Rewarding good practice: improving blood pressure management

Journal of Diabetes Nursing,  Feb, 2005  by Linda Goulden

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The expert resource of a DSN providing monthly clinics has supported inhouse developments to provide an easily-accessible multidisciplinary diabetes team. Overall, this has resulted in referrals to secondary care now being the exception in people newly diagnosed with diabetes.

To demonstrate the successful implementation of recommended changes in practice we would expect to see improvement in blood pressure monitoring and control. The original baseline audit, completed only five months prior to this initiative, showed that although we were achieving a set standard of blood pressure recording, we could not demonstrate the fact electronically. The aim, therefore, was to improve clinical practice and the use of information technology to support high quality diabetes care.

Re-auditing

Under the nGMS contract, we as a practice are required to achieve the quality standards aspired to by 31 March 2005. To assess our progress, in June 2004 I chose to re-audit against the original standard for measurement in the previous 15 months (i.e. 90% of patients having had their blood pressure measured, and the nGMS standard of 55% of patients achieving 145/85 mmHg or under in their last blood pressure reading). This time my audit data was retrieved from EMIS Population Manager alone, as required in the future.

Blood pressure checked in previous 15 months

Data extracted from EMIS on 18 June 2004 revealed that 89% (203/231) people with diabetes had their blood pressure recorded in the previous 15 months. This information was easily accessible and, compared to initial audit figure of 68%, demonstrated significant improvement in retrievable qualitative data.

Last recorded blood pressure <145/85 mmHg

Data extracted from EMIS on 18 June 2004 showed that 48% of those with diabetes had achieved the set blood pressure target, compared with the standard of 55%. At the baseline audit six months previously, achievement of target blood pressure could only be demonstrated electronically for 32% of patients.

These results therefore demonstrate an improvement in electronic recording as well as providing early indicators of improving management of blood pressure.

Future recommendations

As we further advance the technology used in our practice, ongoing training for the whole team has begun in earnest. Some members of the team are more adept than others, but it is early days. Technology must support patient care in the provision of key data across all health and social sectors and aid audit of care to demonstrate standards of care provision. Our EMIS system's Population Manager provides up-to-date information on progress towards nGMS quality indicators and helps to identify those patients who have not had blood pressure measured in the previous 15 months and those who have not achieved target levels.

The aim of implementing changes was to improve a clinical area, and thus patient experience, and also to improve teamwork and advance our use of technology.

Varying degrees of progress across all change areas did hinder consistent development, but that can easily be attributed to the demands of 'the day job'; certainly our plan to go paper light had to shift by four months for this reason.