Improving Measurement of Lying and Standing Blood Pressure in Elderly Patients Presenting with Falls.

Introduction
Orthostatic hypotension, a fall in systolic blood pressure of 20mmHg or a diastolic drop of
10mmHg on standing up, is an important risk factor for falls amongst the elderly
population. This quality improvement project aimed to improve consistent
documentation of lying and standing blood pressure measurements, using sustainable
and cost effective interventions. Polypharmacy review was an additional outcome. 
In this quality improvement project, we assessed the proportion of eligible patients who
had lying and standing BP measurement. We made some interventions to improve this
rate and reassess the proportion of patients who had their lying and standing pressure
done afterwards.
Method
This prospective quality improvement project recruited patients older than 65 years, who
were admitted to an Orthogeriatric ward of a district general hospital, with falls or had an
inpatient fall. Patients who were bedbound or required moving and handling equipment
to stand were excluded.
Initial assessment of patients who had lying and standing blood pressure
measured (first cycle) was done in January 2025. Our interventions included:
1. Identifying suitable patients to each nursing team on the ward.
2. Using reminder tools such as stickers on the board, providing lists of
eligible patients for nursing staff on the case note trolley.
3. Dedicated lying and standing BP sheet in the observation folder to record
three separate measurements.

The post- intervention re-assessment of lying and standing BP was done in February to
April 2025.
Result
In the first cycle, 9 out of 29 patients (31%)  had lying and standing blood pressure
assessment done. This improved to 34 out of 47 patients (73%) after interventions. 20%
of patients who had their lying and standing BP assessed had a significant drop.
Amongst these 7 patients, 6 patients had medication charges. This included dose
reduction of anti-hypertensive medications and increase in Fludrocortisone. Using a
combined intervention approach as described, allows for a sustainable way to assess
for orthostatic hypotension.
Conclusion
Measurement of lying and standing blood pressure is a fundamental part of
comprehensive geriatric assessment of patients presenting with a fall. It can prompt

polypharmacy review and in addition, is a cost effective way to potentially reduce future
risk of falls and fractures.