Policy Manual sample

MDT Home Health Care Agency, Inc. BLOOD PRESSURE MONITORING POLICY Purpose: To provide a high standard of practice within the Agency services. The procedure should be carried out by licensed field staff, nursing personnel and health care assistants. Introduction. 1 Staff should receive training to attain competence in technique and equipment use. 2 As a vital clinical skill it is important that this skill is executed efficiently, effectively and in optimum conditions. Practice should reflect current recommendations and standards based upon evidence. 3 Only equipment which has been validated for use should be used within the patient’s care. The equipment should be maintained and routinely assessed to prevent incorrect data collection. Patient Participation Home Health patients are willing and interested in participating in the home measurements and recording and conveying the same to their home health care team QI-has a surrogate who is willing and able to do so. Our field staff must be willing to record blood pressure reading as often as Patient’s Physician order, record in the “BLOOD PRESSURE MONITORING FORM”, when the form is completed, leave copy at patient’s home, and delivery the original to office to be faxed to the patient’s physician. Any significant finding during monitoring services, must be notified Immediately to the Agency’s Director of Nursing, Clinical Manager of Supervisors, and to the patient’s Physician, and must be obtained any new order if needed. Parameters to report to Patient’s Physician/Agency: BP < 90/50 and > 150/90 Some patients experience higher blood pressure readings when observed by providers in a health care setting. This is commonly called "white coat hypertension" to imply that the providers are in part causing the higher reading, by making the patient nervous. It is seen in home blood pressure readings that these also can be higher for the first month or so, presumably due to nervousness and putting the cuff on too tightly. Patients for whom providers have suspected a role for "white coat hypertension" may be issued home devices as a means to ascertain their real blood pressure more accurately, and thereby to avoid over medications. Field staff feels that patient compliance would improve by greater participation and linkage between treatment program compliance and blood pressure recordings. A YEARLY BLOOD PRESSURE GAUGES CHECK must be performed to all field staff by our Director of Nursing, Clinical Manager or qualified designee. 2. Responsibility/Accountability. 1 Case Manager, Supervisors. To ensure staff are trained to competency of Blood Pressure Monitoring. 2 Staff. i. To ensure training had been received prior to carrying out procedure. ii. To attain competency in technique and use of equipment. Special attention should be paid to: 1. Diabetics whose blood pressure must be maintained at <135/85. 2. Patients with CHF in whom afterload reduction may improve cardiac function. 3. Patients with elevated creatinine in whom improved blood pressure control may delay or eliminate the need for end-stage renal disease care. 4. Patients with history of cerebrovascular infarction or myocardial infarction. Home Health Agency Nursing Care & Procedures K-172