Measurement of lying and standing blood pressure in hospital as
part of a falls prevention programme for older people
, L. Hussain
, N. Vasilakis
, R. Schoo
, F. Martin
Royal College of Physicians (RCP), London,
GKT School of Medical
s College London, United Kingdom
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 hypo-
tension is common in older people, particularly during acute illness.
Its adverse effects include falls in hospital. To understand better this
poor compliance with falls prevention guidance, our study investi-
gated how orthostatic hypotension is assessed.
An online survey using survey monkey was sent out to
elderly care clinicians. 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.
Measurement: 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%
1 minutes and 22% reported more than 10 minutes.
33% reported using a manual instrument, the
remaining majority using an automatic device, in contrast to current
Significant variation exists in assessment for ortho-
static hypotension. This likely affects rates of detection, and thus rates
of appropriate clinical responses, which might reduce falls and
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.
Phlebitis prevention in peripheral intravascular catheters
situational diagnosis to action
H.L. Neves, B.M.J. Augusto, C.M.S. Fernandes, A.S. Cristina,
A.F.F. Almeida, J.A.S. Ferreira, A.F.L. Carvalho Catarino, T.C. Fernandes
Santos, J.R.H. Carvalho Matos, G. Mota Gaspar.
Guideline implementation is many times a challenge,
requiring development of strategies that ensure good adherence by
the healthcare professionals. In order to ensure good practice for
Peripheral IntraVascular Catheters (PIVC) phlebitis prevention guide-
lines, a two-phase study was developed to improve outcomes.
First-phase study A diagnosis of phlebitis incidence was per-
formed and correlated with the multiple guidelines for PIVC. Second-
phase study Corrective measures were implemented and assessed.
During the first-phase, 1302 venous cannulations were
evaluated, with phlebitis occurring in 131 cases (10% incidence).
Through inferential analysis, occurrence of phlebitis was associated
with the interval of PIVC replacement (average of 113 h in the phlebitis
group; p < 0,001). During the second-phase, the nursing staff received
indication to replace all PIVC after 96 h (except in cases where
cannulation was difficult). Also, an eHealth system was developed to
optimize supervision of the PIVC interval of replacement using colours
to red flag the PIVC that had been placed for more than 96 h. During
this phase 1242 PIVC were monitored, with phlebitis occurrence
observed in 81 cases (6,52%) and with the interval of PIVC replacement
decreasing to an average of 67,85 h with no association with the
occurrence of phlebitis (p > 0,05).
Understanding of the causes of phlebitis (phase one)
allowed the team to focus on the main problem and to develop a group
of strategies that lead to a decrease in the incidence of phlebitis
(approx. 3,5%) and, above all, contributing to patient safety and to
better nursing care.
Fall profile in an acute neurological ward in Central Portugal
H.L. Neves, B.M.J. Augusto, C.M.S. Fernandes, C.I. Gamboa Oliveira,
R.S. Correia Ferreira, D.S.R.M. Fonseca, E.M.N.S. Cardoso, H.F. de Oliveira
Barroca, J.F.C. Marçal, V.J. Lourenço Pinto.
is one of the strategic objectives of
the Portuguese National Plan for Patient Safety 2015
2020. In order
to better intervene in fall rates, a diagnosis of the situation was
A review of nursing processes where the diagnosis
was identified was performed. Other variables collected were: medical
diagnosis, age, presence of
during the fall
episode; nursing interventions; date and hour of fall; place; involved
structure; consequences and damage to the patient.
Data analysis showed that the most common medical diagno-
sis was Stroke (43%), with an average age of 72,3 years. 52% of the falls
happened during the morning shift, while 36% happened during the
night shift and 12% during the afternoon shift. 24% of the falls occurred
at Fridays followed by 19% at Mondays. The lowest number of falls
happened during Tuesdays. 82% of the falls occurred during the first
three days after hospitalization. Confusion diagnosis was identified in
36% of these patients, while
Risk of fall
was present in 90%. Patients
fell more in the bedroom (57%) or bathroom (24%). From the involved
structures, bed was referred in 48% and chair in 12%. 69% did not
produce damage to the patients, while only 19% required additional
Taking into account the medical diagnosis, nursing
shift, place, and day of hospitalization when the episode occurred,
a project centered in the promotion of the awareness of physical
limitations has been developed to ensure improvement in fall rates.
Impact of replacement interval decrease in peripheral
intravascular catheters placed in the ER
H.L. Neves, B.M.J. Augusto, C.M.S. Fernandes, M.F.M. Pinto,
A.M.S. Nogueira, M.C.P. Lucas, F.M.V. Teixeira, A.M. Lopes Batista,
M.J.S. Santos Viais, S.C.S. Sousa, C.M. Santos Rocha, S.M. Cordeiro
Search for improvement is a path to quality-care. After
developing a research that focused on good practice for Peripheral
IntraVascular Catheters (PIVC) phlebitis prevention guidelines imple-
mentation, with impact in the reduction of phlebitis from 10,0% to
6,52%, data from the second-phase of the study was reviewed in order
to provide insight regarding other corrective measures with potential
to improve care.
Data from an implementation study of good practices
guidelines for PIVC was reviewed in order to understand what other
problems could be associated with the presence of phlebitis.
From 1242 PIVC, 81 cases developed phlebitis. After analysis
of these cases, an association between presence of phlebitis and the
introduction of the PIVC in the emergency room (ER) was observed,
which could potentially lead to an overall reduction of approx. 3,5% of
incidence of phlebitis. A research protocol has been developed
to target this finding, consisting in reducing the interval for PIVC
replacement from 96 h maximum, to 72 h for all PIVC that were placed
in the ER.
It is expected that the reduction in the time interval
for the PIVC placed in the ER will improve overall phlebitis incidence
rates, thus improving quality of care and ensuring patient safety.
Negative urine dipsticks have little clinical value in nonspecifically
unwell older adults
A. Viggars, S. Ninan.
Leeds Teaching Hospitals NHS Trust
Urine dipsticks are commonly
in older people
and have a poor positive predictive value for UTI, but their negative
Poster presentations / European Geriatric Medicine 7S1 (2016) S29