Operational note – Patient safety in blood pressure measurement in community pharmacy NHS clinical services
Dear colleagues.
Ongoing monitoring for the Hypertension Case Finding Service (HCFS) has identified that there are data discrepancies appearing in the blood pressure (BP) measurement data submitted for a number of patients, as part of claims by community pharmacy teams. Further clinical review with frontline pharmacy teams revealed this may be caused by:
- User error in documenting BP measurements
- Lack of knowledge over how to categorise BP measurements.
The accurate recording of BP results as part of the HCFS is critical. Poor data quality in the pharmacy record can lead to inaccurate BP measurement data being sent to GP practices for inclusion in patient records and can affect the ability of GPs to make an appropriate diagnosis regarding a patient’s hypertension status.
FOR ACTION BY: Pharmacists and pharmacy technicians:
- Carry out regular audits of BP data quality
- Be vigilant when documenting BP measurements in line with the service specification (Annexes B, C & D p15, 16 and 17)
- Undertake regular staff refresher training in measuring and documenting BP measurements for clinic BP and ambulatory BP monitoring (ABPM). Resources include (this list is not exhaustive):
- British & Irish Hypertension Society
- Centre for Pharmacy Postgraduate Education
- Community Pharmacy England
- National Pharmacy Association (NPA members only).
FOR ACTION BY: Contractors:
Ensure staff delivering the service are trained to deliver the service as set out in the service specification and understand how to use the NHS IT assured system for documentation and sending data to patients’ GP practices.
Key reminders:
- As set out in the Hypertension Case Finding Service specification it is not the role of the pharmacy team to diagnose hypertension, and the IT systems used for this national service are not clinical decision-making tools. The intention of this service is to capture clinical BP and ABPM measurements and to share the outcomes back to the patient’s GP practice. The GP will use this data to inform any decision making regarding the ongoing care and management of the patient
- Where an IT system automatically categorises a blood pressure reading (as low, normal, high or very high blood pressure) based on the submitted entries and thresholds set out in the service specification, a need to override this category is unlikely
- All staff must be competent to deliver the service and follow the guidance on the appropriate actions to be taken based on the results, as outlined in the relevant service specifications. Staff must understand the differences between clinic check bandings and ABPM measurements and ensure patients with raised readings or concerning symptoms are appropriately advised, and/or escalated by referral as appropriate in line with the service specification
- Be aware of and ensure all staff involved in service delivery are familiar with the different training resources that support service delivery.