Lying Standing Blood Pressure Measurement following Hip Fracture

Background:
Frail patients are at risk of post-operative orthostatic hypotension. Measuring lying and standing blood pressure (LSBP) is a key part of comprehensive post-operative geriatric assessment.

Method:
Three cycles of data were collected from the National Hip Fracture Database on patients with neck of femur fractures at Leeds General Infirmary. Each cycle was discussed at local governance meetings, followed by implementation of novel interventions. First, information on LSBP was added to online induction resources. Then, a poster was distributed, and finally, an email template was circulated to doctors and physiotherapists.

Results:
 In the first cycle (n=60), 58% of patients had LSBP recorded, with 23% showing a postural drop. The second cycle (n=97) showed improved LSBP recording (74%). Of the 78 patients with a plan to measure LSBP, 69% of these plans were made by orthogeriatricians, and 65% were made on or before day three post-op. In the third cycle, rates of LSBP recording remained consistent. Notably, only 61% of plans were made by seniors, indicating increased junior staff involvement.

Discussion:
LSBP recording improved after the first intervention, with sustained levels in later cycles. The second intervention increased junior staff engagement in planning. Limitations included inconsistent documentation across clinical, MDT, and physiotherapy notes, and difficulty engaging all MDT members due to variable attendance at meetings.

Conclusion:
This multi-cycle quality improvement project improved LSBP recording and promoted awareness of post-operative orthostatic hypotension. The stable proportion of patients with postural drops suggests consistent prevalence. LSBP measurement should be considered by all MDT members.