When contacted does not have their own monitor wrist monitors CEBM guidance BP Loan Practice organises pick up of machine by household member or volunteer to deliver for Volunteer Centre email ID: 1007288
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1. Pt found to have High BP on searchWhen contacted, does not have their own monitor (wrist monitors – CEBM guidance)BP LoanPractice organises pick up of machine by household member or volunteer to deliver (for Volunteer Centre, email info@vchackney.org with details of GP practice staff member to contact and the subject ‘BP Monitor’. Do not share patient addresses on initial email – the Volunteer Centre will get in touch)Text message/Email to patient with instructions, self management guide and recording template Patient to record BP over 1, 3 or 14 days. Template records average BP and template sent back via text via Email/Text/paper copyPractice to arrange drop off of machine by household member or volunteer.If BP normal, review in 6-12 months. Use practice follow up system and consider using Accurx PathwaysIf BP high, discuss adherence and consider titration of existing medication or adding another agent (see guidance)If initiating or titrating up ACEi/ARBCheck recent blood tests for Electrolytes, if not recent consider repeating. If clinically appropriate, initiate or titrate up ACEi/ARBAfter 2 weeks:Discuss adherence and side effects including dry coughRepeat electrolytes with any other relevant blood testsLoan of BP machine for monitoring over 1 dayIf BP still high, and electrolytes normal, consider titrating up and repeating after 2 weeksContinue until maximum tolerated dose reached (including whether intolerable side effects experienced)If initiating thiazide like diureticCheck recent blood tests for Electrolytes, if not recent consider repeating. If clinically appropriate, initiate thiazide like diuretic (inAfter 2 weeks:Discuss adherence and side effects repeat electrolytes with any other relevant blood testsLoan of BP machine for monitoring over 1 day If BP still high, consider adding another agent. If initiating CCB or other antihypertensiveAfter 2 weeks Discuss adherence and side effects Loan of BP machine for monitoring over 1 day If BP still high, consider adding another agent. If BP high on 4+ agents, consider discussing with Dr Abramsvia Advice and guidancePractices to follow infection control policy for BP machines - linkRetain list of patients devices have been sent toBP loan and management protocol
2. Practice organises pick up of machine by household member or volunteer centre to deliverFor Volunteer Centre, email info@vchackney.org with details of GP practice staff member to contact and the subject BP MONITOR. Do not share patient addresses on initial email - the Volunteer Centre will be in touch to obtain details. How to take Home BP measurement https://bihsoc.org/wp-content/uploads/2017/09/Home_blood_pressure_monitoring_explained.pdfHBPM templateshttps://templates.office.com/en-gb/blood-pressure-tracker-tm03986884http://bihsoc.org/wp-content/uploads/2017/09/Home_blood_pressure_diary.pdf https://bihsoc.org/wp-content/uploads/2017/11/BP-Diary-form-v2-26-June-2019.xlsxPatient leaflet https://www.bhf.org.uk/informationsupport/publications/heart-conditions/understanding-blood-pressureSalt leaflethttps://www.bhf.org.uk/informationsupport/publications/healthy-eating-and-drinking/taking-control-of-saltPatient decision aid https://www.nice.org.uk/guidance/ng136/resources/how-do-i-control-my-blood-pressure-lifestyle-options-and-choice-of-medicines-patient-decision-aid-pdf-6899918221 https://www.qmul.ac.uk/blizard/ceg/realhealth/https://www.nice.org.uk/guidance/ng136/resources/visual-summary-pdf-6899919517Patient InfoCEG GuidanceNICE GuidanceAccurx PathwaysVolunteer Centre Details Pathways allows users to send a schedule of delayed messages over a series of days, weeks or months. They help practices provide standardised management according to best practice, improving patient safety, saving time and empowering patients to take control of their care.Examples of Pathways include:Reminders to book annual reviews for long-term conditionsReminders to book routine investigations such as blood tests and chest x-raysReminders to follow-up referrals, for example a Two-Week-Wait or Urgent referral to secondary careReminders to record home blood-pressure readingsNudges to make healthy lifestyle style changeshttps://talkchangesforhealth.org.ukTalk changes (IAPT)