Elements Protocol includes preassessment tools, checklists, and metrics to assess gaps in care. Certification of staff in correct BP measurement skills. Recommended Protocol 2017 Hypertension Clinical Practice Guidelines.4 Blood Pressure Assessment in Adults in Clinical Practice and Clinic-Based Research.133 Documentation Documenting the implementing protocols may impose additional burdens on HCOs. Potential options to consider: Attestation, self-reported information External auditor/rater Competency testing Rationale Accurate measurement and recording of BP are essential to categorize level of BP, ascertain BP-related ASCVD risk, and guide management of high BP. Office BP measurement is often unstandardized, despite the well-known consequences of inaccurate measurement. Errors are common and can result in a misleading estimation of an individual s true level of BP if staff are not trained and a protocol is not followed. The use of automated office BP measurements should be considered as part of the protocol for accurate measurement.134 Checklist for Accurate Measurement of BP135,136 Key Steps for Proper BP Measurements Specific Instructions: Step 1: Properly prepare the patient 1. Have the patient relax, sitting in a chair (feet on floor, back supported) for >5 min. 2. The patient should avoid caffeine, exercise, and smoking for at least 30 min before measurement. 3. Ensure patient has emptied his/her bladder. 4. Neither the patient nor the observer should talk during the rest period or during the measurement. 5. Remove all clothing covering the location of cuff placement. 6. Measurements made while the patient is sitting or lying on an examining table do not fulfill these criteria. Step 2: Use proper technique for BP measurements 1. Use a BP measurement device that has been validated, and ensure that the device is calibrated periodically. 2. Support the patient s arm (eg, resting on a desk). 3. 