Aim To measure the variation in practice of blood pressure measurement in paediatric units in a defined region.
Methods All district general hospitals and the tertiary centre were contacted by telephone to identify what equipment is used; who measures; how is the data interpreted; do all children have blood pressure (BP) measurement in the in-patient (IP) and out-patient (OP) facilities.
Assessing results (figure 1).
Who gets measured
▶ 13 units: All children get a BP measure
▶ In one unit: Children with renal, cardiac, endocrine or cerebral disease
▶ One unit: All children
▶ One unit: Children seen for UTIs, migraine, epilepsy or ADHD
▶ One unit: Children with cardiac, renal, endocrine, cerebral disease
▶ One unit: Routinely for UTIs or obesity
▶ All the rest do not routinely measure unless requested by the pediatrician
Tertiary centre - 11 different machines (9 oscillometric) in 8 facilities sampled.
Conclusions The variation identified includes: type of equipment used; who measures; criteria for measuring; source of reference data. BP is not universally measured. Variation was found between units, within one hospital and within one ward. BP measurement with oscillometric equipment is unreliable, especially in children; uncertainty about the values obtained requires repeat measuring using the more accurate auscultatory technique. Units have made decisions about whether to measure, what equipment to use and generate BP data of uncertain value. Variation in practice occurs because there is no standard to adhere to, can not be adhered, or system assumptions about good practice or process. If measuring BP is a valid and necessary measure of physiology we should, based on existing evidence, be able to reach consensus as to what constitutes a good process.
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