Best Practices for Prevention in SBHCs Screening for High Blood Pressure

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Pilot Program ( ) Early Results (June 2010) Expanded Training (Summer 2010) Best Practices State-Wide Roll Out ( )

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 > 95 th %)” Long-term health risks for hypertensive children and adolescents are significant Critical to detect elevated BP early Body 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 Signs Height Weight BMI BMI % BP %

To Calculate BMI Use formula on the Stature-for-age and Weight-for-age percentiles chart (Growth Chart) appropriate for gender Weight (in pounds) /stature (in inches)/stature (in) x 703 Weight (in kilograms)/ stature (in centimeters) / stature (cm) x 10,000 To Calculate BMI Percentage Use 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 Treatment Visit #2 Visit #3

Diagnosis Normal Blood Pressure (using Quick Glance Chart) SBP and DBP < 90 th % for gender, age and height and < 120/80 Prehypertension SBP or DBP > 90 th % but 3 occasions OR BP > 120/80 but 3 occasions Suspected Hypertension SBP and/or DBP > 95 th % on > 3 occasions

Elevated Blood Pressure Reading Clarification

SBP or DBP > 90 th % BP > 120/80 Quick Glance Chart Expanded BP Tables

Prehypertension (BP > 90 th % but 120/80) - Comprehensive Physical Exam -Counseling -Pre-test -Program Participant Log -Recheck BP in 6 months; Post-test

Suspected Hypertension (BP > 95 th %) Comprehensive Physical Exam Complete HTN Panel Counseling Pre-test Program Participant Log Recheck BP in 3 months Post-test in 6 months

Name BP % Lab Testing Lab Results Diagnosis External Referral Pre-Test/Post-Test Follow-Up Date

Suspected Prehypertension Comprehensive Physical Exam Suspected Hypertension Comprehensive Physical Exam Complete HTN Panel CBC with diff and platelets Chem 7 U/A Urine Culture (if U/A positive) Non-fasting Lipid Profile Hemoglobin 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 Log Reviewed 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 Record Ability to quickly identify students who have had or do have elevated BP on previous visit(s) to SBHC Inside Front Jacket

Lab Testing Ordered Lab Test Results Follow-Up Visit Comments External Referral Signature

Blood Pressure Screening Flow Chart

First BP Screening Visit Students 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 > 90 th %--99 th % Use CODE V81.1 – HTN Screening AND CODE 796.2— Elevated BP reading w/o diagnosis of HTN

Second BP Screening Visit Use 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 NOTE—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 Visit Use CODE V81.1 – HTN Screening AND CODE 796.2— Elevated BP reading w/o diagnosis of HTN If SBP or DBP > 95 th % 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 NOTE—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 CODES –Elevated BP reading w/o diagnosis of HTN SHTN –Suspected Hypertension (Dummy Code) Add to ADD any other Diagnosis noted (if necessary)

Interval Visits Choose from the following CODES –Elevated BP reading w/o diagnosis of HTN SHTN –Suspected Hypertension (Dummy Code) Add to BP Return to WNL- use Dummy Code NBP (normal BP) for students who have returned to WNL following suspected HTN or pre-HTN NOTE—IF YOU CHOOSE THIS CODE (NBP), you must enter comments to note why (or why you think) this student has returned to WNL –HTN (if student diagnosed with HTN) ADD any other Diagnosis noted (if necessary)

DUMMY CODES NBP –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?