Evaluation of skills and knowledge on orthostatic blood pressure measurements in elderly patients

OBJECTIVES: orthostatic hypotension is a common and potentially dangerous condition in elderly patients, often accompanied by dizziness and falls. To diagnose orthostatic hypotension, many physicians rely on blood pressure measurements performed by nurses. DESIGN: observational and descriptive study. SETTING: departments of Internal Medicine, Geriatric Medicine, and Surgery in eight hospitals throughout the Netherlands. SUBJECTS: 170 nurses working with elderly people in a general hospital. We selected a sample of 10 nurses on 17 participating wards. METHODS: to evaluate nurses' skills and knowledge on blood pressure measurements to diagnose orthostatic hypotension, we performed standardized observations, based on published guidelines, of supine and standing blood pressure determination in patients over 65 years. RESULTS: the most important deviations in technique of orthostatic blood pressure measurement from the published guidelines were: time between measuring supine and standing blood pressure varied from 0-30 minutes; in 28% the arm position was not at heart level during standing blood pressure measurements; in 46% the cuff was placed incorrectly. CONCLUSIONS: the skills and knowledge of nurses to measure supine and standing blood pressure are inaccurate for diagnosing orthostatic hypotension in elderly patients. Large differences in measurement technique and timing of standing blood pressure could influence the individual detection and treatment of orthostatic hypotension and the reported prevalence of orthostatic hypotension. The blood pressure measurement procedure to diagnose orthostatic hypotension needs more standardization and implementation of guidelines in daily practice.