Practices in the Residency Program Collaborative are one month into a Blood Pressure Challenge and have great ideas for you to try. The goal: improve BP for 20 patients with diabetes to <130/80.

The key: "Start small." Test interventions in this order:

1. Easy fixes: When and where
   1. If BP is elevated, recheck before the patient leaves (Shadyside)
   2. Test BP in the chair, not on the exam table (Forbes)
2. Still pretty easy: How - follow JNC 7 rules
   1. Use the right size cuff (Shadyside)
   2. Stop using the automated cuff, which tends to read higher (Altoona) – the efficiency isn’t worth patient data you don’t believe
   3. Forbes suspected staff were rounding up when documenting BP so they provided a lunch/learn on proper documentation
3. A little harder: Clinical inertia
   1. Engage a clinical pharmacist if you have one (Lancaster)
   2. If BP is elevated, whoever took the BP must physically talk to the doc during the visit about the elevated BP – not just enter the info in the chart (Lancaster)
   3. Chart elevated BP in chief complaint (Altoona)

Good luck and stay tuned for more ideas in July!