INVESTIGATION AND MANAGEMENT OF POSTURAL HYPOTENSION – A Quality Improvement Project

INTRODUCTION 
 
Postural hypotension (PH) is an identifiable and potentially reversible cause of falls in the elderly patients admitted to hospital. The National Audit of Inpatient Falls recommends lying and standing blood pressure (LSBP) measurement for patients aged over 65. Our project aims to review current clinical practice and to develop a standardised approach to correctly investigate and manage PH in patients admitted following a fall to the geriatric department.
 
METHOD: 
 
We performed two cycles of retrospective data collection across three geriatric wards, looking at percentage of patients investigated for PH and the use of correct technique for LSBP measurements as recommended by the Royal College of Physicians (RCP) guidelines.

Between cycles, formal and informal educational strategies were implemented and the RCP LSBP measurement guidelines were displayed on doctors’ noticeboards and blood pressure monitoring devices. A PH sticker was designed to ensure correct technique was used and documented.
 
RESULTS:  
 
Following the interventions, the percentage of patients who had LSBP measurements performed improved from 28% to 96% [p<0.00001(X2 test)]. Introduction of the PH stickers improved use of correct technique from 12% to 37.5%. Performance and documentation of medication reviews for patients diagnosed with postural hypotension improved from 0% to 87.5% and lifestyle advice given and documented improved from 0% to 37.5%.  
 
CONCLUSIONS: 
 
Our study highlighted the need for further training on investigation and management of PH. Our results demonstrate that educational interventions and a standardised sticker to ensure clear documentation can significantly improve diagnosis of PH. The sticker and a patient advice leaflet have been approved by the local Falls Prevention Team and are now being processed by the Documents Control Team for official usage across all three Mid and South Essex sites.