Abstract
TITLE: Improving the Practice of Measuring Lying and Standing Blood Pressure Among Nursing Staff at a District General Hospital
INTRODUCTION:
Postural hypotension is a significant cause of morbidity in the frail and older population, contributing to falls and related injuries. Accurate measurement of lying and standing blood pressure (LSBP) is essential for identifying patients at risk. This quality improvement project (QIP) aimed to address gaps in LSBP measurement practices among nursing staff by aligning them with Royal College of Physicians (RCP) guidelines. The project sought to raise awareness and improve the accuracy of these measurements, thereby enhancing patient care and safety.
METHODS:
Baseline data was collected from patient notes to assess the accuracy of documented LSBP readings. Additionally, a survey was conducted to evaluate nursing staff’s knowledge of postural hypotension and their interest in further education on the topic. In response, RCP posters detailing correct LSBP measurement techniques were displayed across the wards. Information about these resources was disseminated among the Geriatrics Department, including nurses, junior doctors, registrars, and consultants, and introduced during junior doctors' teaching sessions. To reinforce the practice, placards with measurement reminders were attached to all observation machines. Awareness sessions were concurrently conducted during PDSA cycles to ensure continuous staff engagement and understanding.
RESULTS:
Following two intervention cycles, there was a 50% increase in adherence to the standing BP measurement protocol. Pre-intervention, 66% of respondents were aware of the correct LSBP measurement process, which increased to 100% post-intervention. Additionally, 83% reported knowing where to access further resources on postural hypotension, compared to 44% pre-intervention levels.
CONCLUSION:
The sustained improvement in LSBP measurement compliance demonstrates the effectiveness of multi-faceted interventions, including education, visual prompts, and training. These efforts have facilitated a culture shift in patient management and are expected to improve patient outcomes.
The introduction of a standardised documentation proforma for LSBP measurement is anticipated to further support long-term improvements in this practice.