Improving Orthostatic Hypotension Screening in Fall Prevention: A Two-Cycle Audit on Falls Assessment and Lying and Standing Blood Pressure Measurement

TL;DR

This study shows that checking blood pressure when standing can help prevent falls in older adults, and improving this practice significantly increased after an audit.

Contribution

The study demonstrates how targeted interventions can improve adherence to guidelines for orthostatic hypotension screening in fall prevention.

Findings

Falls assessment completion improved slightly but was already high (93% to 98%).

Lying and standing blood pressure measurement compliance increased significantly from 34% to 68%.

More patients showed systolic BP drops ≥20 mmHg after improved compliance (36% to 46.4%).

Abstract

Introduction: Falls in older adults (≥65 years) are a major health concern, causing significant morbidity, mortality, and healthcare costs. Orthostatic hypotension (OH), a common but often overlooked risk factor, increases fall risk due to blood pressure drops on standing. Despite the National Institute for Health and Care Excellence (NICE) guidelines recommending postural blood pressure measurement in fall assessments, adherence remains inconsistent. This audit evaluates compliance with these guidelines and aims to improve recognition of OH to enhance patient safety.

Methods: This two-cycle audit was conducted in an orthopedic rehabilitation ward in a district general hospital in North East England, assessing 82 patients (41 per cycle) aged 65 and older. Adherence to NICE guidelines on fall assessment and lying and standing blood pressure (LSBP) measurement was evaluated. Data were retrospectively collected from electronic records over two two-week periods (December 2022 and March 2023). Following Cycle 1, interventions were implemented to improve compliance in Cycle 2.

Results: A total of 82 patients were included in this audit. Falls assessment completion remained high, improving slightly from 93% in Cycle 1 to 98% in Cycle 2 (p = 0.61). However, LSBP measurement saw a significant increase from 34% to 68% (p = 0.004). Among those assessed, the proportion with a systolic BP drop ≥20 mmHg rose from 36% to 46.4%. The percentage of patients sustaining fractures before admission remained similar (76% vs. 80%).

Conclusions: The initial audit revealed that 66% of eligible patients were not assessed for OH despite NICE guidelines recommending LSBP measurement. After targeted interventions, compliance significantly improved, demonstrating that clinical audits are an effective tool for enhancing adherence to fall prevention guidelines and improving patient care.