• Project led by Stockport NHS Foundation Trust.
  • Based on an acute elderly care ward and a unit for patients with fractured neck of femur at Stepping Hill Hospital.
  • Aimed to design a pathway to help identify orthostatic hypotension in older patients, to reduce falls and unnecessary medication use.
  • Used a co-production approach to develop an orthostatic hypotension pathway (lying and standing blood pressure assessment) incorporating training, assessments, interventions and improved discharge information.

The Stockport NHS Foundation Trust team set out to design a pathway to help identify orthostatic hypotension - a drop in blood pressure when standing - in older patients, to reduce falls and unnecessary medication use. The project followed a co-production approach, with staff and patients sharing their experiences to establish areas where care could be improved.

Key elements of the new pathway include training, assessments and interventions for orthostatic hypotension, as well as improved discharge information for patients, families, carers and GPs. The pathway was piloted on an acute elderly care ward and a unit for patients with fractured neck of femur.

Who was involved

The project was led by a consultant physician and the assistant director of nursing. Other steering group members included staff with expertise in pharmacy, research and clinical audit, ward staff and managers, the quality lead from the local clinical commissioning group and a patient expert.

Outcomes

  • Use of the pathway identified 28 patients with a significant postural drop.
  • The pathway was rolled out trust-wide and assessment of lying and standing blood pressure became part of the trust's falls risk assessment/care plan for patients.
  • Where medication is stopped or reduced folllowing identification of a postural drop, this information is now included on discharge notes to be followed up by the GP.

Challenges

The team struggled to find the comparable data needed to establish whether the intervention led to a reduction in overall length of stay. This was because data on admissions tends to record the condition causing a fall, rather than the fall itself.