Abstract
Postural hypotension is defined as an abnormal fall in blood pressure upon standing and is an important cause of falls associated with significant morbidity and mortality. Screening for postural hypotension forms an integral aspect in the overall assessment of patients presenting with a fall and furthermore is non-invasive, inexpensive and reproducible. Aims To determine if a lying and standing blood pressure (LSBP) was requested and performed on patients aged >55 years presenting with a fall within three days of admission, and furthermore, to establish if staff could correctly perform and interpret results of a LSBP in accordance with the Royal College of Physicians guidelines across four medical and frailty wards. Method Potential patients were identified by screening nursing handovers. Medical notes were retrospectively reviewed to determine if a LSBP was requested and performed during the initial clerking, post-take ward round (PTWR) or subsequent three days following admission. Fifty staff members were then approached and asked to describe the process of undertaking a LSBP. Results Thirty patients presenting with a fall were identified and admitted during July – November 2022. This included sixteen females (53%) with a mean age of 81 years (range 55-96 years). Two patients were not formally clerked and a LSBP was requested in only 5 (16.6%) patients during initial clerking and 11 (36.7%) during the PTWR. Where not initially requested, four patients (21%) had a LSBP requested within three days of admission and 5 (17.2%) had a subsequent LSBP measurement performed. Only 24% of staff correctly described the process of performing a LSBP. Conclusion This QIP demonstrates significant improvements are required in requesting and correctly performing LSBP measurements. Several recommendations were implemented including posters incorporated in observation charts, clerking labels and improved education for nurses. A repeat QIP cycle is currently underway and results are imminent.