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Measurement of lying and standing blood pressure in hospital as

part of a falls prevention programme for older people

S. O



, L. Hussain


, N. Vasilakis


, R. Schoo


, F. Martin




Royal College of Physicians (RCP), London,


GKT School of Medical

Education, King

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%

reported 0

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


Key conclusions:

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

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.


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.

CHUC-HUC, Portugal


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).

Key conclusions:

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.

CHUC-HUC, Portugal


Fall prevention

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



fall risk

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


Key conclusions:

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

research protocol

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


CHUC-HUC, Portugal


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.

Key conclusions:

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