IMPROVEMENT IN RECORDING, IDENTIFICATION AND

MANAGEMENT OF ORTHOSTATIC HYPOTENSION (CYCLE 3)

Dr Elinor Burn SpR1 , Dr Sooraj Mannil SHO 1, Dr Ethan Maltlyn F11, Dr Anu Thomas SHO1 (1)University Hospitals of Leicester, NHS Trust

Quick Glance : Previous Audits / Interventions Note : Standards from previous samples were slightly different ; hence limiting direct comparison

Management of patients with falls and OH Improvement in recording and identification of LSBP
62% had LSBP measured when indicated
Supine for 5 mins 56 %
87.1 % did not had multiple BP recordings Creating an awareness card about standard guidelines of
1 min - 2nd BP 40 %
22.6 % had standing heart rate mentioned measuring LSBP
CYCLE 1

CYCLE 2
3 min - 3rd BP 33 %
Interventions Sharing information during HCA and Nurses meeting
Symptoms 27 %
To improve the electronic documentation in NerveCentre
Unified guidance for staff on ideal method for measuring LSBP Record and inform 25 %
or flowchart attached in bedside chart.
Proper training on measuring LSBP
Create a prompt card to attach to BP machine
Design a sticker/form to be placed in the notes
Interventions
Guidance for how & when to take action depending on results

Contributing authors from previous cycles : Dr Chan Nyein Khin, Dr Hay Mar Tun, Dr Nyein Aye Thu, Dr Hnin Oo Win, Dr Syed Ahmed, Dr Simon Biju, Dr D Lahhani, Dr George Ghaly, Dr James Reid

OBJECTIVES GUIDELINES
Review the management of Orthostatic Hypotension in acute medical admissions: RCP Guidelines : Measurement of lying and standing blood pressure
1. Interpret postural blood pressure readings The first BP should be taken after lying for at least 5 minutes.
2. Improve the recording of lying and standing blood pressure (LSBP) in acute The second BP should be taken after standing in the first minute.
medical admissions. A third BP should be taken after standing for 3 minutes.
3. Knowledge and confidence in assessment and management of OH
This recording can be repeated if the BP is still falling.
Symptoms of dizziness, light-headedness, vagueness, pallor, visual
METHODOLOGIES disturbance, feelings of weakness and palpitations should be documented.
Quantitative Qualitative

Patients admitted with falls, syncope, Questionnaire responses

orthostatic hypotension, or collapse gathered from 5 different
and aged 65+ admission wards from a
24 patients were reviewed. multidisciplinary team.

RESULTS
POSITIVE Results
Quantitative
The sample had 67% males, average age 82. a drop in systolic a drop to below 90 a drop in diastolic BP of
79% had LSBP measured; 42% experienced BP drop. BP of 20 mmHg or mmHg on standing even 10 mmHg with symptoms
84% had falls history; 58% reported presyncope. more (with or if the drop is less than (although clinically much
without symptoms) 20 mmHg (with or less significant than a
83% had polypharmacy (average 9.2 medications). Common medications:
without symptoms) drop in systolic BP)
antihypertensives (46%), analgesia (42%), diuretics (25%).
Advise patient of results, and if the result is positive:
Outcomes: 30-day mortality 17%, discharge to home 25%, rehab 21%.
inform the medical and nursing team
Qualitative take immediate actions to prevent falls and or unsteadiness

(Junior Doctors on average 0)

Only 9 members of staff were

able to recognise headache as an
atypical presentation of OH.
LSBPs performed in the last month (average)
1st BP recording 2nd BP recording 3rd BP recording

CONCLUSIONS
Orthostatic hypotension contributes to falls and morbidity. Though 79% of patients presenting with falls had LSBP recorded, documentation of heart rate and
symptoms needs improvement. Staff knowledge on LSBP measurement varied (38-42%). This indicates a need for ongoing education, through LSBP roadshow
events alongside reintroducing BP machine LSBP prompt cards and developing a trust based information leaflet for patient education for orthostatic hypotension
management.
References Abbreviations
Trust Guidelines, Orthostatic Hypotension (OH) UHL Emergency and Specialist Medicine Guideline (B45/2017) LSBP: Lying and Standing Blood Pressure HCA: Healthcare Assistant
RCP Standard Guidelines : Measurement of lying and standing blood pressure: A brief guide for clinical staff OH : Orthostatic Hypotension