Promoting sustainability in quality improvement: an evaluation of a web-based continuing education program in blood pressure measurement.

BACKGROUND: The accuracy of blood pressure measurement is variable in office-based settings. Even when staff training programs are effective, knowledge and skills decay over time, supporting the need for ongoing staff training. We evaluated whether a web-based continuing education program in blood pressure measurement reinforced knowledge and skills among clinical staff and promoted sustainability of an existing quality improvement program. METHODS: Medical assistants and nurses at six primary care clinics within a health system enrolled in a 30-min online educational program designed to refresh their knowledge of blood pressure measurement. A 20-question pre- and post-intervention survey addressed learners' knowledge and attitudes. Direct observation of blood pressure measurement technique before and after the intervention was performed. Differences in responses to pre- and post-module knowledge and attitudes questions and in observation data were analyzed using chi-square tests and simple logistic regression. RESULTS: All 88 clinical staff members participated in the program and completed the evaluation survey. Participants answered 80.6% of questions correctly before the module and 93.4% afterwards (p < 0.01). Scores improved significantly among staff from all job types. Licensed practical nurses and staff who had been in their current job at least a year were more likely to answer questions correctly than registered nurses and those in their current job less than a year. Attitudes toward correct blood pressure measurement were high at baseline and did not improve significantly. Prior to the intervention, staff adhered to 9 of 18 elements of the recommended technique during at least 90% of observations. Following the program, staff was more likely to explain the protocol, provide a rest period, measure an average blood pressure, and record the average blood pressure, but less likely to measure blood pressure with the arm at heart level and use the right arm. CONCLUSIONS: We designed, implemented, and evaluated a web-based educational program to improve knowledge, skills, and attitudes in blood pressure measurement and use of an automated device among nurses and medical assistants in ambulatory care. The program reinforced knowledge related to recommended blood pressure measurement technique. TRIAL REGISTRATION: Retrospectively registered with ClincalTrials.gov on March 22, 2012; registration number NCT01566864 .

Implementation of a training and structured skills assessment program for medical assistants in a primary care setting.

As part of ongoing efforts to improve quality of care through clinical education of our medical assisting staff, we developed a competency-based training and assessment program. At the time of program implementation, we assessed clinical skills of 111 certified medical assistants and found that 10% were unable to accurately measure blood pressure, 9% were unable to correctly perform an intradermal injection, and 48% were unable to correctly draw specified volumes into syringes. More than 10 years after program implementation, we continue to detect and remediate clinical skills in newly hired employees. This case study report describes the evolution of the program and assessment findings.