Assessment of Manual Blood Pressure and Heart Rate Measurement Skills of Pharmacy Students: A Follow-Up Investigation
Elliott, Katherine E., McCall, Kenneth L., Fike, David S., Polk, Jill, Raehl, Cynthia, American Journal of Pharmaceutical Education
Objectives. To evaluate the impact of a laboratory course on the manual blood pressure (BP) and heart rate (HR) measurement skills of pharmacy students.
Methods. After 1 lecture and 1 laboratory session on vital sign technique, pharmacy students enrolled in a patient assessment laboratory course were randomly paired with a classmate and manually measured the classmate's BP and HR. Within 2 minutes, the BP and HR were measured by an Omron 711-AC automatic monitor. The same assessment procedures with manual and automatic measurements were repeated near the end of the laboratory course. Student skills were also evaluated through direct observation by faculty members.
Results. Student and machine measurements of systolic blood pressure (SBP), diastolic blood pressure (DBP), and HR significantly correlated at the final assessment (r = 0.92, 0.83, and 0.91 respectively; p < 0.001 for each. The proportion of student and device values agreeing to within 5 units (mmHg and beats-per-minute) at baseline versus at the final assessment significantly improved from 38% to 67% for SBP, 51% to 77% for DBP, and 52% to 79% for HR (p < 0.001 for each). The percentage of students correctly performing all 13 AHA endorsed steps for BP measurement improved significantly from 4.6% to 75.6% (p < 0.001).
Conclusions. Significant improvement and the attainment of competency in manual vital signs measurement were demonstrated by pharmacy students after 11 weeks of skill rehearsal in a laboratory course.
Keywords: vital signs, blood pressure, heart rate, physical assessment, pharmacy students
Arterial blood pressure and heart rate are important indicators of a person's health. The accurate measurement of these vital signs is essential to many diagnostic and therapeutic decisions. Although the manual, indirect method of blood pressure measurement with a sphygmomanometer appears simple, there are many possible causes of inaccuracy. (1) Too small of a blood pressure cuff compared to the patient's arm circumference; body position, such as lack of back support or crossing the legs; arm position in relation to heart level; and rapid deflation of the blood pressure cuff are among the many technical mistakes that can cause up to a 10 mmHg error in blood pressure measurement. (2-7) Therefore, a systematic approach to skill training, assessment, and retraining is important.
Traditionally, healthcare trainees, including pharmacy students, have learned vital sign measurement skills in a physical assessment lecture and laboratory course. (8) Several new instructional strategies for blood pressure measurement training have been described in pharmacy education literature. These strategies include the use of standardized patients in the classroom, public health screenings in early experiential courses, and simulation-based learning with a computerized patient-manikin. (9-11)
The Texas Tech University Health Sciences Center (TTUHSC) School of Pharmacy has also utilized standardized patients in the patient assessment course and early experiential courses to teach vital sign techniques, among other skills. Our previous study involving a comparison between pharmacy student manual measurements and Omron machine (Omron Healthcare, Inc., Bannockburn, IL) measurements near the completion of a patient assessment course revealed room for improvement in vital sign skill mastery. (12) Student and machine measurements of systolic and diastolic blood pressure and heart rate significantly correlated in the previous study (r = 0.79, 0.62, and 0.92, respectively; p < 0.001 for each). However, the proportion of student and device SBP, DBP, and HR readings agreeing to within 5 units (mmHg or beats-per-minute) was only 51%, 47%, and 59%, respectively. Furthermore, terminal digit bias of DBP readings was observed in the previous study. Therefore, the course team designed the present study to evaluate these skills at the beginning and end of a patient assessment laboratory course. …