Abstract
Introduction
Orthostatic hypotension, a fall in blood pressure (systolic drop of 20mmHg, diastolic drop of 10mmHg)
on standing up from lying or sitting position, is an important risk factor for fall among elderly
population. In this quality improvement project, we assess 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 is a prospective quality improvement project that recruited patients older than 65 years old who
were admitted to Orthogeriatric ward of FVRH, Larbert with falls or had a fall whilst on the ward.
Patients who were bedbound or require moving and handling equipment to stand were excluded.
Initial assessment of patients who had lying and standing blood pressure (first cycle) was done in
January 2025. We intervened by;
1. Identifying suitable patients to each nursing team on the ward.
2. Using reminder tools such as stickers on the board, providing list of patients for nursing staff
on the trolley for case notes.
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 were 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 significant drop. Among these 7 patients, 6 patients had medication
charges. This included dose reduction of anti-hypertensive medications and increase in
Fludrocortisone.
Conclusion
Measurement of lying and standing BP is a fundamental part of comprehensive geriatric assessment
of patients presenting with a fall and also a cost effective way to potentially reduce future falls.