232 - Improving the accuracy of blood pressure measurement and documentation in the inpatient pediatric Hematology/Oncology Unit: A quality improvement project

Poster Number: 232
Publication Number: 232.45

Asma Ali, Mayo Clinic Children's Center, Rochester, MN, United States; Stephanie M. Killu, Mayo Clinic Children's Center, Rochester, MN, United States; Chera T. Morrow, Mayo Clinic Children's Center, rochester, MN, United States; Jill K Joerger, Mayo Clinic Children's Center, Rochester, MN, United States; Jamie LeDent, Mayo Clinic Children's Center, Rochester, MN, United States; Christian Hanna, Mayo Clinic Children's Center, Rochester, MN, United States

Background: In pediatric oncology/hematology (onc/hem) patients (pts), hypertension (HTN) is frequently observed during hospitalization, and etiology is usually multifactorial. HTN in childhood cancer has short and long-term adverse effects; thus, it is essential to diagnose and treat HTN accurately. Variations among rooming staff have been observed in measuring and documenting blood pressure (BP) in the electronic health record (EHR).

Objective: To improve the compliance of measuring and documenting accurate BP and relevant vital signs (VS) in all hospitalized pediatric onc/hem pts without adversely delaying other aspects of patients’ care.

Design/Methods: Baseline and post-intervention compliance rates of documenting BP and relevant VS (weight, height, BP cuff size, cuff location, heart rate (HR), pain score, and level of activity) in the EHR were collected. Education materials were provided to the team members as PowerPoint presentations and frequent email reminders, and surveys were sent to the rooming staff to evaluate the impact of this QI project on delaying patients' care. Comparing the compliance rates before and after the intervention was performed using two proportion Z test.

Results:

Baseline data was collected from 63 patients between Feb and April 2022. Intervention and staff education were conducted between June and Sep 2022. Post-intervention data was collected from 36 patients between Oct and Dec 2022. The compliance of EHR documentation was noted to be increased in all parameters (Weight (98.40% to 100%), height (85.70% to 86.10%), cuff size (0% to 17%), cuff location (74.20% to 80.10%), HR (96.40% to 100%), pain score (58% to 97.90%), and level of activity (58.80% to 77.80%) (Figure 1). The compliance rate for documenting pain score and activity level post-intervention reached statistical significance with a p-value of 0.00001 and 0.03, respectively, as these parameters can affect the accuracy of BP intake and interpretation. Twenty survey responses were obtained, and 95% (19/20) of the staff reported no impact on delaying patients’ care.

Conclusion(s):

This QI project improved the accuracy of BP and other relevant VS measurements and documentation in the EHR without delaying patients’ care by the rooming staff. We aim to expand this project to other patient care units at our Children’s Center.