B.ZHU1, FAHREIN G.B.1
Tan Tock Seng Hospital1
Orthostatic hypotension affects 17% of elderly in the community and up to 50% elderly in primary care. Orthostatic hypotension predicts adverse outcomes such as fall, functional decline, prolonged hospitalization, high morbidity and mortality. The stepwise approach with non-pharmacological interventions as the first-line therapy with pharmacological measures as an adjunct therapy if non-pharmacological interventions are ineffective.
Our project “Postural Hypotension Nurse-led Care Bundle (5+1)” was implemented in subacute ward 8 at Tan Tock Seng Hospital (TTSH), with the aim of improving nurses’ compliance rate of non-pharmacological interventions.
Project team voted for the top 3 contributing factors as lack of standardized care protocol, insufficient fluid intake, nurses’ knowledge deficiency on postural hypotension management. To address these, we developed a nurse-led care bundle and conducted in-service teaching.
The result had shown a significant improvement of nurses’ knowledge in post-test, 47.5% increment of compliancy, 2.5% reduction of postural hypotension medication initiation, no postural-related fall during project period.
The care bundle consisted of bed elevation at night, morning bolus water, scheduling and encouraging fluid intake, counter-maneuvers and exercise. Through classroom teaching and case discussion, a significant improvement in nurses’ knowledge, which is an important factor, resulted in an increment of compliancy of care bundle. With the compliancy of care bundle, it reduced initiation of postural hypotension medication and prevented postural-related fall.
Currently all subacute wards at TTSH had implemented this care-bundle. As the absence of standardized nursing workflow of postural hypotension management, it posts a need to develop the workflow in the near future.