27 Re-Audit of Orthostatic Blood Pressure Measurement to Prevent Falls and Fall-Related Complications for Geriatrics Inpatients from A Secondary Care Hospital

Abstract

Abstract Introduction Orthostatic Hypotension is a common cause of falls leading to injury and morbidity in older adults. In the National Audit of Inpatient Falls 2015 audit, only 16% of 4846 patients had an orthostatic Blood Pressure (L/S BP) recorded by their third day in the hospital. There is also variation in the understanding of how doctors and nurses perform orthostatic BP. This could have adverse effects on detection rates and accuracy of the procedure resulting in misdiagnosis. As a result, the Royal College of Physicians (RCP) has released guidance on Orthostatic BP measurements to perform the standardising practice and improving accuracy. The purpose of this quality improvement project (QIP) is to work on the action plan from the orthostatic BP measurement QIP has done in 2017, by introducing laminated guidelines in patient’s notes and re-audited in 2018 to record any improvement. The re-audit of 2018 showed remarkable improvement but still not as equal as the gold standard as RCP. Therefore, the second loop of re-audit performed in 2019 in major Geriatrics wards and other wards while involved larger sample (patient) numbers. We used four questioners as the audit proforma. Methods Wards were audited to find out whether orthostatic BP is measured as per RCP guidelines. Afterward, a laminated copy of the RCP recommended method of measuring orthostatic BP was put into all Early Warning Score ‘Observation’ folders with a sheet designed specifically for recording Orthostatic (L/S BP). The procedure of L/S BP measurement was re-audited after the intervention to find out changes in performing orthostatic (L/S BP) (as per RCP guidelines). Results There is a remarkable improvement of outcome reveals in the second loop of re-audit. Regarding RCP guideline compliance, it is 93.33% which is closer to the gold standard. And in case of symptoms identification and documentation, it is 100%, which is equal to the RCP gold standard. Conclusions Inclusion of guidelines in notes improves investigation; inclusion of supplementary recording sheet improves documentation. Re-audit reflects the remarkable improvement to compliance with RCP guidelines in measuring Orthostatic BP measurement and patient’s symptoms documentation.