What is the recommended standard for documenting blood pressure (BP) in patients undergoing anesthesia?

Recommended Standard for Documenting Blood Pressure During Anesthesia

Blood pressure must be documented at least every 5 minutes throughout anesthesia, with automated electronic anaesthetic record systems strongly preferred over manual charting. 1

Documentation Frequency Requirements

Standard Monitoring Intervals

• Blood pressure recordings must occur at minimum every 5 minutes during all phases of anesthesia (induction, maintenance, and emergence) 1
• Heart rate, SpO2, ETCO2, and blood pressure should all be recorded at this 5-minute interval 1
• Other monitoring values should be documented at least every 15 minutes 1
• Additional values must be recorded whenever significant hemodynamic changes occur between the standard 5-minute intervals 1

Critical Safety Consideration

• NIBP monitors must not continue to display readings for more than 5 minutes, as this creates risk of displaying outdated readings that may mask current hypotension 1
• This is particularly important because intraoperative hypotension occurring between 5-minute measurement intervals is associated with adverse outcomes 1

Preferred Documentation Method

Electronic Systems (Strongly Recommended)

• Automated electronic anaesthetic record systems are the recommended standard 1
• These should preferably be anaesthesia information management systems integrated into the hospital's electronic health record 1
• Electronic systems allow for automatic capture of continuous monitoring data and reduce documentation gaps 1

Manual Charting (When Electronic Systems Unavailable)

• Manual anaesthetic charts must be structured to accommodate the minimum 5-minute documentation intervals for vital signs 1
• The chart design should facilitate recording of heart rate, blood pressure, SpO2, ETCO2, and processed EEG (when used) every 5 minutes 1
• Space for other parameters should allow documentation every 15 minutes 1

Documentation During Emergency Situations

Handling Documentation Gaps

• Contemporaneous records may be difficult to maintain during emergency circumstances 1
• When gaps occur, they must be completed as soon as the clinical situation permits using trend data stored in monitoring devices 1
• This approach ensures accurate reconstruction of hemodynamic events while prioritizing immediate patient care 1

Minimum Monitoring Equipment Standards

Essential Blood Pressure Monitoring

• Non-invasive blood pressure (NIBP) monitoring is mandatory minimum equipment for all anesthetized patients regardless of duration or location 1
• NIBP should be measured at least every 5 minutes, recognizing that hypotension between intervals may still be associated with adverse outcomes 1
• For high-risk patients or those with chronic hypertension, continuous non-invasive BP monitoring in addition to standard NIBP cuff measurements improves BP stability and reduces hypotensive events 2, 3

Alarm Configuration

• All alarms must be set to appropriate values and enabled 1
• Anaesthetic departments should establish consensus-based alarm limits and have medical engineering set these as standardized defaults 1
• Smart alarm technology should be adopted where available to improve clinical communication of alarm priority 1

Duration of Monitoring and Documentation

Continuous Coverage

• Monitoring and documentation must continue until the patient is discharged from the post-anesthesia care unit (PACU), including during transfer to PACU 1
• During induction in children or uncooperative adults where immediate monitoring attachment is not feasible, monitoring should be attached as soon as possible with the reason for delay documented 1

Common Pitfalls to Avoid

Documentation Errors

• Do not rely on outdated BP readings displayed beyond 5 minutes - this is a significant safety risk 1
• Do not allow documentation gaps to persist - use stored trend data from monitors to complete records retrospectively when necessary 1
• Do not use unstructured manual charts that don't facilitate the required 5-minute vital sign documentation intervals 1

Handover Documentation

• When transferring patient care to another anaesthetist, a detailed handover must be delivered and recorded in the anaesthetic record 1
• The incoming anaesthetist must verify all appropriate monitoring is in place with suitable alarm limits before accepting care 1
• A handover checklist (such as the ABCDE aide-memoire) is useful for ensuring completeness 1