Daily Orthostatic B/P Evaluation in Reducing Moderate to Severe Injury Rates on an Inpatient Cardiac Rehabilitation Unit

Purpose:
Increase in the number of falls with moderate to severe injuries that resulted in adverse outcomes for the 3rd Q'08 as compared to NDNQI benchmark. Analysis of the falls reveal underlying changes in Medical condition that were possibly related to Orthostatic hypotension, medication or pt condition.

Significance:
To evaluate the effectiveness of the clinical indications of daily blood pressure monitoring as it relates to current medication regime, patient medical condition, mobility, gait and ability to participate in therapy and activities of daily living.

Strategy and Implementation:
For 4th Quarter 2008 the following changes were implemented 1) Daily Orthostatic B/P monitoring performed daily by the Ancillary staff. Results are discussed at the Interdisciplinary Team conference, weekly Medications rounds and at impromptu meetings. 2) Weekly medication review performed by Physician, Rn and Pharmacy input to review dose, indication, duration, frequency, schedule, med added and parameters to assess the clinical indications for the current med list that may affect molibity, gait and orthostasis 3) Standardization of unit supply of teds stocking, abdominal binders and ace wraps to reduce time of MD order to acquisition of device application. 4) Patient symptomatic complaints 5) Attendance and participation of increased workload in therapy group gym exercises that may affect length of stay.

Evaluation:
3rd Q'08- Unit was above NDNQI benchmark at 43% of falls with moderate to severe injuries compared to 2.6% for the national average.4th Q'08 results = 0% injury rate on the Nursing Unit as compared to the NDNQI Benchmark of 2.13%. There were zero falls related to orthostatic hypotension.

Implications for Practice:
As a result of the implementation of Daily Orthostatic B/P monitoring/ evaluation with application of supportive devices plus timely evaluation of medication changes there was a significant reduction in the number of moderate to severe injuries that occurred for the 4th Quarter of 2008.