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Tuesday, January 15, 2013

Don't Fudge on the Numbers!!!!

Try on this scenario for size.  If this happened to you how would you feel?  Would your trust be shaken?  Would you have complete faith in the patient safety of a facility like this?

A mother insisted that a blood pressure measurement be taken at a well child visit.  The health care facility does not yet do this automatically.  The health care employee appeared a little hesitant to do it.  There was no digital machine so it had to be done manually.  Initially an adult sized cuff was brought out.  The mother had educated herself enough to know this was not an inappropriately sized cuff for her 4 year old daughter.  The nurse then got a smaller cuff.  After taking the pressure she smiles and says it is perfect, 120/80.  This mother's heart sank knowing that this was not an acceptable reading for a 4 year old. The mother asked if she would give her a few minutes and repeat the measurement.  When asked why because her reading was perfect the mother explained this was not a "perfect" reading for a 4 year old female.  The employee became a little embarrassed and said she would have someone else repeat the measurement.  Another employee came into the exam room and repeated it.  This time it was 90/60 which was much more acceptable.  This certainly gave relief to the mother.

In this instance you can only insinuate what truly happened.  Did the employee "fudge" the numbers because she didn't really know what she was doing?  Was the child a little apprehensive and this caused her reading to go higher?  Either is possible, but after having two similar stories relayed to me in the past week of manual bp's being taken with unusual numbers for the patient it leads me to think that there are more instances of employees not giving true and accurate blood pressure assessments through manual cuffs.  We do rely heavily on technology in this day and time but every hands on employee should know how to take an accurate blood pressure manually. Further more, they should all know what sized cuff is correct and what is the "normal" range for everyone.  This includes children who have a range of acceptable values based on their age and gender. 

To most this may not seem like a big deal but I am here to tell you that it IS a big deal.  A blood pressure measurement is one of the most important values a doctor can obtain in order to provide a correct assessment of a patient.  A bp that is too low or too high can be indicative of many issues.  It is truly one of the most important pieces of the puzzle.

Education on the appropriate range and knowing when to repeat a pressure and when to dismiss it can make all the difference in a patients outcome.  My 4 1/2 year old son had his first bp taken at a pre-op appt. His systolic reading was over 130.  The nurse simply dismissed it as him being nervous.  She did not repeat it before the visit was over, nor did she alert the doctor.  His pre op sheet was signed and he was cleared for surgery.  This was at a time before I was uneducated on the importance of this.  This one act nearly caused my son his life.  He should have never been cleared for surgery to have tubes put in his ears.  What's the old saying, hindsight is 20/20?  So very true in this case.  It happens but we can change this.

KYKN.....KNOW YOUR KID'S NUMBERS!!  Know what is acceptable for them and know to ask questions.  The parent is the best advocate a child has.

There is no bigger health care employee cheerleader than me, but I know that there are mistakes that are made.  It is part of being human.  But don't let these mistakes happen because of inadequate education or preparation.  If you are  not sure, then say so! Get back up and make sure the patient gets the absolute best care possible.  It could mean the difference between life and death.

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