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Best Practices for Prevention in SBHCsScreening for High Blood Pressure
Welcome and Introductions
Pilot Program (2009-2010)
Early Results (June 2010)
Expanded Training (Summer 2010)
Best Practices State-Wide Roll Out (2010-2011)
BEST PRACTICES
Research has confirmed that primary hypertension is detectable in children and occurs commonly
Data on healthy adolescents demonstrated “hypertension in approx. 30% of overweight children (BMI > 95th %)”
Long-term health risks for hypertensive children and adolescents are significant
Critical to detect elevated BP earlyBody size is the major (but not only)
determinant for elevated BP among children and adolescents
Children and Adolescents should be SCREENED,
starting at AGE 3, on an ANNUAL
basis
Vital SignsHeightWeightBMIBMI %BP %
To Calculate BMI Use formula on the Stature-for-age and Weight-for-age
percentiles chart (Growth Chart) appropriate for genderWeight (in pounds) /stature (in inches)/stature (in) x 703Weight (in kilograms)/ stature (in centimeters) / stature (cm) x
10,000
To Calculate BMI PercentageUse Body mass index-for-age percentiles chart
appropriate for gender plotting student’s age and BMI
Record Calculations on top portion of Hypertensive Screening Form
3 Blood Pressure (BP) readings taken on same visit
Average < 90% and < 120/80 -- Screen again Next Year
(using Quick Glance Chart) > 90% or > 120/80-- Repeat BP Twice within 2
Weeks on 2 Separate Visits > 99% or Symptomatic – Promptly Refer for
Evaluation and TreatmentVisit #2Visit #3
DiagnosisNormal Blood Pressure (using Quick
Glance Chart)SBP and DBP < 90th% for gender, age and height
and < 120/80
PrehypertensionSBP or DBP > 90th% but < 95th% on > 3 occasions
OR BP > 120/80 but < 95th% on > 3 occasions
Suspected HypertensionSBP and/or DBP > 95th% on > 3 occasions
Elevated Blood Pressure Reading Clarification
SBP or DBP > 90th%BP > 120/80Quick Glance ChartExpanded BP Tables
Prehypertension (BP > 90th% but < 95th% OR > 120/80)
-Comprehensive Physical Exam-Counseling-Pre-test-Program Participant Log-Recheck BP in 6 months; Post-test
Suspected Hypertension(BP > 95th%)
Comprehensive Physical ExamComplete HTN PanelCounselingPre-testProgram Participant LogRecheck BP in 3 monthsPost-test in 6 months
NameBP %Lab TestingLab ResultsDiagnosisExternal ReferralPre-Test/Post-TestFollow-Up Date
Suspected Prehypertension Comprehensive Physical Exam
Suspected Hypertension Comprehensive Physical Exam Complete HTN Panel
CBC with diff and plateletsChem 7U/A
Urine Culture (if U/A positive)Non-fasting Lipid ProfileHemoglobin A1C
EKG
Additional upon Referral Renal Ultrasound Echocardiography
Additional to Consider Phosphorous Uric Acid Drug Screen Insulin Polysomnogram Retinal Exam
Pre Test To test patient initial knowledge of elevated BP Given on date patient diagnosed and put on
Program Participant LogReviewed with provider
Post Test To test increased knowledge of elevated BP Given on or around 6 month follow-up visit
Completed Tests Stapled together and sent to OPH with next
quarterly report
Medical RecordAbility to quickly identify students
who have had or do have elevated BP on previous visit(s) to SBHC
Inside Front Jacket
Lab Testing OrderedLab Test ResultsFollow-Up VisitCommentsExternal ReferralSignature
Blood Pressure Screening Flow Chart
First BP Screening VisitStudents with a BP reading WNL
Use CODE V81.1 – HTN Screening(only use this code 1 time/year for students with normal
BP)
Students with a BP reading > 90th%--99th%Use CODE V81.1 – HTN Screening AND CODE
796.2—Elevated BP reading w/o diagnosis of HTN
Second BP Screening VisitUse CODE V81.1 – HTN Screening AND CODE
796.2—Elevated BP reading w/o diagnosis of HTN
Or if BP is WNL on this visit, Use Dummy Code NBP (normal BP) instead of 796.2NOTE—IF YOU CHOOSE THIS CODE (NBP), you
must enter comments to note why (or why you think) this student has returned to WNL
Third BP Screening VisitUse CODE V81.1 – HTN Screening AND CODE
796.2—Elevated BP reading w/o diagnosis of HTN
If SBP or DBP > 95th% for gender, age and height measured on > 3 separate occasions ADD Dummy Code SHTN (Suspected Hypertension)
if BP is WNL on this visit, Use Dummy Code NBP (normal BP) instead of 796.2NOTE—IF YOU CHOOSE THIS CODE (NBP), you must
enter comments to note why (or why you think) this student has returned to WNL
Visit to Review Lab Test Results (Follow-Up Visit)
Choose from the following CODES796.2 –Elevated BP reading w/o diagnosis of HTNSHTN –Suspected Hypertension (Dummy Code)
Add to 796.2
ADD any other Diagnosis noted (if necessary)
Interval VisitsChoose from the following CODES
796.2 –Elevated BP reading w/o diagnosis of HTNSHTN –Suspected Hypertension (Dummy Code)
Add to 796.2BP Return to WNL- use Dummy Code NBP (normal
BP) for students who have returned to WNL following suspected HTN or pre-HTNNOTE—IF YOU CHOOSE THIS CODE (NBP), you must enter comments to note why (or why you think) this student has returned to WNL
401.9 –HTN (if student diagnosed with HTN)ADD any other Diagnosis noted (if necessary)
DUMMY CODESNBP –BP has returned to WNL (Comments
Required)NOTE—IF YOU CHOOSE THIS CODE (NBP), you
must enter comments to note why (or why you think) this student has returned to WNL; if reason unknown, put UNKNOWN in comments field
SHTN –Suspected Hypertension
Hypertension Screening
Box
QUESTIONS?
