Improve quality and reduce patient harms
We are committed to ensuring our staff have the autonomy to influence decisions on how care is structured and delivered to create a culture of innovation, whilst continually striving to generate opportunities to improve clinical outcomes in a supportive culture.
As part of their strategy to reduce the risk of patients falling in the community, Newcastle’s Community response and rehabilitation team (CRRT) has taken advantage of being able to see patients in their own homes as an opportunity to carry out a full comprehensive assessment.
As well as looking at factors such as mobility and the home environment, as part of a pilot project the team began to take peoples’ lying and standard blood pressures, as a standard measure in identifying patients’ risk of fall and a potential trigger for further medical review or investigation.
Their results revealed significant findings: 1 out of 3 patients had orthostatic hypertension and 2 out of 3 of them did not display symptoms but dropped their blood pressure significantly on sitting or standing, reinforcing the importance of checking lying and standing blood pressure as part of what they do and not only when people complain of symptoms such as dizziness.
An area often overlooked by professionals, this can have a massive impact on patients’ ability to cope and manage their condition at home.
Holistic assessment
Specialist Nurse Alpha Toledo explains: “The idea to start this project stemmed up from my own personal observation of how assessments were carried out in CRRT since I joined the team in April 2020. The team has been doing a fabulous job in terms of holistic assessment, but I still felt that we can do more for our patients considering that Covid has forced all of us to change the way we work.
“As a nurse, I wondered why lying and standing blood pressure is not a standard assessment carried out by the team for patients who are at high risk of falls, more so for patients who have fallen. During Covid, a lot of patient referrals we were receiving were due to falls and we all saw the terrible consequences of deconditioning and inactivity to the elderly and frail.
“We regularly look at mobility, home environment, footwear, need for equipment or adaptation but not everybody was considering the role of orthostatic hypotension as a potential predictor of fall.”
Whilst remote and teleconsultations became common practice and and excellent way to maintain contact with patients, most factors of falls like mobility, balance, home environmental hazards, functional ability, and blood pressure are impossible to fully assess over the phone.
“If the postural blood pressure responses are not checked, there will be no basis for doctors to safely add, withdraw or change medication doses, which could be vital for reducing patients’ risk of falling” continues Alpha.
“I thought at that time that CRRT was in the best position to fill that gap and we could do a bit more to help our patients still achieve the best health outcome they deserve despite all the pressures within the NHS services because of Covid-19.”
Psychological safety at workplace fosters the development of brave and innovative leaders.
Alpha Toledo, Specialist Nurse in the Community
Alpha began to develop standard practice for the wider team to follow regarding assessment of lying and standing blood pressure. This would ensure that no matter what healthcare professional was seeing the patient, a standardised approach meant they would receive the same assessment and treatment.
The team was also seeing significantly high number of patients with a history of falls who may or may have symptoms. All patients benefit from medication review, assessment of hydration status, further investigations and health education for prevention and management of orthostatic hypotension.
Positive results
The simple and straightforward pathway that Alpha developed could be easily adopted by every professional within the multi professional team and during the pilot stage the team:
- achieved 18% increase in the number of lying and standing blood pressure assessments during the pilot stage
- identified more patients with orthostatic hypotension, making these patients aware of their health issue and what they can do to keep themselves safe and well at home.
- improved care and support planning through linking with GPs and geriatricians in the community to ensure that treatment from medical-point-of-view is in place.
A seemingly simple project with a big impact they are now looking to launch this to the entire team to fully implement shortly.
Alpha says that whilst it was challenging at first it is often the smallest changes that have the biggest impact and it’s been incredibly fulfilling to see the team’s hardwork reap such fantastic benefits for their patients.
Have the courage to speak up and show your vulnerability at the same time.
Alpha Toledo, Specialist Nurse in the Community
