Abstract
Purpose: The purpose of this quality improvement project was to evaluate the efficacy of increasing the frequency of ambulatory blood pressure monitoring (ABPM) in a pediatric nephrology clinic.|Background: The rate of hypertension is increasing in the pediatric population. The 24-hour ABPM is the gold standard in diagnosing pediatric hypertension and is more predictive for end organ damage than office BP monitoring alone. Inconsistencies exist in defining an adequate study.|Sample/Setting: The setting was a pediatric nephrology clinic at a Midwestern children’s hospital. The sample included patients between the age of five and 19 years who underwent evaluation utilizing a 24-hour ABPM. There were 25 patients in both Phase I and Phase II groups.|Methods: The study was completed utilizing the Plan-Do-Study-Act (PDSA) cycle for evaluation of hypothesis. The intervention consisted of increasing the frequency of ABPM readings from every 30 to every 15 minutes during the day and every 60 to every 30 minutes during the night.|Results: In Phase I, eight out of 25 ABPM studies (32%) and Phase II, 24 out of 25 studies (96%) were considered adequate. The average total number of blood pressure reading, M = 36, in Phase I. Phase II demonstrated a range of 34 to 82 (M = 69.8). The mean percentage of adequate readings per study were as follows: Phase I, 59%, Phase II, 68.6%. The proportion of patients who were reported as having received an adequate study differed significantly from Phase I to Phase II (x (1, N=50) = 22.2, p < 0.001).|Conclusions: Increasing ABPM frequency yielded significantly more adequate studies for the population served in the pediatric nephrology clinic. This prevents the need for repeating the studies, which may result in cost savings, conservation of resources, and may ultimately improve patient and family satisfaction with the ABPM procedure.