Obtaining an accurate maternal blood pressure: A quality improvement initiative to improve nursing knowledge and confidence

Abstract

Background: Inaccurate assessment of maternal blood pressure (BP) contributes to misdiagnosis of hypertension, unnecessary or missed interventions, and maternal morbidity. This study examines obstetric nursing knowledge and confidence in proper assessment of maternal BP before and after an institutional quality improvement project.

Methods: We implemented an online educational initiative in our women’s health unit based on the American Heart Association’s Blood Pressure Improvement Program. Simultaneously, a standard assessment of BP cuff sizing by arm measurement was implemented. We conducted a pre- and post-intervention assessment of nursing knowledge and confidence of BP measurement. Responses were analyzed using the χ² test, two-sample t test, ordinary least squares and logistic regression.

Results: A total of 145 nurses completed the pre- and 68 completed the post-intervention assessments. Participants answered 62% of pre- and 73% of post-intervention questions correctly (p < .001). Before implementation, 86.9% of participants reported feeling very or extremely confident in obtaining an accurate BP measurement, increasing to 98.5% following (p = .007). 73.8% of pre-intervention respondents reported feeling very or extremely confident in choosing an appropriate BP cuff compared to 96.3% post (p < .001). Following implementation, confidence levels were similar irrespective of years in practice, years of experience at our hospital, and primary nursing unit.

Conclusions: A BP educational initiative and standardized BP cuff assessment increased nurses’ knowledge and confidence in selecting the correct cuff size and obtaining accurate readings. Increased knowledge and confidence may lead to greater adherence to standardized BP assessment during peripartum admission, more accurate BP measurements, and improved management of hypertensive disorders in pregnancy.