Clinical audit on blood pressure measurement practices using the simple app in primary care institutions under the regional director of health services, Colombo, Sri Lanka

Accurate blood pressure measurement is essential for reliable diagnosis of hypertension, treatment monitoring, and quality improvement in primary care. This clinical audit assessed adherence to standard blood pressure measurement and documentation practices among healthcare personnel using the Simple App in selected primary care institutions under the Regional Director of Health Services, Colombo, Sri Lanka. A descriptive clinical audit was conducted from August to October 2025 using a structured observation checklist based on national hypertension guidance and accepted blood pressure measurement principles. A total of 185 observations were assessed across 15 measurement and documentation components, generating 2,775 component-level fields. Overall adherence was 65.19%, with 1,809 components performed according to the audit criteria. High adherence was observed for correct cuff size, forearm support, mid-arm positioning at heart level, and correct documentation, each at 99.5%. Use of a validated digital blood pressure meter was observed in 90.3% of measurements. Major gaps were identified in the inquiry about recent smoking, exercise, or coffee intake (0.5%), inquiry about empty bladder (0.0%), taking two measurements from both arms (0.0%), provision of proper back support (24.9%), and allowing 3 to 5 minutes of seated rest before measurement (51.9%). Facility adherence ranged from 53.07% to 76.86%. The audit shows that documentation and several technical steps were strong, but patient preparation, repeat measurement, and clinic environment require targeted quality improvement