The idea for this study orginated from a clinical question posed to Lisa Fox, RN and primary investigator by Patient Care Assistants (PCA). They noticed that some patients had BPs taken in the ankles but they had not been trained on this technique. A literature review revealed there was no evidence supporting the use of the ankle for BP measurement and a research study was born. Lisa Fox pursued the project and was approved for a Nursing Research Fellowship which provided time and mentorship for the study. This study was designed to determine the association between BP measurements of the arm and ankle and to determine if the ankle can be used as an alternative BP site. The results, derived from six simultaneous BP measurements, conclude that the readings taken in the arm are significantly different than those taken in the ankle. In fact, for patients with a BMI > 30 the systolic mean difference was statistically different (p<.001). Since BP measurements are used to guide patient care decisions, these findings have the potential to significantly impact patient safety. The results were shared with the Nurse Practice Council due to the complexity of interpretation of BP results, the need for site consistency and accurate documentation of site. The vital signs section of the electronic documentation system was modified to allow for documentation of all BP sites. Further criteria are being developed to identify patients that should have both ankle and arm blood pressures measured on admission.
By Lisa Fox, BSN RN; Kimberly Fowler, MSN, RN, CNS-BC; Cyndy Wilson, MS, BSN, RN; Luara Sheads-Cole, BSN, RN-BC; Rhonda E. Maneval, PhD, RN