1046 STANDARDIZING THE APPROACH TO POSTURAL HYPOTENSION: A QUALITY IMPROVEMENT PROJECT

Abstract

Abstract Background & Aims Falls in the older population cause significant morbidity and mortality, and can be a catalyst for deconditioning and a decrease in functional baseline. In the long-term, this results in higher levels of care needs and health issues. As orthostatic hypotension is a common cause for falls in the elderly, our QIP aims to develop a standardized approach to postural hypotension assessment. Methodology We undertook two rounds of retrospective data collection on the ward focusing on LSBP as part of the assessment that should be completed on every patient who presents with a fall. In between we undertook an intense period of small group education sessions. We involved a nurse and an HCA in delivering this teaching to ensure sustained change. We also created cards demonstrating the correct technique of doing a LSBP and attached these to all BP machines. Finally, we introduced a midday board round which allowed for more effective communication between the MDT. Results In cycle 1, 26% of patients presenting with a fall had a LSBP done prior to discharge whilst in cycle 2, 56% of patients did. We significantly improved the technique and documentation on our electronic system from 0% in the first cycle to 95% in the second. However, this increase in LSBP comes from increased nursing staff completion and documentation as opposed to more doctors requesting a LSBP as part of the falls assessment, with only 63% of patients having documented requests in both cycles. Conclusion Our results were encouraging but also highlighted further areas for development in this area. Moving forward, we have extended the project to increase doctors’ awareness of the falls assessment. We have presented at the departmental meeting and included multifactorial falls assessment teaching in the induction handbook to allow for sustained change.