Document Type

Final Project

Graduation Date

Spring 5-2-2024

Degree Name

Doctor of Nursing Practice

First Advisor

LeAnn Holmes, DNP, FNP-C, FAANP

Second Advisor

Amy Ford, DNP, WHNP-BC


Introduction: Hypertension is a preventable disease that frequently goes unrecognized and undertreated. Early diagnosis can prevent further comorbidities such as heart disease, stroke, and chronic kidney disease. Implementation of this protocol aims to decrease the number of patients with undiagnosed hypertension and increase the identification of patients with elevated blood pressure who did not have a pre-existing diagnosis of hypertension. The goal of implementing a standardized protocol would help eliminate the number of patients who go undiagnosed.

Methods: This quality improvement design had clinical staff flag patients with elevated blood pressure. Identified patients without a diagnosis of hypertension were educated by providers, given an education packet, encouraged to monitor their blood pressure at home, and asked to return for a follow-up appointment in two to four weeks.

Results: Prior to the protocol being initiated from June to August 2021, 0 (0%) patients were identified with elevated blood pressure, and 93 (100%) were found to have elevated blood pressure with no pre-existing diagnosis of hypertension. After the protocol was initiated from June to August 2022, however, 49 (13.6%) patients were identified with elevated blood pressure, and 312 (86.4%) were not identified for a total of 361 patients with elevated blood pressure and no current diagnosis of hypertension.

Discussion: Overall, the protocol implementation improved identification of patients with high blood pressure without a previous diagnosis of hypertension. The protocol raised awareness within the clinic regarding hypertension and associated comorbidities. There was a large increase in the number of patients found to have elevated blood pressure from 2021 to 2022. This increase is likely influenced by the change from manual to standardized automatic blood pressure cuffs. Despite protocol implementation, there was still a large volume of patients that had elevated blood pressures that remained unidentified. While staff training was done prior to protocol implementation, there was no process in place to monitor the fidelity of proper blood pressure technique and protocol adherence. Continued focus on protocol adherence may improve the number of individuals identified with elevated blood pressure.