Date of Publication


Project Team

Site Mentor: Renee Dall


Background: 16% of children ages 3-18 have high blood pressure (BP) which, if untreated, may lead to hypertension and organ damage. The American Academy of Pediatrics recommends screening all children for high BP, starting at age 3.

Local problem: A Vermont pediatric primary care clinic screened age 3 patients for high BP only 66.7% of the time. This quality improvement project aimed to raise rates of BP screenings by increasing the clinic staff understanding of the rationale for and confidence in performing age 3 BPs.

Methods: Surveys of clinic staff and interviews with content experts led to the creation of an educational program and a novel BP aid. Retrospective chart reviews compared rates of screening before and after the project’s intervention. Likert scale surveys of clinic staff after the intervention measured changes in staff confidence and knowledge.

Interventions: The educational program included a presentation and handouts with recommendations for obtaining BPs in difficult patients. The novel BP aid utilized a distraction technique to ease the apprehension of children having their BP taken for the first time.

Results: Fifty-five 3-year-old patients had annual visits during the post-intervention period. Of those, 81.8% had their BP recorded, an increase of 15 percentage points over the pre-intervention period. Staff reported increased understanding of the rationale for and confidence in obtaining BPs from 3-year-olds.

Conclusions: This project demonstrated how a few easy-to-implement interventions can improve the experience of first-time BPs for 3-year-old patients and clinic staff alike.

Document Type


Available for download on Wednesday, May 04, 2022