Reduction of Wrong-Limb Blood Pressure Cuff Placement Attempts With a High-Visibility Limb Alert Sleeve: A Randomized Crossover Simulation Study.

backgroundWrong-limb blood pressure (BP) measurement is a persistent and preventable clinical error, particularly in patients with limb restrictions such as arteriovenous fistulas, post-mastectomy status, or vascular compromise. Despite documentation in electronic medical records, adherence to limb alerts remains inconsistent, placing patients at risk for complications including fistula thrombosis, lymphedema exacerbation, and vascular injury. Reliance on chart review alone may be insufficient in fast-paced clinical environments. This study evaluated whether a high-visibility limb alert sleeve could improve adherence to limb restrictions and reduce wrong-limb BP cuff placement attempts.

methodsWe conducted a randomized, within-subject crossover simulation study involving 50 clinical staff members, including nurses and ancillary personnel, recruited from inpatient, intensive care unit, surgical, and emergency department settings. Each participant completed both the chart-only and sleeve-present study conditions and therefore served as their own control. Participants obtained vital signs during two simulated patient encounters under different study conditions: (1) chart-only, in which limb restrictions were documented solely within the patient chart, and (2) sleeve-present, in which a high-visibility limb alert sleeve was placed on the restricted arm in addition to chart documentation. The order of conditions was randomized to minimize learning effects. The primary outcome was the rate of wrong-limb BP cuff placement attempts. Secondary outcomes included spontaneous recognition and correction of incorrect initial attempts. Paired statistical analysis was performed using McNemar's test, with significance defined as p < 0.05.

resultsWrong-limb BP cuff placement attempts occurred in 30 of 50 encounters (60%) in the chart-only condition compared with one of 50 encounters (2%) in the sleeve-present condition (p < 0.0001). The paired absolute reduction in wrong-limb BP cuff placement attempts associated with the sleeve-present condition was 58.0% (95% CI: 44.3%-71.7%). The single incorrect attempt observed in the sleeve-present condition was recognized and corrected prior to cuff inflation.

conclusionsIn this simulated clinical study, high-visibility limb alert sleeves significantly reduced wrong-limb BP cuff placement attempts compared with chart-based documentation alone. By providing an immediate visual cue at the point of care, the intervention may help address an important gap in recognition of limb restrictions during routine clinical workflow. Given its straightforward design and visibility at the point of care, the limb alert sleeve may represent a practical strategy to reduce preventable wrong-limb BP cuff placement attempts in patients with limb restrictions. Further studies in real-world clinical settings are warranted to confirm these findings and evaluate long-term effectiveness across broader patient populations.