Man versus Machine: the importance of manual blood pressure measurement skills amongst registered nurses

Abstract

Background: The manual recording of blood pressure is widely accepted to be more accurate than the recording of blood pressure using an automated device. Despite this many western healthcare systems have moved almost entirely to the automated recording of this important vital sign using oscillometric devices. Such devices may either fail to record the patient's blood pressure in persistent hypotension or may give inaccurate readings in people with arteriosclerotic or atherosclerotic changes. This paper explores the importance of manual blood pressure recording, the availability of aneroid sphygmomanometers in UK hospitals and the maintenance of the skills of the workforce following initial nurse education. Methods: Using a survey of nursing students to explore what opportunities they have to practice manual blood pressures in the clinical setting, the paper explores the maintenance of skills following initial nurse education. The paper also describes the results of data collection, using unobtrusive methods, regarding the availability of aneroid sphygmomanometers in general and specialist hospital facilities in Northern England (UK). Data using both methods were collected in the spring of 2014. Results: The results suggest that despite most hospitals having some aneriod sphygmomanometers available (mean was 1 device for every 6 beds in acute, 1 device for every 3 beds in specialist hospitals and 1 device for every 12 beds in mental health) they were rarely used in clinical practice with only 35% of students reporting that they had undertaken a manual blood pressure in a clinical setting during the first year of their course. In addition, some hospitals had no aneroid devices and several others had no central record of location and regular calibration of such devices. Conclusions: The suggested infrequent use of aneroid devices raises a concern that nurses skills in manual blood pressure recording may be subject to decay over time. Given the importance of these skills in patient safety and, in ensuring accurate and effective care, failure to ensure adequate equipment and opportunities for skill maintenance could result in practitioners and hospitals being open to negligence claims

The Importance of the Manual Blood Pressure Skill amongst Nursing Students

“…Additionally, clinical situations exist in which the manual blood pressure method validates the blood pressure obtained using an automatic blood pressure device. For example [1], in patients with persistent hypotension, automated blood pressure devices will often produce an error message, suggesting that the blood pressure is unobtainable when blood pressure is obtainable via the manual method.…”