91MEASUREMENT OF LYING AND STANDING BLOOD PRESSURE IN HOSPITAL AS PART OF A FALLS PREVENTION PROGRAMME FOR OLDER PEOPLE

Abstract

Introduction: A comprehensive national audit in 2015 of 4,846 patients aged 65+ from acute hospitals in England and Wales showed that only 16% of inpatients had their lying and standing blood pressure (LSBP) measured by the third day of admission. Orthostatic hypotension is common in older people, particularly during acute illness. It can therefore increase the risk of a fall in hospital. Methods: An online survey using survey monkey was sent out to elderly care clinicians. This survey focused on the specifics and interpretation of LSBP recordings in hospital and gave defined responses for each question. Out of 316 respondents, 271 (86%) stated that they measured LSBP in their usual clinical practice. These respondents (doctors, nurses or physiotherapists) were asked further questions. Results: Number of measurements: When recording LSBP in clinical practice, 37% of respondents took 3 measurements, a further 37% taking more than 3, and 26% taking 2. Time patients lay down before initial BP measurements: a range of answers were provided, the majority (38%) reported 4-5 minutes, 6% reported 0-1 minutes and 22% reported more than 10 minutes. Timing of first standing blood pressure: the majority (83%) took it after 0-1 minutes. Timing of second standing blood pressure: the majority (52%) took it between three and four minutes, 31% took it between one and two minutes. Sphygmomanometer: 33% reported using a manual instrument, the remaining majority using an automatic device, in contrast to current guidance. Discussion: Significant variation exists in assessment for orthostatic hypotension. This likely affects rates of detection, and thus rates of appropriate clinical responses, which might reduce falls and promote recovery. Clearer guidance on measurement and interpretation of lying and standing BP may promote a better and more consistent approach. We plan to develop an educational tool to promote this.