How do you write an order for weekly blood pressure monitoring?

How to Write a Blood Pressure Order for Weekly Monitoring

For weekly blood pressure monitoring, write an order that specifies taking readings twice daily (morning and evening) with 2-3 measurements at each session, 1 minute apart, for 7 consecutive days. 1

Essential Components of a Blood Pressure Monitoring Order

Device Specifications

• Use a validated automated upper arm oscillometric device with memory storage capability
• Ensure appropriate cuff size that encircles 80% of the arm
• Verify device accuracy annually by comparing with clinical readings

Measurement Protocol

• Frequency: Twice daily (morning before medications and evening before supper)
• Number of readings: 2-3 readings at each session, 1 minute apart
• Duration: 7 consecutive days
• Timing: Begin 2 weeks after any treatment change and during the week before clinic visits

Patient Instructions

1. Proper positioning:

   • Rest quietly for 5 minutes before measurement
   • Sit with back straight and supported on a chair
   • Keep feet flat on floor with legs uncrossed
   • Support arm on flat surface with upper arm at heart level
   • Place bottom of cuff directly above antecubital fossa

2. Pre-measurement preparation:

   • Avoid smoking, caffeine, or exercise for 30 minutes before measurement
   • Empty bladder before measuring
   • Remove clothing from measurement arm

3. Documentation:

   • Record all readings without selection bias
   • Bring monitor with stored readings to clinic appointments
   • Calculate average BP by discarding first day readings and averaging the remaining values

Sample Order Template

ORDER: Home Blood Pressure Monitoring
FREQUENCY: Twice daily (morning before medications and evening before supper)
DURATION: 7 consecutive days per week
PROTOCOL: 
- Take 2-3 readings 1 minute apart at each session
- Follow proper positioning and preparation guidelines
- Record all readings or use device with memory storage
- Begin monitoring 2 weeks after medication changes and week before clinic visit
- Target BP goal: <135/85 mmHg (or <130/80 mmHg for high-risk patients)
FOLLOW-UP: Bring device with stored readings to next appointment for review

Interpretation Guidelines

The target home BP goal should be specified in the order based on patient risk factors:

• Standard target: <135/85 mmHg (equivalent to office BP <140/90 mmHg) 1
• High-risk patients (diabetes, coronary heart disease, chronic kidney disease): <130/80 mmHg 1

Common Pitfalls to Avoid

1. Inadequate measurement frequency: Single daily readings or sporadic measurements provide insufficient data for clinical decision-making 1, 2

2. Improper technique: Failure to specify proper positioning, rest periods, or arm support can lead to inaccurate readings 2, 3

3. Selection bias: Patients may selectively report only "good" readings; using devices with memory storage helps prevent this 1, 2

4. Insufficient duration: Less than 3 days of measurements may not provide reliable estimates of true home BP 4

5. Failure to specify target BP goals: Orders should clearly state the target BP thresholds based on patient-specific factors 1

Home blood pressure monitoring provides valuable diagnostic information beyond office readings and can improve hypertension management when properly implemented 5, 6. Following these guidelines ensures the collected data will be clinically useful for treatment decisions.