Dear colleagues,
My health center has contracted with a remote patient monitoring company to provide home BP monitors to our patients with hypertension. The devices transmit readings to a cloud-based platform via cellular data, and a team of nurses from the health center monitors the readings and follows up on abnormals and concerning trends. For quite some time, we have been asking the company to send us extra-large BP cuffs, because the standard cuffs do not fit patients with larger arms. We recently received our first shipment of XL cuffs, only to discover that the size range on the XL cuff is just one inch larger than the ones we already had. This creates an obvious health equity issue, where higher weight patients do not have access to the same quality of care as smaller patients. Sadly, we have had to turn interested patients away from the remote monitoring program due to lack of appropriately sized equipment.
When we asked the company for a solution to this issue, their suggestion was to use the standard cuff on the patient's forearm if it is too small for the upper arm. They do not have a wrist monitor available, and other companies' larger BP cuffs like the ones we use in clinic will not connect to the RPM equipment. The vendor reports that "many of their clients" (other health centers) use the forearm method and get good results, however they do not have information from the manufacturer about whether the device is validated for forearm or wrist measurements, and they did not specify whether other facilities made this decision based on any evidence. That brings me to my question for you all: are you aware of any research on the accuracy of forearm BP measurements, specifically using an automated home monitor with higher weight patients? Has anyone already done a literature review on this topic? If not, we will dive into the evidence ourselves, but thought I would first check here in case someone else has already solved this problem!
Thanks in advance for any input,
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Charlotte Badler, MSN, RN
Nursing Professional Development Specialist
Lynn Community Health Center
Pronouns: she/her
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