall-mounted blood pressure devices in good working order;
• teach the nursing staff how to properly size a cuff; and
• educate the nursing staff that manual blood pressure machines are preferable in some emergencies.

To move the recommendations into reality, Conlon led a task force in 2009 composed of representatives from materials management, biomedical engineering, procurement and an equipment vendor.

They explored a wide range of issues from outfitting machines with an adapter to accommodate the new single-use blood pressure cuff to developing a regular maintenance and repair schedule.

Spurring action

As a result of the PACT’s work, 164 manual blood pressure machines were either repaired or replaced from a total of 486 that were inspected. Another 130 blood pressure machines were replaced last year.

An additional offshoot of the project was that yet another nurse experienced the value and effect of evidence-based research.

Now, Conlon is pursuing his master’s degree in nursing education and has ideas for future projects related to infection control. He has already published a paper on the blood pressure cuff initiative in Oncology Nursing Forum.