Design and implement an SMBP protocol

Ensure standardized procedures and workflows are followed and objectives are clearly established. Determine specific goals, such as improving blood pressure control, empowering patients in self-management, and enhancing communication between patients and providers. Guidelines and protocols for blood pressure management program can help organizations to establish standardized procedures for patient eligibility, monitoring frequency, target ranges, and appropriate actions based on blood pressure readings.

Create guidelines and protocols that outline the program’s procedures, including patient eligibility criteria, the recommended frequency of blood pressure measurements, target blood pressure ranges, and actions to take based on blood pressure readings.
Choose validated and accurate blood pressure monitoring devices suitable for home use.
Assemble a team within the clinic that will support the SMBP program. This is essential for continuity and standardization. Along with clinical staff members such as MA’s or Nurses, include at least 1 provider on the health care team. If multiple providers will participate, designate a provider champion. Having a provider champion provides high-quality care and ensures that care never falls below the standard and will help with clinician buy-in and dissemination of protocols and workflows throughout the clinic.
Provide staff competency training to ensure each staff member involved in the SMBP process is trained in how to instruct patients to conduct proper home monitoring. Staff blood pressure competency training should be conducted bi-annually or annually. (Consider using the clinical competency guide located in the resources of this section)
Train all staff on the SMBP program, including its benefits, procedures, and appropriate interpretation of blood pressure measurements. Ensure they understand the role of SMBP in hypertension management and can efficiently communicate with patients about the program.
Prepare patient education materials regarding SMBP, including proper measurement techniques, appropriate cuff sizing, and monitoring frequency. Ensure patients understand how to accurately record their readings and transmit the data to the clinic.
Determine the frequency and duration of self-monitoring based on individual patient needs. The patient should measure their blood pressure at home multiple times a day, at different times of the day, for a specified timeframe. Define the timeline that works best for the patient and their follow-up visits to review data.
Schedule follow-up visits to review the patient’s blood pressure measurements. It is important to note that these are general guidelines, and the exact frequency of follow-up visits should be determined by the healthcare provider, taking into consideration the individual circumstances.
- For patients with well-controlled blood pressure or with no significant underlying health conditions, follow-up visits may be scheduled for 3 to 6 months. This frequency could allow for adequate monitoring and adjustment of medications or lifestyle modifications.
- For patients with hypertension, especially those with more severe or uncontrolled blood pressure, more frequent follow-up visits may be necessary. In such cases, visits every 1 to 3 months may be recommended to closely monitor the patient’s progress and make timely adjustments to the treatment plan.
Evaluate the data, compare with target ranges, and provide feedback. Use these follow-up visits to adjust treatment plans, lifestyle modifications, and address any questions the patient may have.
Cultivate effective communication between patients and providers. Encourage your patients to share their blood pressure readings and any concerns they may have. Establish a system with your staff and providers to implement prompt feedback and guidance to support patient self-management.
Offer ongoing support and resources to patients participating in the SMBP program. This could include educational materials, lifestyle modification guidance, and encouragement.

DEVICE LOANER PROGRAM

Decide if your clinic will be providing loaner devices or asking patients to purchase their own. Consider purchasing a supply of SMBP loaner devices for patients unable or unwilling to purchase a device for themselves. Consider following these steps when setting up your loaner program:

Assess the demand for blood pressure monitor loaner devices in your practice. Identify patients who may need temporary access to a device, such as those patients who are undergoing evaluation, are experiencing device malfunction, or are awaiting a permanent device. Define the criteria for patients to qualify for a loaner device. This could include medical conditions, insurance coverage, device malfunctions, and any other relevant situations. Make sure the criteria are communicated to patients and providers.
Purchase a supply of blood pressure monitor loaner devices to meet your identified needs. Ensure these devices are in good working condition and are validated and calibrated.
Create a loaner device agreement that outlines the terms and conditions for borrowing a device. Include in the agreement information on device responsibilities, return timelines, potential fees for lost or damaged devices, and patient obligations on using, maintaining, and returning the device to the practice.
Determine which patients may be eligible to receive a discounted monitor through their insurance, such as Medicare, or, if relevant, check with your state to see what coverage exists under Medicaid plans (see link below). Sometimes, commercial insurance carriers will cover the cost of a patient blood pressure monitoring device.

Links:

List of Devices that have been validated

American Medical Association Patient Training Checklist for Loaner Device

American Medical Association Loaner Device Agreement- English

American Medical Association Loaner Device Agreement- Spanish

American Medical Association Loaner Device Inventory Management

NACHC Self Monitoring Blood Pressure Implementation Toolkit

NACHC/Million Hearts Learning Lab Miscellaneous resources including patient training videos

American Medical Association Engaging Patients in SMBP including Clinical Competency Checklist for staff

SMBP Monitoring Action Steps for Clinicians

SMBP Device Accuracy List

AMA Self-measured blood pressure cuff selection