Abstract
Introduction: Orthostatic hypotension is very common and increases with age, affecting about 20% of community-dwelling older adults and it increases up to 50% in long-term care units. Measuring lying and standing blood pressure (LSBP) is an important and simple bedside clinical test needed to diagnose the condition. The regulation of blood pressure depends on the baroreflexes, normal blood volume, and defenses against excessive venous pooling. These mechanisms are altered in older adults that lead to increased incidence of OH. Orthostatic hypotension leads to symptoms of dizziness, syncope, cognitive decline, impaired mobility and falls if it is left untreated.
Objective:
1. The primary aim is to standardize the approach to falls assessment on long term care units amongst all members of the multi-disciplinary team. We plan to address this by focusing on OH.
2. To educate all the multi-disciplinary team and increase knowledge of OH.
3. To improve accuracy in recording and documentation of LSBP to proactively screen patients and plan the clinical management accordingly.
Method: The study adopted an educational approach to orthostatic hypotension assessment in long term care. We did survey questionnaire before and after the study to check the understanding of MDT about the OH. We have undertaken two rounds of data collection with orthostatic hypotension related variables in each cycle. After round one, we did a PDSA that involved small group education sessions by physicians, pharmacists and physiotherapists to raise awareness of orthostatic hypotension.
Results: The study developed a standardized approach to measure LSBP in all long-term care units. It also improved the accuracy in assessment and recording of LSBP and it helped to raise awareness of OH among the MDT in long term care units. The knowledge domain improved to 90% from 10% in MDT. The documentation of LSBP improved to 85% on Long Term Care.
Comments
Question
Hello and thank you for presenting your poster on orthostatic hypotension. What other steps would you suggest could be implemented to improve management of this condition?
Hello. Thanks for the question. As a result of this project, we were able to look at the prevalence of Orthostatic Hypotension (OH) which is as high as 30% on the Geriatric long term care units. We suggest the following based on our findings:
1. LSBP champions on wards to improve the understanding and adherence to RCP protocol for measuring LSBP.
2. PDSA led by Physicians and other members of MDT to educate the staff about the condition as it can interfere with rehabilitation and cognition of our Geriatric patients. With MDT involvement, we hope to have a wider understanding of the condition and we also suggest a protocol for management of OH that concentrates on rehabilitation and quality of life.
3. We want to implement it as a part of falls risk assessment on all Geriatric wards and Geriatric outpatients as it will help us manage the condition early and prevent its complications.
Orthostatic Hypotension
Thank you