Improving Implementation and Documentation of Lying and Standing Blood Pressure on Acute Inpatient Ward

Introduction 

Falls are a common cause of hospital admission in older adults and contribute significantly to morbidity. Postural hypotension is a recognised and potentially reversible contributor to falls. NICE NG249 and the National Audit of Inpatient Falls (NAIF) recommend measurement of lying and standing blood pressure (LSBP) as part of a multifactorial assessment. NAIF 2024 reported 47% national completion of LSBP, with an improvement target of >60%. Local observations suggested inconsistent implementation and documentation of LSBP assessments.

Methods 

A closed-loop audit was conducted on an acute older persons’ ward at Arrowe Park Hospital. Electronic records of patients aged ≥65 years were reviewed to assess compliance with LSBP measurement before and after targeted multidisciplinary interventions, including staff education and documentation prompts. Outcomes included LSBP measurement within 6 hours and 24 hours of admission, and at least once during admission. Statistical analysis was performed using Fisher’s exact test.

Results 

A total of 54 people were included, 27 people in the first audit cycle, 27 people in the re-audit following intervention. LSBP measurement within 6 hours improved from 33.3% to 66.6% (Fisher’s exact test P value= 0.0285), and within 24 hours from 44.4% to 85.2% (Fisher’s exact test P value= 0.0038). Patients receiving ≥1 LSBP during admission increased from 81.4% to 92.6%. 

Conclusion

Targeted multidisciplinary interventions significantly improved the implementation and documentation of LSBP assessment in older inpatients. Improved adherence to national guidance may enhance detection and management of postural hypotension, contributing to inpatient falls prevention. Ongoing work aims to sustain these improvements and expand the initiative across additional frailty wards.