Office-based nursing staff management of hypertension in primary care.

A family medicine practice in a large multi-specialty clinic undertook a quality improvement initiative focusing on blood pressure control. Current rooming procedures were reviewed, including obtaining accurate and reliable blood pressures. All rooming staff were instructed how to take an accurate blood pressure and were observed at random over a 3-month period to ensure continued accuracy. Rooming staff (medical assistants and licensed practical nurses) were engaged to give patient education and to arrange a standard 2-week follow-up with a rooming staff team member (nurse visit) if the patient's blood pressure was elevated. Clinicians were educated briefly about the importance of managing hypertension regardless of reason for visit. Blood pressure control (<140/90) in patients age 18-85 without diabetes improved from 68.4% to 75.8% in 3 months.