Abstract
Introduction:
Orthostatic hypotension (OH) is common in both community dwelling and hospitalised older adults. It is associated with significant morbidity, falls and all cause mortality. A spot audit of inpatients across all care of the elderly wards in Gloucester Royal Hospital and Cheltenham General Hospital revealed only 67% of appropriate patients where having documented lying and standing blood pressure measurements. Of those with documented orthostatic hypotension 44% had no documented action plan.
Methods:
Using quality improvement methodology this project aimed to achieve 100% of appropriate patients having a documented lying and standing blood pressure when admitted to a care of the elderly ward. Patients identified to have orthostatic hypotension should have this recorded in their working diagnosis with a documented action plan. Change ideas were implemented using the plan, do, study, act (PDSA) framework initially looking at recognition of OH and subsequently management of patients identified to have OH. Outcome measures included prevalence of OH in the inpatient population and inpatient falls rates. Process measures included percentage of patients with documented lying and standing blood pressure, percentage of patients with confirmed OH documented in their working diagnosis and percentage of patients with confirmed OH having a documented management strategy.
Results:
Following the first PDSA cycle the project demonstrated increased number of patients having a recorded lying and standing blood pressure, however following the second cycle a sustained increase was not seen. A third PDSA cycle is underway involving MDT education.
Conclusion:
Baseline data confirmed that in the elderly inpatient population orthostatic hypotension was both under diagnosed and under treated. Ensuring sustained change remains a challenge due to staff turnover and rotational working. Further work is ongoing to increase recognition and treatment of OH.