WEBVTT 00:00:09.000 --> 00:00:19.000 Live captions provided by Rev.com. For 99% accurate post-meeting transcripts and captions, visit Rev.com. 00:00:19.000 --> 00:00:32.000 Okay. All right. 00:00:32.000 --> 00:00:34.000 Well, good afternoon and welcome to today's webinar. 00:00:34.000 --> 00:00:36.000 What's all the hype about hypertension. 00:00:36.000 --> 00:00:38.000 Bringing focus back to the basics. 00:00:38.000 --> 00:00:40.000 We'll get started in just a few minutes, 00:00:40.000 --> 00:00:42.000 but first a few housekeeping items. 00:00:42.000 --> 00:00:50.000 All participants entered today's webinar in listen, only mode. 00:00:50.000 --> 00:00:52.000 Should you have a question or a comment during today's call. 00:00:52.000 --> 00:00:55.000 We just ask that you please type it into either the chat or the Q and 00:00:55.000 --> 00:00:57.000 a box, which should be located at the bottom of your zoom window. 00:00:57.000 --> 00:01:00.000 You may need to hover your mouse around the bottom of the window to 00:01:00.000 --> 00:01:01.000 get the icons to appear. 00:01:01.000 --> 00:01:02.000 At the end of today's program, 00:01:02.000 --> 00:01:05.000 you'll be directed to an evaluation and some reflective questions. 00:01:05.000 --> 00:01:06.000 Once completed, 00:01:06.000 --> 00:01:09.000 you'll be presented with a certificate for you to fill out and print 00:01:09.000 --> 00:01:15.000 as proof of your webinar completion. 00:01:15.000 --> 00:01:17.000 And even if you do not need the continuing education credits, 00:01:17.000 --> 00:01:20.000 we hope that you will still complete the evaluation because it just 00:01:20.000 --> 00:01:22.000 helps us determine how we did and it can, 00:01:22.000 --> 00:01:23.000 and it can shape our future programming. 00:01:23.000 --> 00:01:27.000 So first I would like to go ahead and go over a couple of slides 00:01:27.000 --> 00:01:34.000 right here. 00:01:34.000 --> 00:01:38.000 To complete the course, the learner must watch our webinars. 00:01:38.000 --> 00:01:40.000 It's not going to be a full 60 minutes today. 00:01:40.000 --> 00:01:42.000 I'm more like 30 to 45 minutes. 00:01:42.000 --> 00:01:44.000 You can either watch the live or the recorded version. 00:01:44.000 --> 00:01:46.000 You must complete the evaluation and reflective questions. 00:01:46.000 --> 00:01:52.000 And then once completed, you'll be awarded a. 00:01:52.000 --> 00:01:54.000 You'll be awarded one contact hour, 00:01:54.000 --> 00:01:55.000 which has been approved for nursing. 00:01:55.000 --> 00:01:57.000 And we are here at quality insights. 00:01:57.000 --> 00:01:59.000 We've been accredited as a provider of nursing, 00:01:59.000 --> 00:02:00.000 continuing professional development. 00:02:00.000 --> 00:02:01.000 By the American nurses, 00:02:01.000 --> 00:02:04.000 credentialing center's commission on accreditation. 00:02:04.000 --> 00:02:08.000 And there are no disclosures from quality insights. 00:02:08.000 --> 00:02:09.000 So after this course today, 00:02:09.000 --> 00:02:12.000 the learner will be able to identify barriers to optimal blood 00:02:12.000 --> 00:02:18.000 pressure control for patients. 00:02:18.000 --> 00:02:21.000 We'll be able to explain and provide resources related to improving 00:02:21.000 --> 00:02:24.000 self management of hypertension, to patients, 00:02:24.000 --> 00:02:26.000 and be able to describe their role in a hypertensive patients journey. 00:02:26.000 --> 00:02:29.000 So we have a lot of information today. 00:02:29.000 --> 00:02:30.000 Let's get us back to this front side here. 00:02:30.000 --> 00:02:32.000 Without further ado. 00:02:32.000 --> 00:02:41.000 I'm going to go ahead and introduce our guest speaker. 00:02:41.000 --> 00:02:44.000 Ms. Antoinette Murphy is a registered nurse with a certification in 00:02:44.000 --> 00:02:45.000 oncology. 00:02:45.000 --> 00:02:48.000 She's worked with patients in both the inpatient and outpatient 00:02:48.000 --> 00:03:03.000 setting over the last seven years. 00:03:03.000 --> 00:03:06.000 Antoinette also has served as a nurse ambassador in the integrated 00:03:06.000 --> 00:03:09.000 oncology program and has had the honor of receiving the award for 00:03:09.000 --> 00:03:13.000 rising star of 2018 for her work in the inpatient diabetes 00:03:13.000 --> 00:03:15.000 committee, where she created educational resources, 00:03:15.000 --> 00:03:19.000 organized research and presented diabetes related topics at various 00:03:19.000 --> 00:03:21.000 nursing conferences across the state of Pennsylvania. 00:03:21.000 --> 00:03:23.000 And we're very happy to say that she's now working with us here at 00:03:23.000 --> 00:03:26.000 quality insights as a quality improvement specialist. 00:03:26.000 --> 00:03:28.000 So welcome Antoinette and thank you for bringing your insight and 00:03:28.000 --> 00:03:31.000 expertise to us today. And I'll now turn the program over to you. 00:03:31.000 --> 00:03:33.000 Thank you Mitzi. Hi everyone. Good afternoon. 00:03:33.000 --> 00:03:34.000 Thank you for joining me today. 00:03:34.000 --> 00:03:36.000 For this special presentation on hypertension. 00:03:36.000 --> 00:03:37.000 Over the next half hour. 00:03:37.000 --> 00:03:40.000 So we will be focusing on bringing our focus back to the basics when 00:03:40.000 --> 00:03:43.000 it comes to managing our patients with hypertension. 00:03:43.000 --> 00:03:44.000 Next slide. 00:03:44.000 --> 00:03:50.000 Well, we thought. 00:03:50.000 --> 00:03:53.000 This would be a good time to review some of this information with you 00:03:53.000 --> 00:03:56.000 all since may is national high blood pressure education month. 00:03:56.000 --> 00:04:00.000 This has increased value as we face the COVID-19 pandemic. 00:04:00.000 --> 00:04:02.000 And as we take a step back to see how our numbers are looking in the 00:04:02.000 --> 00:04:05.000 aftermath. 00:04:05.000 --> 00:04:07.000 Physician office closures restrictions. 00:04:07.000 --> 00:04:09.000 And especially now that we're getting back to normal. 00:04:09.000 --> 00:04:11.000 That's fine. 00:04:11.000 --> 00:04:17.000 Some of. 00:04:17.000 --> 00:04:20.000 They key facts surrounding hypertension here in the United States are 00:04:20.000 --> 00:04:29.000 well startling to say the least. 00:04:29.000 --> 00:04:32.000 The prevalence of hypertension is extremely high in the United States. 00:04:32.000 --> 00:04:36.000 And treatment of hypertension is notably the most common reason for 00:04:36.000 --> 00:04:40.000 office visits and for the use of chronic prescription medications. 00:04:40.000 --> 00:04:42.000 Reports from the American heart association showed that nearly half of 00:04:42.000 --> 00:04:44.000 our adult population has high blood pressure. 00:04:44.000 --> 00:04:49.000 And only about 25% of those patients actually have it under control. 00:04:49.000 --> 00:04:51.000 What we can take from these reports and numbers is that there is more 00:04:51.000 --> 00:04:54.000 work to do to help our patients understand their numbers and risks of 00:04:54.000 --> 00:04:55.000 this silent killer. 00:04:55.000 --> 00:05:00.000 Next slide. 00:05:00.000 --> 00:05:04.000 This is the most current graph and analysis of blood pressure readings 00:05:04.000 --> 00:05:19.000 and how they are currently being categorized. 00:05:19.000 --> 00:05:22.000 As you can see the new qualification for a normal blood pressure is a 00:05:22.000 --> 00:05:25.000 reading of less than 120 over 80. 00:05:25.000 --> 00:05:27.000 I found this to be startling to a lot of people and an eye opener to 00:05:27.000 --> 00:05:31.000 those that are right on the cusp of a diagnosis of hypertension to 00:05:31.000 --> 00:05:32.000 really see those numbers of categories. 00:05:32.000 --> 00:05:34.000 Categorization shift downward. 00:05:34.000 --> 00:05:38.000 Kind of narrowing that, you know, opportunity for just squeaking by. 00:05:38.000 --> 00:05:41.000 And so now there's this marker we're using to classify an elevated 00:05:41.000 --> 00:05:44.000 blood pressure, which is that reading. 00:05:44.000 --> 00:05:46.000 120 To 129 over 80. 00:05:46.000 --> 00:05:49.000 And this is really an opportunity to raise the awareness for patients 00:05:49.000 --> 00:05:51.000 that they might be entering that danger zone of hypertension. 00:05:51.000 --> 00:05:54.000 So we're seeing this as a chance to push that education on healthy 00:05:54.000 --> 00:05:55.000 lifestyle changes. 00:05:55.000 --> 00:05:58.000 And to reinforce that prevention is worth its weight in gold. 00:05:58.000 --> 00:06:07.000 Next slide, please. 00:06:07.000 --> 00:06:10.000 The topic of COVID is frightening for just about everyone, 00:06:10.000 --> 00:06:13.000 especially since more and more information about COVID is being 00:06:13.000 --> 00:06:14.000 discovered. 00:06:14.000 --> 00:06:17.000 And in, in the arena of patients with pre-existing conditions, 00:06:17.000 --> 00:06:21.000 this can be felt on an even higher level. 00:06:21.000 --> 00:06:25.000 The CDC reports that adults with uncontrolled high blood pressure are 00:06:25.000 --> 00:06:28.000 at an increased risk for more severe illness from COVID-19. 00:06:28.000 --> 00:06:31.000 This is putting patients with hypertension and the same category as 00:06:31.000 --> 00:06:33.000 those with pre-existing conditions, such as diabetes. 00:06:33.000 --> 00:06:36.000 Kind of kidney disease and cardiovascular disease. 00:06:36.000 --> 00:06:38.000 I'm controlled hypertension has been found to lower people's immune 00:06:38.000 --> 00:06:40.000 systems. 00:06:40.000 --> 00:06:48.000 Which increases the risk of contracting COVID-19. 00:06:48.000 --> 00:06:49.000 I'm controlled. 00:06:49.000 --> 00:06:52.000 Hypertension also has led to an increased severity of lung injury and 00:06:52.000 --> 00:06:56.000 mortality. And those with COVID-19. 00:06:56.000 --> 00:07:00.000 And those with uncontrolled hypertension have increased rates of being 00:07:00.000 --> 00:07:02.000 hospitalized and therefore increases the risk for exposure. 00:07:02.000 --> 00:07:04.000 And contracting COVID-19. 00:07:04.000 --> 00:07:10.000 Next slide. 00:07:10.000 --> 00:07:13.000 Something that isn't discussed as frequently is how difference in race 00:07:13.000 --> 00:07:17.000 affects how we care for our hypertensive population. 00:07:17.000 --> 00:07:20.000 It is estimated that 55% of African-Americans have high blood 00:07:20.000 --> 00:07:23.000 pressure, which is a, the highest rate. 00:07:23.000 --> 00:07:26.000 Amongst all ethnic populations. 00:07:26.000 --> 00:07:28.000 And so highlighting how we are treating our African-American patients. 00:07:28.000 --> 00:07:32.000 Should be considered. 00:07:32.000 --> 00:07:35.000 Some of the cheapest antihypertensive drugs on the market today are 00:07:35.000 --> 00:07:42.000 ACE inhibitors. 00:07:42.000 --> 00:07:45.000 Is inhibitors are frequently used in first-line treatment of 00:07:45.000 --> 00:07:48.000 hypertension because of its potent blood pressure effects and the 00:07:48.000 --> 00:07:49.000 mortality benefits of caries. 00:07:49.000 --> 00:07:51.000 However you're seeing angioedema, 00:07:51.000 --> 00:07:53.000 which is often requiring emergency room visits. 00:07:53.000 --> 00:07:57.000 And about 5% of the African-American population that are taking ACE 00:07:57.000 --> 00:07:59.000 inhibitors. 00:07:59.000 --> 00:08:03.000 This is compared to 0.7% amongst Caucasians using ACE 00:08:03.000 --> 00:08:09.000 inhibitors. 00:08:09.000 --> 00:08:13.000 With such an increased incidence of ACE inhibitor induced angio edema. 00:08:13.000 --> 00:08:14.000 And African-Americans, 00:08:14.000 --> 00:08:17.000 it is probably safer to choose other options for controlling 00:08:17.000 --> 00:08:18.000 hypertension. 00:08:18.000 --> 00:08:22.000 Or to at least bring awareness to those patients that are using them 00:08:22.000 --> 00:08:25.000 and that they should be closely monitored for those potential side 00:08:25.000 --> 00:08:26.000 effects. 00:08:26.000 --> 00:08:36.000 Next slide. 00:08:36.000 --> 00:08:38.000 Detection can be difficult in those with hypertension. 00:08:38.000 --> 00:08:42.000 Most people who are diagnosed have no symptoms and studies are showing 00:08:42.000 --> 00:08:45.000 that approximately one in three adults with hypertension are actually 00:08:45.000 --> 00:08:47.000 unaware. They even have high blood pressure. 00:08:47.000 --> 00:08:50.000 These numbers are proving why bringing awareness to annual wellness 00:08:50.000 --> 00:08:53.000 visits and community resources is crucial to identifying those at risk 00:08:53.000 --> 00:08:55.000 or who have hypertension. 00:08:55.000 --> 00:08:59.000 Next slide. 00:08:59.000 --> 00:09:00.000 To diagnose hypertension. 00:09:00.000 --> 00:09:03.000 We are looking for an average of two or more accurately measured blood 00:09:03.000 --> 00:09:10.000 prepper pressure readings. 00:09:10.000 --> 00:09:12.000 We are preferring a combination of readings. 00:09:12.000 --> 00:09:16.000 So either one in office visit compared to an out of office visit for 00:09:16.000 --> 00:09:18.000 those that have the white coat syndrome. 00:09:18.000 --> 00:09:21.000 To an office visits with an appropriate amount of time between those 00:09:21.000 --> 00:09:24.000 visits can also be helpful and utilized. 00:09:24.000 --> 00:09:26.000 Next slide. 00:09:26.000 --> 00:09:35.000 When monitoring blood pressure readings, accuracy is a key component. 00:09:35.000 --> 00:09:37.000 As you can see by this graph, 00:09:37.000 --> 00:09:40.000 improper blood pressure measurement technique can affect blood 00:09:40.000 --> 00:09:42.000 pressure readings on a large scale. 00:09:42.000 --> 00:09:46.000 So applying your best practices can help address possible current gaps 00:09:46.000 --> 00:09:47.000 in blood pressure measurement. 00:09:47.000 --> 00:09:55.000 Next slide. 00:09:55.000 --> 00:09:59.000 No, the common barriers to achieving optimal blood pressure control. 00:09:59.000 --> 00:10:02.000 Right now, we are seeing patients that are lost to follow up. 00:10:02.000 --> 00:10:11.000 The decline in annual wellness visits. 00:10:11.000 --> 00:10:13.000 The increased number of telemedicine visits. 00:10:13.000 --> 00:10:15.000 So not being able to get those patients into the office to have their 00:10:15.000 --> 00:10:19.000 blood pressure taken accurately. Again, key component. 00:10:19.000 --> 00:10:20.000 Lack of education. 00:10:20.000 --> 00:10:22.000 We are finding people. 00:10:22.000 --> 00:10:23.000 Thinking it's as serious as what it is. 00:10:23.000 --> 00:10:27.000 So need a little bit more education in that area. 00:10:27.000 --> 00:10:30.000 The effects of medication such as side effects and the cost of 00:10:30.000 --> 00:10:34.000 medication. 00:10:34.000 --> 00:10:37.000 Not being able to attain a Ford, 00:10:37.000 --> 00:10:40.000 have transportation to go pick up things of that nature. 00:10:40.000 --> 00:10:42.000 And then the overall distrust of healthcare professionals. 00:10:42.000 --> 00:10:44.000 Especially amongst certain ethnic backgrounds. 00:10:44.000 --> 00:10:55.000 Next slide. 00:10:55.000 --> 00:10:58.000 So this is on us as healthcare providers to see where we can improve 00:10:58.000 --> 00:10:59.000 in our practice to help break down. 00:10:59.000 --> 00:11:03.000 These barriers opportunities are clearly being missed to move this 00:11:03.000 --> 00:11:04.000 initiative in the right direction. 00:11:04.000 --> 00:11:06.000 And we're going to take a peak at how we can start moving that in the 00:11:06.000 --> 00:11:07.000 right direction. 00:11:07.000 --> 00:11:08.000 Next time. 00:11:08.000 --> 00:11:10.000 Our physicians. 00:11:10.000 --> 00:11:14.000 So most hypertensive patients present with a modest elevation of blood 00:11:14.000 --> 00:11:15.000 pressure and no clinical. 00:11:15.000 --> 00:11:26.000 Cardiovascular disease or signs of hypertension. 00:11:26.000 --> 00:11:29.000 So the diagnosis of hypertension is made in the physician office 00:11:29.000 --> 00:11:30.000 setting. 00:11:30.000 --> 00:11:33.000 Usually only after an elevated and properly measured blood pressure 00:11:33.000 --> 00:11:39.000 has been confirmed on at least two separate occasions. 00:11:39.000 --> 00:11:43.000 If an elevated blood pressure is obtained it in the office. 00:11:43.000 --> 00:11:46.000 We also, like I said earlier, like to confirm with an out of office. 00:11:46.000 --> 00:11:49.000 Measurement for the second time around or another in-office visit. 00:11:49.000 --> 00:11:52.000 As long as the appropriate amount of time has passed. 00:11:52.000 --> 00:11:58.000 And going from there, we look at. 00:11:58.000 --> 00:12:01.000 Making treatment plans and really completing a thorough evaluation 00:12:01.000 --> 00:12:03.000 prior to. 00:12:03.000 --> 00:12:05.000 So prior to creating your treatment plan, 00:12:05.000 --> 00:12:09.000 positions are going to want to understand. 00:12:09.000 --> 00:12:12.000 The patient's risk factors and get general information about their 00:12:12.000 --> 00:12:15.000 health, such as eating patterns, physical activity level. 00:12:15.000 --> 00:12:19.000 And their family's health history. 00:12:19.000 --> 00:12:21.000 For most people with high blood pressure, 00:12:21.000 --> 00:12:23.000 a treatment plan for hypertension may include heart healthy lifestyle 00:12:23.000 --> 00:12:27.000 changes alone, or with medicines. 00:12:27.000 --> 00:12:30.000 So if high blood pressure is caused by another medical condition or 00:12:30.000 --> 00:12:33.000 medicine, it may improve once the cause is treated or removed. 00:12:33.000 --> 00:12:36.000 And it's thorough and accurate evaluation is most helpful when making 00:12:36.000 --> 00:12:37.000 a treatment plan. 00:12:37.000 --> 00:12:43.000 Next side. 00:12:43.000 --> 00:12:45.000 Making hypertension control a practice priority, 00:12:45.000 --> 00:13:00.000 things that we've seen. 00:13:00.000 --> 00:13:03.000 Move this initiative in the right direction can be designating a 00:13:03.000 --> 00:13:06.000 champion or lead for the practice or unit. 00:13:06.000 --> 00:13:07.000 If you are inpatient, 00:13:07.000 --> 00:13:10.000 that can always be helpful to have one person designated, 00:13:10.000 --> 00:13:12.000 to be the eyes and ears of the operation, 00:13:12.000 --> 00:13:14.000 making sure everyone knows their roles. 00:13:14.000 --> 00:13:16.000 Providing blood pressure checks without appointment. 00:13:16.000 --> 00:13:19.000 Or having designated walk-in hours or hypertensive. 00:13:19.000 --> 00:13:20.000 Clinics. 00:13:20.000 --> 00:13:26.000 Those things. 00:13:26.000 --> 00:13:27.000 You know, 00:13:27.000 --> 00:13:30.000 kind of open up the opportunity for more people to present to the 00:13:30.000 --> 00:13:32.000 clinic, maybe outside of normal operating hours. 00:13:32.000 --> 00:13:36.000 If you have office hours that are outside in the normal operating 00:13:36.000 --> 00:13:38.000 hours, opening those up to this clinic or walking. 00:13:38.000 --> 00:13:39.000 Patients. 00:13:39.000 --> 00:13:41.000 Providing blood pressure checks without copays. 00:13:41.000 --> 00:13:44.000 This could be utilized when looking at the, 00:13:44.000 --> 00:13:51.000 bringing a patient back in for a second blood pressure check to. 00:13:51.000 --> 00:13:53.000 Confirm the hypertensive diagnosis, 00:13:53.000 --> 00:13:57.000 or even if someone is struggling with being able to find the resources 00:13:57.000 --> 00:13:59.000 in their community or having at-home resources to take their blood 00:13:59.000 --> 00:14:00.000 pressure. 00:14:00.000 --> 00:14:02.000 You know, bringing them in for those checks without copay. 00:14:02.000 --> 00:14:05.000 Expanding the care team. So looking at community health workers, 00:14:05.000 --> 00:14:09.000 community pharmacists, seeing where we can improve in those areas. 00:14:09.000 --> 00:14:12.000 And then creating a standardized treatment approach, 00:14:12.000 --> 00:14:21.000 which we'll talk about in the next slide. 00:14:21.000 --> 00:14:22.000 So here at quality insights, 00:14:22.000 --> 00:14:25.000 we have worked with the American heart association to create a unique 00:14:25.000 --> 00:14:27.000 assessment tool for adopting a standardized treatment approach for 00:14:27.000 --> 00:14:29.000 improved blood pressure control. 00:14:29.000 --> 00:14:32.000 We have also collaborated with them to align the key components with 00:14:32.000 --> 00:14:37.000 the million hearts initiative. 00:14:37.000 --> 00:14:41.000 Which provides great resources to physicians, nurses, 00:14:41.000 --> 00:14:43.000 anyone with high blood pressure. It's a great resource. 00:14:43.000 --> 00:14:46.000 That's out there. 00:14:46.000 --> 00:14:49.000 So really looking at this and we did include a link here as well as in 00:14:49.000 --> 00:14:52.000 the resource slide at the end, in order for you to go in. 00:14:52.000 --> 00:14:55.000 It's a pretty simple template to be able to plug and pull information 00:14:55.000 --> 00:14:56.000 and create that template for you. 00:14:56.000 --> 00:14:57.000 Next slide. 00:14:57.000 --> 00:15:03.000 Nurses. 00:15:03.000 --> 00:15:06.000 Nurses, provide patients with educational materials, 00:15:06.000 --> 00:15:09.000 most commonly to help them understand. 00:15:09.000 --> 00:15:11.000 Hypertension and its implications. 00:15:11.000 --> 00:15:14.000 Key points are. 00:15:14.000 --> 00:15:23.000 At home blood pressure monitoring systems. 00:15:23.000 --> 00:15:25.000 Other things to mention our healthy lifestyle changes. 00:15:25.000 --> 00:15:33.000 And if they are on medication, really educating on those medications. 00:15:33.000 --> 00:15:36.000 Time of day to be taken with or without food, 00:15:36.000 --> 00:15:38.000 how we can fit those into the patient's daily routine. 00:15:38.000 --> 00:15:41.000 Those are all pretty common things that we like to educate about when. 00:15:41.000 --> 00:15:52.000 Having a new hypertensive diagnosis. 00:15:52.000 --> 00:15:56.000 Resources for these patients that nurses can provide our 00:15:56.000 --> 00:15:58.000 principal blood pressure logs at home blood pressure, cuffs, 00:15:58.000 --> 00:16:00.000 and resources on how to obtain those. 00:16:00.000 --> 00:16:02.000 If they are not able to afford them. 00:16:02.000 --> 00:16:05.000 And then behind the scenes, we do have a, 00:16:05.000 --> 00:16:09.000 a hypertension registry with some of our physician 00:16:09.000 --> 00:16:10.000 offices. 00:16:10.000 --> 00:16:11.000 That you know, 00:16:11.000 --> 00:16:14.000 Tracking the blood pressure logs that are coming in from patients at 00:16:14.000 --> 00:16:15.000 home. 00:16:15.000 --> 00:16:21.000 Promptly getting medication refills out to pharmacies. 00:16:21.000 --> 00:16:24.000 Creating a good followup system and keeping up to date educational 00:16:24.000 --> 00:16:26.000 materials on hand. 00:16:26.000 --> 00:16:27.000 For new diagnosis is in the office. 00:16:27.000 --> 00:16:35.000 Next bite. 00:16:35.000 --> 00:16:39.000 We're going to take a moment and listen to a nurse's conversation 00:16:39.000 --> 00:16:44.000 with a newly diagnosed hypertensive patient. 00:16:44.000 --> 00:16:46.000 Just see what we think, where she 00:16:46.000 --> 00:16:48.000 does things well and where she could use some improvement. 00:16:48.000 --> 00:16:50.000 So take a listen. 00:16:50.000 --> 00:16:51.000 Mr. Thomas, I received your blood pressure log. 00:16:51.000 --> 00:16:53.000 For this week. 00:16:53.000 --> 00:16:55.000 And wanting to take some time today. 00:16:55.000 --> 00:17:05.000 And your meetings with you. 00:17:05.000 --> 00:17:09.000 I understand how frustrating and your data Nazi the numbers of group. 00:17:09.000 --> 00:17:11.000 Let's start by going through your daily routine. And from this week, 00:17:11.000 --> 00:17:14.000 It looks like they usually take your blood pressure around 80. 00:17:14.000 --> 00:17:24.000 Every day, is that correct? 00:17:24.000 --> 00:17:33.000 My blood pressure. 00:17:33.000 --> 00:17:35.000 It's a great first step. 00:17:35.000 --> 00:17:44.000 Can you tell me about your assets? 00:17:44.000 --> 00:17:49.000 Really timely. 00:17:49.000 --> 00:17:51.000 Are you making sure to follow the directions on how to. 00:17:51.000 --> 00:17:58.000 The most accurately take your blood pressure. 00:17:58.000 --> 00:18:00.000 And the packet of information the nurse gave you. 00:18:00.000 --> 00:18:01.000 There was an instructional gauge. 00:18:01.000 --> 00:18:03.000 Things to do and not to do when taking your blood pressure. 00:18:03.000 --> 00:18:07.000 Do you have that page? 00:18:07.000 --> 00:18:11.000 With you to review with me. 00:18:11.000 --> 00:18:16.000 No. 00:18:16.000 --> 00:18:19.000 It's very important to make sure you were following these instructions 00:18:19.000 --> 00:18:20.000 when taking your blood pressure. 00:18:20.000 --> 00:18:21.000 This washer, 00:18:21.000 --> 00:18:23.000 we are getting the most accurate results so we can compare. 00:18:23.000 --> 00:18:25.000 And make informed decisions moving forward. 00:18:25.000 --> 00:18:26.000 If we don't have accurate numbers. 00:18:26.000 --> 00:18:28.000 We can't make the beds. 00:18:28.000 --> 00:18:30.000 It's treatment decisions because technically we'll be guessing. 00:18:30.000 --> 00:18:51.000 To inaccuracy. 00:18:51.000 --> 00:18:54.000 As you can see those factors can raise your blood pressure results. 00:18:54.000 --> 00:18:57.000 And that also explains why your blood pressure machine was cycling so 00:18:57.000 --> 00:18:59.000 many times. 00:18:59.000 --> 00:19:00.000 If you're doing everything right, 00:19:00.000 --> 00:19:06.000 the machine should give you a results after the first tape. 00:19:06.000 --> 00:19:09.000 I know it's an adjustment, but. 00:19:09.000 --> 00:19:10.000 Once you get in the habit of doing these things regularly. 00:19:10.000 --> 00:19:12.000 It will become second nature to you. 00:19:12.000 --> 00:19:14.000 I've always heard. 00:19:14.000 --> 00:19:21.000 In any way I can, along the way. 00:19:21.000 --> 00:19:23.000 How can I give you a call in a few days to check in again and see how 00:19:23.000 --> 00:19:26.000 your results are looking now that we know your results will be more 00:19:26.000 --> 00:19:34.000 accurate? 00:19:34.000 --> 00:19:35.000 And so after listening, 00:19:35.000 --> 00:19:38.000 you can tell she picked up on cues about inaccuracy and made sure to 00:19:38.000 --> 00:19:40.000 bring around those important education pieces. 00:19:40.000 --> 00:19:42.000 In the packet that they worked so hard on for their patients to follow 00:19:42.000 --> 00:19:43.000 at home. 00:19:43.000 --> 00:19:46.000 She developed a quick turnaround time to follow up so that the patient 00:19:46.000 --> 00:19:48.000 wasn't lost to follow-up. 00:19:48.000 --> 00:19:50.000 She gave him credit where credit was due when he was going through the 00:19:50.000 --> 00:19:51.000 correct processes. 00:19:51.000 --> 00:19:55.000 And she encouraged and supported him when he was frustrated. 00:19:55.000 --> 00:19:57.000 Which can be the most challenging tasks sometimes. 00:19:57.000 --> 00:20:03.000 Next slide. 00:20:03.000 --> 00:20:07.000 This is one of quality insights, resources. 00:20:07.000 --> 00:20:25.000 As was mentioned in the previous slide, in the. 00:20:25.000 --> 00:20:26.000 The clip that we played, 00:20:26.000 --> 00:20:30.000 this provides very helpful information on tips 00:20:30.000 --> 00:20:31.000 to get an accurate blood pressure. 00:20:31.000 --> 00:20:33.000 Readings is a nice handout to provide to patients, 00:20:33.000 --> 00:20:35.000 to remind them of things that can get the most, 00:20:35.000 --> 00:20:36.000 the most accurate reading. 00:20:36.000 --> 00:20:38.000 And this is again, 00:20:38.000 --> 00:20:41.000 included in the resources side at the end. 00:20:41.000 --> 00:20:42.000 Next slide. 00:20:42.000 --> 00:20:45.000 So we know healthcare professionals already play a critical role in 00:20:45.000 --> 00:20:52.000 reducing heart disease and preventing stroke in the United States. 00:20:52.000 --> 00:20:53.000 But more can be done. 00:20:53.000 --> 00:20:56.000 Pharmacists specifically have a unique opportunity to have an effect 00:20:56.000 --> 00:21:01.000 on outcomes associated with heart disease and stroke. 00:21:01.000 --> 00:21:05.000 And so community community pharmacists can help by being proactive in 00:21:05.000 --> 00:21:08.000 identifying the needs of their patients and taking action to influence 00:21:08.000 --> 00:21:11.000 healthy behaviors. 00:21:11.000 --> 00:21:14.000 Pharmacist can also also have a positive effect on their local 00:21:14.000 --> 00:21:18.000 population by creating community awareness about heart disease and 00:21:18.000 --> 00:21:22.000 stroke. 00:21:22.000 --> 00:21:25.000 Providing patient centered care services, 00:21:25.000 --> 00:21:28.000 such as encouraging lifestyle modifications and self-management and 00:21:28.000 --> 00:21:31.000 counseling. Those who are not adhering to prescribed drug treatments. 00:21:31.000 --> 00:21:33.000 Helping patients take their medications correctly. 00:21:33.000 --> 00:21:36.000 And screening for uncontrolled and undiagnosed high blood pressure. 00:21:36.000 --> 00:21:43.000 Pharmacists are encouraged to partner with our state or local. 00:21:43.000 --> 00:21:46.000 Health departments, community health workers, doctors, 00:21:46.000 --> 00:21:47.000 and other healthcare professionals, 00:21:47.000 --> 00:21:49.000 to understand the prevalence of high blood pressure in their 00:21:49.000 --> 00:21:50.000 communities. 00:21:50.000 --> 00:21:58.000 And to learn how to help people manage this condition. 00:21:58.000 --> 00:22:01.000 Because of their combined combination of access skills and services, 00:22:01.000 --> 00:22:04.000 pharmacists are uniquely positioned and qualified to respond to the 00:22:04.000 --> 00:22:05.000 health needs of their communities. 00:22:05.000 --> 00:22:06.000 Next slide. 00:22:06.000 --> 00:22:12.000 And so. 00:22:12.000 --> 00:22:14.000 Working with the whole collaborative team. 00:22:14.000 --> 00:22:16.000 We want to make sure that when we are creating a plan, 00:22:16.000 --> 00:22:19.000 we're keeping it simple, simple as the acronym. 00:22:19.000 --> 00:22:20.000 I'm seeing on this screen. 00:22:20.000 --> 00:22:41.000 S this per simplify, the regimen. 00:22:41.000 --> 00:22:45.000 We're wanting to make sure that we're working on encouraging patients 00:22:45.000 --> 00:22:49.000 to use adherence tools like the days of the week pill boxes or mobile 00:22:49.000 --> 00:22:51.000 applications that are available nowadays, 00:22:51.000 --> 00:22:55.000 and also to match the actions of their medication regimen with their 00:22:55.000 --> 00:22:57.000 daily routine. For example, 00:22:57.000 --> 00:22:58.000 taking medications with certain meals. 00:22:58.000 --> 00:23:01.000 Or at bedtime and with other medications, 00:23:01.000 --> 00:23:03.000 if there are you taking those ones properly. 00:23:03.000 --> 00:23:05.000 I is for imparting knowledge. 00:23:05.000 --> 00:23:08.000 And so that is doing education with medication. 00:23:08.000 --> 00:23:12.000 So writing down prescription instructions clearly and reinforcing them 00:23:12.000 --> 00:23:13.000 verbally. 00:23:13.000 --> 00:23:15.000 And providing resources for additional reading. 00:23:15.000 --> 00:23:18.000 M is for modifying patient's beliefs and behavior. 00:23:18.000 --> 00:23:21.000 So providing positive reinforcement when patients are taking 00:23:21.000 --> 00:23:22.000 medications correctly. 00:23:22.000 --> 00:23:25.000 Making those healthy lifestyle changes and offering incentives if 00:23:25.000 --> 00:23:36.000 possible. 00:23:36.000 --> 00:23:38.000 P is for providing communication and trust. 00:23:38.000 --> 00:23:40.000 And this allows patients to speak freely. 00:23:40.000 --> 00:23:41.000 Time is really of the essence. 00:23:41.000 --> 00:23:44.000 But research is showing that most patients will talk no longer than 00:23:44.000 --> 00:23:46.000 two minutes when given the opportunity. 00:23:46.000 --> 00:23:48.000 So using plain language when talking with patients instead of. 00:23:48.000 --> 00:23:52.000 Prompting them with specific questions, maybe. 00:23:52.000 --> 00:23:55.000 Avoiding the word adherence and asking, 00:23:55.000 --> 00:23:58.000 did you take all of your pills instead of asking if they are adherent 00:23:58.000 --> 00:23:59.000 with taking their pills? 00:23:59.000 --> 00:24:01.000 And then also asking for the patient's input when discussing 00:24:01.000 --> 00:24:17.000 recommendations and changes. 00:24:17.000 --> 00:24:19.000 L is for leaving the bias. 00:24:19.000 --> 00:24:22.000 So understanding the predictors of nonadherence and addressing them as 00:24:22.000 --> 00:24:26.000 needed with patients and E is for 00:24:26.000 --> 00:24:27.000 evaluate adherence. 00:24:27.000 --> 00:24:30.000 So asking patients simply and directly when they are sticking to their 00:24:30.000 --> 00:24:31.000 drug regimen. 00:24:31.000 --> 00:24:33.000 You could also use a scale. 00:24:33.000 --> 00:24:34.000 From zero to 10. 00:24:34.000 --> 00:24:36.000 To see what their adherence level is that way. 00:24:36.000 --> 00:24:39.000 And the million hearts website is a great tool for even more 00:24:39.000 --> 00:24:40.000 resources. 00:24:40.000 --> 00:24:43.000 Next slide. 00:24:43.000 --> 00:24:45.000 So over the past couple of years, 00:24:45.000 --> 00:24:48.000 many of us weren't seeing the doctor regularly due to employment 00:24:48.000 --> 00:24:50.000 issues, homeschooling financial hardships. 00:24:50.000 --> 00:24:52.000 And even the fear of catching COVID. 00:24:52.000 --> 00:24:55.000 In the very place that was being diagnosed and treated. 00:24:55.000 --> 00:24:58.000 A report last year from the journal of American medicine, 00:24:58.000 --> 00:25:02.000 back to this up. 00:25:02.000 --> 00:25:05.000 Researchers found that 41% of people surveyed skipped medical care in 00:25:05.000 --> 00:25:07.000 the early months of 2020. 00:25:07.000 --> 00:25:08.000 Here are the reasons why. 00:25:08.000 --> 00:25:10.000 63% Said their doctor's office was closed. 00:25:10.000 --> 00:25:13.000 Temporarily or permanently. 00:25:13.000 --> 00:25:17.000 57% Were worried about catching COVID 19. 00:25:17.000 --> 00:25:29.000 7% Could not pay for services. 00:25:29.000 --> 00:25:31.000 Respondents reported skipping care for just about everything from 00:25:31.000 --> 00:25:34.000 annual wellness exams to treatment for new serious conditions, 00:25:34.000 --> 00:25:37.000 including preventative care outpatient. 00:25:37.000 --> 00:25:38.000 Medical appointments. 00:25:38.000 --> 00:25:41.000 One or more doses of prescription medications, elective surgery. 00:25:41.000 --> 00:25:43.000 Outpatient mental health appointments. 00:25:43.000 --> 00:25:48.000 New severe mental or physical health issues. 00:25:48.000 --> 00:25:59.000 And among other reasons, but those are really the most important ones. 00:25:59.000 --> 00:26:02.000 And so now as COVID cases are, 00:26:02.000 --> 00:26:06.000 are better handled and better understood and more and more 00:26:06.000 --> 00:26:09.000 information is coming out. 00:26:09.000 --> 00:26:11.000 We are starting to see those restrictions ease. 00:26:11.000 --> 00:26:14.000 And it's more important now than ever to get back on track with your 00:26:14.000 --> 00:26:17.000 health and wellness. So promoting those. 00:26:17.000 --> 00:26:18.000 Annual wellness visits. 00:26:18.000 --> 00:26:24.000 Next slide. 00:26:24.000 --> 00:26:27.000 The annual wellness visit was introduced in 2011 by Medicare and made 00:26:27.000 --> 00:26:30.000 available to all eligible benefit beneficiaries without deductibles or 00:26:30.000 --> 00:26:31.000 copays. 00:26:31.000 --> 00:26:35.000 So there is a list of required components that prioritize preventative 00:26:35.000 --> 00:26:36.000 care. 00:26:36.000 --> 00:26:41.000 And helps us to invest in the relationship with our patient. 00:26:41.000 --> 00:26:44.000 And includes assessing risks, risk factors, inquiring about care, 00:26:44.000 --> 00:26:47.000 support, creating a personalized care plan. 00:26:47.000 --> 00:26:50.000 And educating beneficiaries on how to maintain their health outside of 00:26:50.000 --> 00:26:55.000 an acute illness episode. 00:26:55.000 --> 00:26:58.000 And notably the only physical examinations required of the visit are 00:26:58.000 --> 00:27:01.000 blood pressure measurement and height and weight measurement for BMI. 00:27:01.000 --> 00:27:03.000 One of the most important doctor's appointments you can make is your 00:27:03.000 --> 00:27:11.000 annual wellness exam. 00:27:11.000 --> 00:27:13.000 Yes. It's an appointment to make and keep, 00:27:13.000 --> 00:27:14.000 even when you're feeling good. 00:27:14.000 --> 00:27:17.000 And that's because your annual physical gives you the opportunity to 00:27:17.000 --> 00:27:18.000 check in with your doctors. 00:27:18.000 --> 00:27:21.000 You can discuss anything new or concerning symptoms. 00:27:21.000 --> 00:27:24.000 And stay up to date on any necessary health screenings based on your 00:27:24.000 --> 00:27:26.000 age and risk factors. 00:27:26.000 --> 00:27:27.000 And most importantly, 00:27:27.000 --> 00:27:30.000 your well-check doesn't just cover your physical health. 00:27:30.000 --> 00:27:32.000 Your doctor will check on your whole health, including mental, 00:27:32.000 --> 00:27:39.000 physical, and emotional. 00:27:39.000 --> 00:27:53.000 We do have a little video here. 00:27:53.000 --> 00:28:03.000 Let's talk about cars. 00:28:03.000 --> 00:28:08.000 We all. 00:28:08.000 --> 00:28:18.000 That way. 00:28:18.000 --> 00:28:23.000 Your body helps you get around. 00:28:23.000 --> 00:28:26.000 How about your body? 00:28:26.000 --> 00:28:28.000 One reason we take care of our cars. 00:28:28.000 --> 00:28:35.000 To avoid expensive repairs later. 00:28:35.000 --> 00:28:38.000 That is why Medicare offers. 00:28:38.000 --> 00:28:40.000 Out of pocket. 00:28:40.000 --> 00:28:43.000 100%. 00:28:43.000 --> 00:28:44.000 The annual wellness visit. 00:28:44.000 --> 00:28:46.000 It's covered every 12 months. 00:28:46.000 --> 00:28:49.000 To help you stay healthy. 00:28:49.000 --> 00:28:52.000 All the medications. 00:28:52.000 --> 00:28:54.000 Vitamins and supplements you're taking. 00:28:54.000 --> 00:28:56.000 Some of the doctor's office can update your records. 00:28:56.000 --> 00:28:59.000 This visit helps your doctor. 00:28:59.000 --> 00:29:01.000 Identify any health risks you may have. 00:29:01.000 --> 00:29:03.000 It allows your doctor to work with. 00:29:03.000 --> 00:29:07.000 To develop a plan to address your healthcare needs. 00:29:07.000 --> 00:29:10.000 Wellness visit. It's not just a yearly checkup. 00:29:10.000 --> 00:29:11.000 It is a time when your doctor. 00:29:11.000 --> 00:29:13.000 Provides you with personalized health advice. 00:29:13.000 --> 00:29:18.000 I put together a plan. 00:29:18.000 --> 00:29:25.000 You helping to take care of your car? 00:29:25.000 --> 00:29:28.000 Wash it you'll get an annual inspection. 00:29:28.000 --> 00:29:30.000 Shouldn't you do all of these things for your body to. 00:29:30.000 --> 00:29:31.000 Let's review. 00:29:31.000 --> 00:29:33.000 Medicare annual wellness visit. 00:29:33.000 --> 00:29:37.000 Chance to create a personalized. 00:29:37.000 --> 00:29:39.000 And best of all Medicare covers. 00:29:39.000 --> 00:29:40.000 A hundred percent of the costs. 00:29:40.000 --> 00:29:42.000 Annual wellness visit. 00:29:42.000 --> 00:29:44.000 So, what are you waiting for? Call. 00:29:44.000 --> 00:29:47.000 Call your doctor's office today. 00:29:47.000 --> 00:30:12.000 So your annual wellness visit. 00:30:12.000 --> 00:30:15.000 So the annual wellness visit is an important service for achieving the 00:30:15.000 --> 00:30:18.000 quadruple aim of healthcare, which has increased quality, lower cost, 00:30:18.000 --> 00:30:21.000 patient experience and provider experience. 00:30:21.000 --> 00:30:24.000 And so the bottom line is that a 30 minute appointment can go a long 00:30:24.000 --> 00:30:26.000 way in improving wellness and wellbeing. 00:30:26.000 --> 00:30:30.000 Next slide. 00:30:30.000 --> 00:30:33.000 So the annual wellness visits are usually conducted by a primary care 00:30:33.000 --> 00:30:37.000 physician. 00:30:37.000 --> 00:30:40.000 And entails a series of questions to understand the patient's health 00:30:40.000 --> 00:30:42.000 history and what future care will be needed. 00:30:42.000 --> 00:30:45.000 It results in a care plan. 00:30:45.000 --> 00:30:46.000 That documents, 00:30:46.000 --> 00:30:48.000 what the patient will need for the remainder of the year, 00:30:48.000 --> 00:30:51.000 based on current health and underlying risk factors. 00:30:51.000 --> 00:30:52.000 And for qualified individuals, 00:30:52.000 --> 00:30:56.000 the cost of the annual wellness visit is 100% covered. 00:30:56.000 --> 00:31:04.000 Once every 12 months as are many specific preventative services. 00:31:04.000 --> 00:31:11.000 I think. 00:31:11.000 --> 00:31:12.000 The, 00:31:12.000 --> 00:31:15.000 the numbers on this screen can cause some frustration amongst 00:31:15.000 --> 00:31:19.000 healthcare workers. 00:31:19.000 --> 00:31:22.000 Annual wellness visits remained vastly under utilized, 00:31:22.000 --> 00:31:25.000 especially among the high risk groups that we want to be utilizing 00:31:25.000 --> 00:31:27.000 those programs. 00:31:27.000 --> 00:31:31.000 8.1% Of all Medicare beneficiaries utilize the annual 00:31:31.000 --> 00:31:33.000 wellness visit in 2020. 00:31:33.000 --> 00:31:45.000 Compared to. 00:31:45.000 --> 00:31:47.000 20 20 16, 00:31:47.000 --> 00:31:51.000 where 23% of all Medicare beneficiaries had a wellness 00:31:51.000 --> 00:31:54.000 visit. And just before coat. 00:31:54.000 --> 00:31:57.000 So we started it in 2016. We were at 23%. 00:31:57.000 --> 00:32:00.000 2019, we dropped to 19% and then 2020, 00:32:00.000 --> 00:32:03.000 right in the middle of the pandemic, we were at 8.1%. 00:32:03.000 --> 00:32:06.000 So really looking to get those numbers back up, 00:32:06.000 --> 00:32:07.000 especially now with. 00:32:07.000 --> 00:32:10.000 COVID kind of lifting all those restrictions 00:32:10.000 --> 00:32:12.000 and getting back to a new normal. 00:32:12.000 --> 00:32:16.000 Next week. 00:32:16.000 --> 00:32:18.000 So come on in, we're open most, 00:32:18.000 --> 00:32:21.000 if not all businesses are back to business as usual. 00:32:21.000 --> 00:32:25.000 Or a new usual as we are putting it. 00:32:25.000 --> 00:32:29.000 Really encouraging patients to get back into the office to do the most 00:32:29.000 --> 00:32:33.000 accuracy screenings. 00:32:33.000 --> 00:32:35.000 Put a set of eyes on patients, you know, 00:32:35.000 --> 00:32:39.000 being there in front of you is the most important. 00:32:39.000 --> 00:32:42.000 And if that is not possible, then always utilizing that telemedicine, 00:32:42.000 --> 00:32:43.000 if that is available as well. 00:32:43.000 --> 00:32:46.000 Next screen. 00:32:46.000 --> 00:32:55.000 Since our abundance of resources from this presentation. 00:32:55.000 --> 00:32:58.000 Quality insights is also putting together and sending out a toolkit 00:32:58.000 --> 00:33:01.000 for providers who want more resources and to help improve the quality 00:33:01.000 --> 00:33:02.000 of care for patients. 00:33:02.000 --> 00:33:04.000 So please reach out to us if you're interested in these toolkits. 00:33:04.000 --> 00:33:07.000 And any resources, quality insights has for you. 00:33:07.000 --> 00:33:09.000 Let's pitch. 00:33:09.000 --> 00:33:20.000 And this is our references. 00:33:20.000 --> 00:33:25.000 Mitzi, I'll send it back to you for the evaluation. 00:33:25.000 --> 00:33:31.000 All right. Thanks so much internet. 00:33:31.000 --> 00:33:33.000 Just a reminder to everyone. 00:33:33.000 --> 00:33:42.000 If you would like to receive continuing education, just please. 00:33:42.000 --> 00:33:45.000 Fill out the evaluation and reflective questions at the end of this 00:33:45.000 --> 00:33:46.000 webinar, when the, 00:33:46.000 --> 00:33:48.000 when the webinar concludes you'll be directed to this survey survey 00:33:48.000 --> 00:33:50.000 monkey link, or you can. 00:33:50.000 --> 00:33:54.000 Use your smartphone to scan the QR code to get to that link as well. 00:33:54.000 --> 00:33:56.000 So at this time, if you have any questions for Antoinette, 00:33:56.000 --> 00:33:59.000 I just encourage you to go ahead and enter those into the chat or to 00:33:59.000 --> 00:34:00.000 the Q and a. 00:34:00.000 --> 00:34:01.000 Let's see. 00:34:01.000 --> 00:34:07.000 The first I see a question asking. 00:34:07.000 --> 00:34:10.000 Should I advise my patients to get the COVID 19 vaccine. 00:34:10.000 --> 00:34:12.000 If they have hypertension. 00:34:12.000 --> 00:34:16.000 My answer to that is going to be yes. 00:34:16.000 --> 00:34:17.000 When it comes to getting vaccinated, 00:34:17.000 --> 00:34:21.000 the benefits far outweigh the risks for people with cardiovascular 00:34:21.000 --> 00:34:23.000 issues. 00:34:23.000 --> 00:34:24.000 As a side note, 00:34:24.000 --> 00:34:27.000 you are advised to take your blood pressure medications before going 00:34:27.000 --> 00:34:29.000 to your vaccination appointment. 00:34:29.000 --> 00:34:33.000 Especially if you have cardiovascular complications, like chest pain, 00:34:33.000 --> 00:34:34.000 angina. 00:34:34.000 --> 00:34:37.000 Other things like that. 00:34:37.000 --> 00:34:44.000 Okay. 00:34:44.000 --> 00:34:46.000 Another question asks, 00:34:46.000 --> 00:34:51.000 who should we reach out to for toolkits that you mentioned previously? 00:34:51.000 --> 00:34:53.000 How you can reach out to myself. 00:34:53.000 --> 00:34:56.000 My email address is listed on the page right in front of you. 00:34:56.000 --> 00:34:57.000 Ah, that's a Murphy at quality insights. 00:34:57.000 --> 00:35:01.000 Or. 00:35:01.000 --> 00:35:03.000 We're going to be keeping track of who is interested in that 00:35:03.000 --> 00:35:11.000 information and get it out to you as soon as it is released. 00:35:11.000 --> 00:35:12.000 And like I said, 00:35:12.000 --> 00:35:16.000 there was information on one of the previous slides for some 00:35:16.000 --> 00:35:28.000 of the resources that were already in this presentation. 00:35:28.000 --> 00:35:29.000 And just as a reference, 00:35:29.000 --> 00:35:32.000 the slides as well as a recording of today's presentation will be 00:35:32.000 --> 00:35:35.000 available on our website here within the next few days. 00:35:35.000 --> 00:35:39.000 So you can access that information as well through our website. 00:35:39.000 --> 00:35:42.000 I'm looking to see if we have any other questions at this point. 00:35:42.000 --> 00:35:45.000 And we do have some comments saying that people enjoyed the 00:35:45.000 --> 00:35:46.000 presentation. 00:35:46.000 --> 00:35:54.000 Okay. Here's a question. 00:35:54.000 --> 00:35:57.000 When taking blood pressure of patients in bed, 00:35:57.000 --> 00:36:01.000 would you say it's best to reposition them to semi fellers 00:36:01.000 --> 00:36:02.000 first? 00:36:02.000 --> 00:36:03.000 I would say that when taking blood pressure in bed, 00:36:03.000 --> 00:36:08.000 making sure that they're sitting upright. 00:36:08.000 --> 00:36:10.000 Is probably best. 00:36:10.000 --> 00:36:12.000 So you're not going to want to make sure they're inclined. 00:36:12.000 --> 00:36:13.000 You're want to set them up at that 90 degree level, 00:36:13.000 --> 00:36:14.000 if at all possible. 00:36:14.000 --> 00:36:17.000 And making sure that they haven't. 00:36:17.000 --> 00:36:26.000 You know, if, if moving them is causing, you know, exertion. 00:36:26.000 --> 00:36:28.000 On their behalf, you know, 00:36:28.000 --> 00:36:32.000 giving them the appropriate time to rest after moving them or having 00:36:32.000 --> 00:36:34.000 them sit up just so that the exertion. 00:36:34.000 --> 00:36:36.000 Isn't playing a factor into the blood pressure being raised. 00:36:36.000 --> 00:36:43.000 You're welcome. 00:36:43.000 --> 00:36:48.000 Okay. 00:36:48.000 --> 00:36:54.000 I'm seeing no other questions at this time. 00:36:54.000 --> 00:36:56.000 Antoinette. Do you have any closing remarks? And again, 00:36:56.000 --> 00:36:59.000 I just want to say thank you for providing us with this information 00:36:59.000 --> 00:37:00.000 today. 00:37:00.000 --> 00:37:01.000 You're welcome. 00:37:01.000 --> 00:37:04.000 Thank you all for being in attendance and taking time out of your day. 00:37:04.000 --> 00:37:20.000 Great. 00:37:20.000 --> 00:37:21.000 If there's no other questions, 00:37:21.000 --> 00:37:24.000 we will give you the rest of your hour back. And again, 00:37:24.000 --> 00:37:27.000 Antoinette's contact information is available on the screen. 00:37:27.000 --> 00:37:30.000 Please consider taking our evaluation and answering the reflective 00:37:30.000 --> 00:37:31.000 questions. 00:37:31.000 --> 00:37:32.000 And tune into our website. 00:37:32.000 --> 00:37:35.000 If you'd like to see a recording of this webinar or access the 00:37:35.000 --> 00:37:36.000 presentation slides.