Authors (including presenting author) :
Chan SYJ(1), Wong WLW(1), Yeung KCA(1)
Affiliation :
(1)Physiotherapy Department, Prince of Wales Hospital
Introduction :
Blood pressure (BP) measurements in addition to routine heart rate monitoring prior to physiotherapy treatment could provide more information of the patient’s real-time condition and thus reducing risks of cardiovascular event incidence during exercises. In the first session, patients who had hypertension, diabetes mellites, ischaemic heart disease and/or renal diseases were instructed to measure BP. Yet, the compliance rate to self-BP measurement before treatment in their subsequent sessions was low, requiring extra effort for therapists to track down and remind the targeted patients during treatment time.
Objectives :
1) To clearly identify patients requiring BP measurement before treatment using up-to-date evidence-based guidelines.
2) To increase the compliance rate of BP measurement before attending therapists among the targeted patients.
Methodology :
Upon arriving to the out-patient, new patients would be screened by supporting staff using lists of cardiovascular risk factors, major signs and symptoms suggestive of active cardiovascular event and cardiopulmonary/metabolic diseases according to the updated American College of Sports Medicine guidelines. Patients would then be stratified into different risk classes and marked in the updated decision criteria for BP measurement printed on the patients’ folder. The case therapist would then staple an easily identifiable slip onto the patient's folder if the patient required routine BP measurement. In every session, supporting staff would be able to identify the targeted patient and supervise the BP measurement. Case therapist as the second safeguarding person would also check whether the targeted patient had BP measurement before any treatment.
Result & Outcome :
Compliance rate was measured before and after implementation by random sampling inspection. Incidence of adverse events due to unstable BP during treatment was also recorded during the period. 20 targeted patients were reviewed pre- and post-intervention respectively and compared using Fisher’s exact test. The compliance rate to BP measurement before attending therapists significantly increased from 35% to 95% after implementation for a month (p< .001). Therapists and supporting staff gave positive feedback to the new measures as the targeted patients could be easily identify and measure BP more accurately under supervision. As the BP measurement decision criteria was refined from disease-dependent to multi-factorial, there were no incidents of patients with unstable BP doing exercises of unsuitable intensity and thus causing adverse events reported since the implementation.
