Improving Quality and Timeliness of Lying and Standing Blood Pressure Assessments in Older Adults 

Introduction 

Orthostatic hypotension is a significant risk factor for falls and is associated with increased morbidity and mortality in older adults. The National Institute for Health and Care Excellence (NICE) recommends recording Lying-Standing Blood Pressure (LSBP) for all patients ≥65 years, with the Royal College of Physicians (RCP) advising readings after 1 and 3 minutes. On a geriatrics ward,  LSBP  assessments were frequently delayed, missed , or performed incorrectly. This Quality Improvement Project (QIP) aimed to improve the timeliness and quality of LSBP assessments to enhance patient safety. 

Methods: 

Plan Do Study Act (PDSA) methodology was used. Initial data were collected on a geriatric ward over four weeks. Patients were assessed on whether LSBP was recorded within 72 hours of admission and in accordance with RCP guidance. Patients with contraindications  were excluded. Three interventions were implemented: visual diagrams at the bedside to alert staff to patients requiring LSBP; a central tracking board to monitor outstanding assessments; and a multidisciplinary teaching session covering indications, technique, and importance of LSBP. Post-intervention data were collected using the same criteria. 

Results: 

The initial assessment reviewed 51 patient records. 48 patients had a LSBP documented (94%), 24 patients had a LSBP performed within 72 hours of admission (47%), and 27 patients’ LSBP adhered to RCP guidance (53%). Post intervention, 57 patients' records were reviewed. 57 patients had a LSBP documented (100%), 56 patients had a LSBP performed within 72 hours of admission (98%), and 53 patients’ LSBP adhered to RCP guidance (93%). 

Conclusions 

Targeted education and visual ward-based prompts significantly improved the timeliness and quality of LSBP assessments. Embedding these changes into routine ward practice streamlined LSBP assessments, enhanced falls risk assessments, and improved patient care. Future steps include expanding the project to other wards around the hospital.