HospitalInspections.org

Based on review of facility documents and staff interviews (EMP), it was determined that the facility's special care unit failed to adopt basic hospital nursing policies and/or standards of care for the intermittent removal of blood pressure cuffs.

Findings include:

1) Surveyors requested a facility policy related to automatic blood pressure cuffs.

Interview with EMP1, on January 29, 2013, revealed "... We don't have a policy related to blood pressure cuffs ... We're looking at best practices for blood pressure cuffs ... There is no policy or standard of care for moving or removing blood pressure cuff ... ."

2) Review of documents received by the facility on February 11, 2013, revealed "Clinical Nursing Skills & Techniques ... 7th Edition ... Perry Potter" nursing practice manual undated revealed, " ... [page] 93 ... STEP ... 2. Determine best site for BP assessment. Avoid applying cuff to extremity when intravenous fluids are infusing, an arteriovenous shunt or fistula is present, or breast or axillary surgery has been performed on that side. Also, avoid applying the cuff to extremity that has been traumatized, diseased, or requires cast or bulky bandage. Use the lower extremities when the brachial arteries are inaccessible RATIONALE ... Application of pressure from inflated bladder temporarily impairs blood flow and can further compromise circulation in extremity that already has impairs blood flow. ... [page] 99 ... Gerontological Considerations Older adults, especially frail older adults, have lost upper arm mass, requiring special attention to selection of BP cuff size. Skin of older adults is more fragile and susceptible to cuff pressure when BP measurements are more frequent. More frequent assessment of skin under cuff or rotation of BP site is recommended. ... [page] 100 ... If frequent BP cuff measurements are required, the cuff may be left in place. Remove cuff at least every 2 hours to assess underlying skin integrity and if possible, alternate BP sites ... When the patient no longer requires frequent BP monitoring, remove and clean BP cuff ... ."

A telephone interview was conducted with EMP1 on February 11, 2013, at 10:00 AM. EMP1 stated, "If there isn't a specific policy, the manual is used for med/surg (Medical/Surgical nursing units) as a reference. The CCU (Critical Care Unit) would have their own policies and procedures and would not use the manual. There is no policy for the blood pressure cuff ... . "