Measurement of lying and standing blood pressure in hospital

O'Riordan, Shelagh E; Vasilakis, N; Hussain, Labib; Schoo, R; Whitney, Julie; Windsor, Julie; Horton, Khim; Martin, Finbarr C.

doi:10.7748/nop.2017.e961

Cited by 7 publications

(5 citation statements)

References 14 publications

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“…The time needed for bedside staff to perform this assessment and the risk of measurement inaccuracy as a result of variations in time of day, device, and position influence the value of this assessment (Aydin et al, 2017; Cooke et al, 2009; Dind et al, 2011; McDonald et al, 2016; Soysal et al, 2016). Additionally, inadequate staff knowledge (Irvin & White, 2004; O’Riordan et al, 2017; Vloet et al, 2002), the need for more than one set of measurements and the fact that OH is often not reproducible challenge the usefulness of bedside OVS.…”

Section: The Problemmentioning

confidence: 99%

Orthostatic Hypotension and Falls in Hospitalized Older Adults

Schell

Lyons²,

Bodt

2021

Clin Nurs Res

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The aim of this retrospective study was to determine the prevalence of orthostatic hypotension (OH) among a convenience sample of older adults on two Acute Care of the Elderly (ACE) units of the ChristianaCare™ in Delaware. Another aim was to determine if subjects with documented OH experienced falls. Retrospective de-identified data was obtained from electronic medical records for the years 2015 to 2018. Among all patients who had valid first orthostatic vital sign (OVS) readings ( n = 7,745), 39.2% had orthostatic hypotension on the first reading. Among the patients, 42.8% were found to be hypotensive during OVS. Thirty-one (0.9%) of those with OH fell at some point during their stay. The odds ratio for falls in the presence of OH was 1.34 with a 95% confidence interval (0.82, 2.21), but a chi-square test failed to find significance ( p = .2494). The results could not determine if OVS should be mandatory in fall prevention protocols.

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Section: The Problemmentioning

confidence: 99%

Orthostatic Hypotension and Falls in Hospitalized Older Adults

Schell

Lyons²,

Bodt

2021

Clin Nurs Res

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“…In the 2015 national audit of inpatient falls (NAIF), Vasilakis et al (2015) identified that only 16% of 4846 eligible patients had an LSBP recorded by their third day in hospital. A review of the literature, which focused upon clinician knowledge and understanding of the correct OH measurement procedure, identified that in general, participating clinicians had poor knowledge of the OH measurement process, and the procedure they utilised to physically measure LSBP was inaccurate to diagnose OH ( Barsaiyan & Mildner, 2014 ; O’Riordan et al, 2017 ; Vloet et al, 2002 ). The participants were predominantly nurses, and some of the studies were dated so extrapolation of the findings to ambulance clinicians requires caution.…”

Section: Discussionmentioning

confidence: 99%

An atypical presentation of orthostatic hypotension and falls in an older adult

Thoburn

Cremin

Holland

2022

British Paramedic Journal

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Introduction: Falls are a significant cause of morbidity and mortality in older adults. Orthostatic hypotension (OH) is very common in this cohort of patients and is a significant risk for falls and associated injuries. We present the case of an 89-year-old female who fell at home, witnessed by her husband. OH was identified during the clinical assessment and considered to be the predominant contributing factor, although the clinical presentation was not associated with classical symptoms.Case presentation: The patient lost balance while turning away from the kitchen sink; she noted some instability due to a complaint of generalised weakness in both of her legs. No acute medical illness or traumatic injury was identified. A comprehensive history was obtained that identified multiple intrinsic and extrinsic risk factors for falling. The cardiovascular examination was unremarkable except for OH, with a pronounced reduction in systolic blood pressure of 34 mmHg at the three-minute interval and which reproduced some generalised weaknesses in the patient’s legs and slight instability. Although classical OH symptoms were not identified, this was considered to be the predominant factor contributing to the fall. A series of recommendations was made to primary and community-based care teams based upon a rapid holistic review; this included a recommendation to review the patient’s dual antihypertensive therapy.Conclusion: It is widely known that OH is a significant risk factor for falls, but asymptomatic or atypical presentations can make diagnosis challenging. Using the correct technique to measure a lying and standing blood pressure, as defined by the Royal College of Physicians, is crucial for accurate diagnosis and subsequent management. Ambulance clinicians are ideally placed to undertake this quick and non-invasive assessment to identify OH in patients that have fallen.

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“…FIGURE 2: Documenting orthostatic blood pressure measurements [21] A retrospective audit of patients above the age of 60, admitted with a hip fracture secondary to a fall between August 10 and September 21, 2020, in the Orthopaedics department was undertaken to assess progress and compliance with set standards. Fifty-eight (58) patients (73% females) were included in this reaudit.…”

Section: Methodsmentioning

confidence: 99%

Clinical Audit as a Quality Improvement Tool in Measurements of Lying and Standing Blood Pressure for Elderly Patients Admitted With a Hip Fracture

Okereke¹,

Mmerem²,

Aly³

2021

Cureus

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Background: Around one in three adults aged 65 years and over will have a fall at home within a one-year period. Falls are estimated to cost the NHS more than £2.3 billion per year. The National Institute for Health & Care Excellence (NICE) guidelines recommend older people who present for medical attention because of a fall, report recurrent falls in the past year, or demonstrate abnormalities of gait and/or balance should be offered a multifactorial falls risk assessment which includes a cardiovascular examination and review of medications. Orthostatic hypotension (OH) is a common cardiovascular disorder, independently associated with an increased risk of falls in the elderly.Aims & Objectives: This study was carried out to assess improvement in lying and standing blood pressure (LSBP) measurement using clinical audit and staff education.Method: An initial audit of patients over the age of 60, admitted with a hip fracture between the 14th of April and the 25th of May 2020 to assess measurement and accurate recording of LSBP. This cycle was followed by brainstorming, root cause analysis, teaching sessions for staff, and use of aide-memoires. A second audit cycle of patients was admitted with a hip fracture secondary to a fall between the 10th of August and the 21st of September 2020.Result: Our initial audit results showed 68% of patients who met the criteria in the NICE guidelines on measurement of LSBP were not being assessed for OH. Following interventions, the second audit cycle showed significant improvement in compliance, confirming audits to be a powerful tool in quality improvement programs.

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Measurement of lying and standing blood pressure in hospital

Cited by 7 publications

References 14 publications

Orthostatic Hypotension and Falls in Hospitalized Older Adults

Orthostatic Hypotension and Falls in Hospitalized Older Adults

An atypical presentation of orthostatic hypotension and falls in an older adult

Clinical Audit as a Quality Improvement Tool in Measurements of Lying and Standing Blood Pressure for Elderly Patients Admitted With a Hip Fracture

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