Date of Award

2018

Document Type

Open Access Dissertation

Department

College of Nursing

Sub-Department

Nursing Practice

First Advisor

Joan M. Culley

Abstract

The purpose of this process improvement project is to determine efficiency of ambulatory blood pressure monitoring (ABPM) vs. 5-day blood pressure checks in a military treatment facility. The sample consists of male and female active duty soldiers ages 18 to 54 years without a previous diagnosis of hypertension (HTN). The soldiers were assigned to a unit that is physically and mentally challenging, has demanding training opportunities and duty requirements, and are rapidly deployable in support of peacekeeping, humanitarian and combat missions.

The data collection method included a retrospective chart review of 128 charts randomly selected between June 2016 and May 2017. The 128 charts had an ICD-10 code of elevated blood pressure without a diagnosis of hypertension. Sixty-five charts utilized ABPM and sixty-three charts used 5-day blood pressure checks. Efficiency for both methods of blood pressure monitoring was measured in calendar days to determine number of days for a soldier to: a) see a provider with a suspicion of HTN and initiate prescribed method of blood pressure monitoring, b) complete the prescribed method of blood pressure monitoring, and c) follow up with a provider for determination Findings were documented on the Client Data and Data Points tool and analyzed using SAS 9.4. A significant difference was found between ABPM and 5-day blood pressure checks for the number of days it took for the soldier to initiate the prescribed method by a mean 5.46 (SD2.11) and 14.87 (SD 8.43), the time it took the soldier to complete the prescribed method with a mean 6.73 (SD 3.04) and 10.97 (SD7.05) and determination of a diagnosis with a mean 12.22 (SD3.67) and 25.84 (SD 11.70) respectively. Analysis of the data using t-tests determined that use of ABPM was statistically significant when compared to 5-day blood pressure checks (p=<.0001). Although the benefits in use of ABPM has been studied and recommended for practice, implementation of use in the primary care setting has not been fully applied. Based on results, recommendations for this process improvement project are to implement ABPM into clinical practice to improve patient outcomes.

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