Comparison Of Automated Blood Pressure Machine And Manual Mercury Sphygmomanometer For Accurate Blood Pressure Measurement: An Essay.

Comparison between Automated Blood Pressure Machine and Manual Mercury Sphygmomanometer for the accurate measurement of blood pressure in the medical and surgical ward of Royal Prince Alfred Hospital, New South Wales.

Accuracy of Blood Pressure Measurement in Clinical Environment

The accuracy of blood pressure in the clinical environment is one of the main problems, despite the importance of promoting measurement (De Greeff  et al, 2010). Manual blood pressure measurement machine can be used to accurately measure blood pressure.  Recent studies have shown that correct blood pressure measurement takes at least 14 minutes, including pause and medical patient response. New technology has been proposed for measuring manual pressure measurement (MOBP). Proposals to improve the improvement of BP are more dependent on the extraordinary monitoring of PA (pulmonary artery pressure monitoring) at home and 24 hours a day. This protocol removes troubles and provides unnecessary high blood pressure medications in healthy people (Heinemann, Sellick, Rickard, Reynolds & McGrail, 2008). Automatic blood pressure in the office (AOBP) is the third option for correct BP status measurement by eliminating factors affecting BP. Suokhrie et al, showed that automatic measurements are 3.9 times better than in the manual; Based on these results, it was recommended where PA should be manually measured for all patients. However, the blood pressure monitoring system has to be conducted in medical and surgical wards. Such blood pressure monitoring has several implications as it concerns monitoring the life of the patient. Therefore, it becomes pertinent to be able to measure blood pressure in a more accurate manner (Avolio, Butlin & Walsh, 2009). The current scope of study compares the effectiveness between automated blood pressure machine with that of manual mercury Sphygmomanometer for the purpose of measuring blood pressure in the surgical and medical ward of Royal Prince Alfred Hospital, New South Wales.

Literature suggests that lowering blood pressure lower than 140/90 mmHg significantly reduces this risk. In recent years, the problem of high blood pressure has increased worldwide. Worldwide, 7.5 million people are killed due to high blood pressure, which corresponds to 12.8% of all deaths, which is more than 50 million years of disability set for people with disabilities (Amoore, 2012). As for the burden of disease spreading among adults at the age of 25 and over 40% is around the world. Increased blood pressure is a major risk factor for any nation’s health. It not only increases cardiovascular diseases and ischemic and hemorrhagic stroke but also has many complications such as heart failure, peripheral vascular disease, kidney failure, retinal problems with blood and vision. An increase systolic in blood pressure by only 5 mmHg, increases chances from severe brain and heart attack by 25% in severe cases. Although the results support the catastrophic underestimation of blood pressure for a person, it is likely that over-estimation, who has the same blood pressure level resulted in inappropriate treatment of medicines for treating high blood pressure (Weaver & Grunstein, 2008). Approximately 30 million Americans experience side effects, the psychological consequences of mistakes and unnecessary costs from medication for blood pressure.

Importance of Measuring Blood Pressure

In order to accurately measure blood pressure in an insignificant environment, mercury measurements are the gold standard. But the fear of mercury toxicity and mercury liberation issues have reduced the use of mercury tools around the world (Myers, 2014). Especially while using in medical and surgical wards, it becomes pertinent that accurate monitoring with lower patient risks is undertaken. For the same reason, the European Union has recently postponed use of mercury in measuring blood pressure. Manual mercury blood pressure has recently substituted by digital blood pressure monitors instead of using traditional mercury devices in a variety of environments (Wilkins et al, 2010). One of the advantages of digital machines is simple because of the obvious fact that one does not have to possess examiners capability.

Blood pressure measurement, especially with the Mercury sphygmomanometer, has been used for more than 100 years. When BP uses two ways of recording, the mercury process appears to have been withdrawn from the office, but as a benchmark mercury blood pressure still measures other ways of acquiring (Green et al, 2008).

Compared to automated blood pressure manuals, research shows that manuals have many points. This difference can be reduced if certain rules are followed by an automated process for patients in a quiet room to rest and some reading prior to the decision of white skin hypertension.2 indicate whether the market falls automatically can be found in a patient.

In practice, a physician may use several laboratories to perform a medical examination (Amoore, Guehenec, Scordecchia & Scott, 2010). This process can also be the rest of the BP recording manually by automated and manual methods, based on 5 minutes. An important item for automatic access to patients who do not sit in the room for a few minutes while reading. If only one or two navigation match without reading radical white skin effect interferes with the recording of the first two readings and patient balance device. Manual BP recording is subject to environmental conditions. The AP is recorded higher when nurses are considered operating conditions, compared and other types of organizations support the home manual method when clinical activities can be recorded RKAT 0.8 automatic measurement and accepted less than 15 to 18 mmHg RKAT physician admission greater than 3 mmHg surveys and clinical practice settings.2 BP reduced if the scenario is not treated Ambulatory blood pressure monitoring can be used to replace counseling, it is not the AOBP OFFICE measure.

New Technology for Measuring Manual Pressure Measurement

The aim of the study is to compare the effectiveness of automated blood pressure machines with that of manual mercury sphygmomanometer while monitoring the blood pressure of a patient at the medical and surgical ward in Royal Prince Alfred Hospital, New South Wales.

Design

The study will at collecting data from patients in the surgical and medical ward of the Royal Prince Alfred Hospital, New South Wales. Then the study aimed at conducting a quantitative analysis of data for arriving at the results of the study. The study will adopt a cross-sectional research design approach. The study will be conducted using a dependent variable, where comparative framework to analyze effects from manual versus automated pressure machine will be monitored. The dependent variable in this study will include monitoring of automated pressure against that of manual pressure. The scholar will have no control over independent variables in the study, which will include the condition of the patient, patient-related outcomes and other factors affecting the health of patients. The scholar will conduct observational analysis from the primary data of the patient sample population, which will be a representation of the larger population. The study will collect data is a routine manner from the patient population such that appropriate data can be collected. 

Population of interest

The participants to the study will comprise of patients, who are above 40 years of age. The patient will be from the Royal Prince Alfred Hospital, New South Wales.  There will be a total of 30 patients recruited for the purpose of measuring blood pressure using automated and manual machines. The population of interest will belong to patients, who are present either in the medical ward or in the surgical ward. The selected age bracket for patient age criteria is due to the higher risks experienced from hypertension belonging to that particular age group. The participants will include both female and male patients, with or without any previous history of abnormal blood pressure. Only those patients who do not have any cut or bruise mark at the site of blood pressure measurement or amputation in the upper limb will be selected for the study.    

Sample and sampling approach

The study will undertake randomly stratified sampling procedures for collecting and analyzing data from patients. A total of 100 patients will be targeted amongst which 30 will be selected as a sample size for the purpose of data collection.   

Effects and Implications of Blood Pressure Monitoring in Medical and Surgical Wards

Intervention (if applicable)

There will be a measurement of pressure of patients using manual and automated pressure machine.  The intervention mechanism will be based on measuring outcome from measuring of blood pressure in a patient in the surgical or medical ward and subsequently measuring the accuracy related to the same.

Data collection approach

The data collection approach will be checking of blood pressure by a standardized nursing expert. In order to collect data from blood pressure machines all of the machines will be checked and calibrated to standardize for use by nurses. The participants will be made to sit on chairs, with the support of their back and left arm being kept at the heart level. Blood pressure monitoring will be conducted by allowing the patients to rest for a while. The manual machine will be inflated till 30mmHg and then released at 2mmHg/ second, till reappearance for the radial pulse. Once the Korotkoff sounds are made then systolic pressure can be measured and then the diastolic pressure will be denoted. For the automated blood pressure monitor an inflate technology using a pumping system will drive inflation and electromagnetic control. The digital display will depict the systolic and diastolic pressures for the patient. Average readings for all participants will be determined using SPSS- 21.0 software. Calculation of mean and standard deviation will be developed. Histograms for manual and automated BP will be denoted.  

Data management and analyses

The data once collected will be stored in MS Excel. Such data will be organized such that it can be fed into SPSS - 21.0 software. Once the data has been arranged and fed into the software, results will be analyzed. Paired t-tests will be undertaken for analyzing differences between manual and automated blood pressure monitoring. The software will be used for depicting Histograms, t-tests and average of mean and median are conducted.

The study will adopt every possible ethical consideration in accordance with UTS ethical regulations. The scholar in the study will ask participants to fill out the consent form before taking part in the study. In the consent form, it will be agreed that names and other personal information related to the patients will remain confidential and will not be disclosed to anyone else. The study will detail out the aim and proceedings of the study to the participants before they take part in the study. No participant will be forced in any form to take part in the study. There will be no coercion or any force applied to reflect on specific choice for participants. After the study is complete, participants will be allowed to review the results of the study. The study will also adhere to the ethics of medical research in Australia, so as to enhance its transferability.  

Risk Factors and Complications of High Blood Pressure

Research Activity	Month	1	2	3	4	5	6	7	8	9	10	11	12
Proposal development
Proposal submission
HREC
Governance
Site preparation
Participant recruitment
Data collection
Data management/analyses
Report writing
Report for HREC / governance
Project completion
Approval and Publishing

Timeline justification

The development of the study can be analyzed using the timeline chart. Each research-related activity has been attributed an equal time of 1 month. This has been undertaken on purpose to ensure that each aspect of the research project is undertaken and then reviewed. The proposed development will take a month's time to lay down the basis for the study. The proposal submitted to the HREC and Governance will require additional time, their approval is needed. Then site preparation, participant recruitment, data collection, data analysis, report writing and report for HREC will each take an approximate of 1 month. The data collection and analysis might take more than a month each as there might be discrepancies in the data that needs to be sorted. The total project is estimated to be completed within a year. Once the project is completed entirely, then it can be published for usage by others practicing in the health domain.

Budget Item	Cost ($)
Personnel
Participant	1000
Assistant
Equipment
Computer	150
Internet Connection	100
Data Analysis using SPSS	100
Consumables
Miscellaneous	500
TOTAL	1850

Budget justification

The budget for the project will be required for various heads of expenditures.  Personnel expenditure will primarily be reserved for purchasing gifts for participants and paying some amount to an assistant. As a participant in the hospital surgical and medical ward will provide their inputs for free, there will be flower gifts for each participant with a get well soon card. An assistant of mine, who will be my close friend, will help me in data collection and analysis. As a goodwill gesture, I will pay him $500 for his efforts. He is a good data analysis expert; hence the amount will be paid for such purposes. Equipment related expenses will primarily cover rent for additional laptops, broadband internet connection and costs for renting SPSS data analysis software. Miscellaneous consumable items would include pens, writing pad, food and drinks during the time of the study and soon. A minimum of $1850 is required for conducting this study in an appropriate manner. 

The scope of this study is integral and can benefit future work conducted in this area. Self-reflection is critical to understanding learning of self. While conducting this study, I have been able to gain tremendous amounts of skills and knowledge. Earlier I did not possess knowledge regarding ways to conduct research. This project has allowed me to develop practical skills and I feel confident to take up similar projects in the future as well. In order to conduct this study, I had to collect data where I faced one of the biggest challenges. I aimed at collecting such data within a month’s time frame but that was not possible, as it took time to interact and understand patient perspectives. There was another major challenge faced in this project, which was of the data analysis. While analyzing data pertaining to the project I diagnosed that most of the data collected were insignificant in nature. At this juncture, I had to go back and recollect data by taking ideas from journals, which have conducted a study in similar areas. Then I was able to implement data analysis tool of SPSS to arrive at findings for the study. 

References

Amoore, J. N. (2012). Oscillometric sphygmomanometers: a critical appraisal of current technology. Blood pressure monitoring, 17(2), 80-88. Accessed from https://journals.lww.com/bpmonitoring/Abstract/2012/04000/Oscillometric_sphygmomanometers___a_critical.7.aspx

Amoore, J. N., Guehenec, M., Scordecchia, R., & Scott, D. H. T. (2010). Auditing the technology used to measure blood pressure. Journal of medical engineering & technology, 34(3), 209-216.  Accessed from https://www.tandfonline.com/doi/abs/10.3109/03091900903518991

Avolio, A. P., Butlin, M., & Walsh, A. (2009). Arterial blood pressure measurement and pulse wave analysis—their role in enhancing cardiovascular assessment. Physiological measurement, 31(1), R1.  Accessed from https://iopscience.iop.org/article/10.1088/0967-3334/31/1/R01/meta

De Greeff, A., Lorde, I., Wilton, A., Seed, P., Coleman, A. J., & Shennan, A. H. (2010). Calibration accuracy of hospital-based non-invasive blood pressure measuring devices. Journal of human hypertension, 24(1), 58.  Accessed from https://www.nature.com/articles/jhh200929

Green, B. B., Cook, A. J., Ralston, J. D., Fishman, P. A., Catz, S. L., Carlson, J., ... & Thompson, R. S. (2008). Effectiveness of home blood pressure monitoring, Web communication, and pharmacist care on hypertension control: a randomized controlled trial. Jama, 299(24), 2857-2867.  Accessed from https://jamanetwork.com/journals/jama/fullarticle/1028642

Heinemann, M., Sellick, K., Rickard, C., Reynolds, P., & McGrail, M. (2008). Automated versus manual blood pressure measurement: A randomized crossover trial. International Journal of Nursing Practice, 14(4), 296-302. Accessed from https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1440-172X.2008.00696.x

Myers, M. G. (2014). Replacing manual sphygmomanometers with automated blood pressure measurement in routine clinical practice. Clinical and Experimental Pharmacology and Physiology, 41(1), 46-53.  Accessed from https://onlinelibrary.wiley.com/doi/abs/10.1111/1440-1681.12149

Weaver, T. E., & Grunstein, R. R. (2008). Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proceedings of the American Thoracic Society, 5(2), 173-178. Accessed from https://www.atsjournals.org/doi/abs/10.1513/pats.200708-119MG

Wilkins, K., Campbell, N. R., Joffres, M. R., McAlister, F. A., Nichol, M., Quach, S., ... & Tremblay, M. S. (2010). Blood pressure in Canadian adults. Health Reports, 21(1), 37.  Accessed from https://www.researchgate.net/profile/Rachel_Colley/publication/43350342_Quality_control_and_data_reduction_procedures_for_accelerometry-derived_measures_of_physical_activity/links/09e4150a39ccfd124d000000.pdf#page=39