Abstract
Background
Postural hypotension, defined as a systolic blood pressure drop of ≥20 mmHg or diastolic drop of ≥10 mmHg within 3 minutes of standing, is common in older hospitalised patients and is a major risk factor for falls, injury and mortality. Management is often complicated by coexisting supine hypertension, for which national guidance is limited. An internal audit (n=28) highlighted low resident doctor confidence in managing these conditions. Our aim was to improve clinician knowledge and confidence through the introduction of a clear guideline and educational materials.
Methods
A Plan-Do-Study-Act approach was used. Educational posters summarising key investigations and management steps were displayed on Medicine for the Elderly wards. A new trust-wide guideline, developed with geriatricians, nurses, and pharmacists, provided diagnostic criteria, risk factors and stepwise management for postural hypotension, including cases with supine hypertension. Clinician confidence and knowledge were evaluated using repeated surveys with Likert scales.
Results
Following poster introduction (Cycle 1, n=8), confidence in managing postural hypotension rose from 32.1% to 75%, and confidence in managing postural hypotension with supine hypertension increased from 39.3% to 50%. Following trust-wide guideline rollout (Cycle 2, n=11), confidence in postural hypotension management remained above baseline at 63.7%. Confidence in managing supine hypertension declined, though awareness of non-pharmacological strategies rose to 90.9% and awareness of risks increased to 72.7%.
Conclusions
Educational posters and a structured guideline improved clinician knowledge and confidence in managing postural hypotension. Embedding the guideline through staff education and awareness campaigns may ensure long-term impact and enhance patient care by reducing the risk of falls, related injuries and mortality.
Comments
I agree with checking clinician's awareness
I do encounter this issues in our own orthogeriatrics ward being shared with orthopaedics. This highlights the importance of education and training since our surgical colleagues rely on orthogeriatrics or medical clinicians in managing postural hypotension in the ward, and addressing the issue aids in prioritising early mobilisation in physical rehabilitation facilities. Well done!
A valuable project…
A valuable project addressing a common clinical challenge, but the very small survey samples limit the strength of conclusions. Confidence gains were inconsistent across cycles, and reasons for the decline in managing supine hypertension could be explored further. Longer follow-up and larger cohorts would strengthen the findings.
Importance of sharing knowledge across MDT
Very interesting project and great to see the confidence in managing postural hypotension improving/maintaining across the two cycles. Postural hypotension can have a significant impact on patients de-conditioning whilst in hospital due to concerns with falls. Did your project evaluate other members of the MDTs confidence with managing postural hypotension too?
Great work!
A well-designed and…
A well-designed and practical quality improvement project that clearly enhances clinician confidence in managing postural hypotension. The use of simple educational tools and a collaboratively developed guideline is commendable, and the measurable improvements in knowledge and awareness highlight its positive impact on patient safety.
Thank you for this project
As a doctor working in an Frailty Hospital at Home team, I find myself routinely managing this pathology. For our team in the community, we find ourselves balancing management plans, alongside our patient's risks of falls, and whether it is still safe to keep patients in their home. So thank you for your work in this area.
Your interventions improved confidence initially, but Cycle 2 showed some decline. Have you considered what factors might influence long-term sustainability of behaviour change, and whether ongoing reinforcement (such as e-learning, simulation, ward champions) might be needed?