Purpose of Session. Purpose of Study. Staff Knowledge of Orthostatic Vital Signs Measurement in the Hospital Setting 10/10/2017

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1 Staff Knowledge of Orthostatic Vital Signs Measurement in the Hospital Setting Kathleen Schell, PhD, RN Denise Lyons, DNP, APRN, AGCNS BC Purpose of Session The purpose of this activity is to enable the learner to describe staff knowledge of orthostatic vital signs measurement in the hospital setting. Purpose of Study Primary Objective to determine nursing staff knowledge of the proper procedure for measuring orthostatic vital signs. Secondary Objective to determine staff knowledge of abnormal orthostatic blood pressure (BP) findings. 1

2 Background Orthostatic hypotension (OH) contributes to falls in the geriatric population. A fall is considered a hospital acquired condition, not reimbursable by CMS. Orthostatic BPs are often included in clinical management guidelines for those with fall risk. Feasibility, usefulness and time required for orthostatic BPs are questioned. Measurement inaccuracy and misinterpretation are possible. Brief Summary of Literature Review Measurement Challenges: Aydin, Soysal, & Isik, 2017; Cooke, Carew, O Connor, Costelloe, Sheehy & Lyons, 2009; Dind, Short, Ekhlm, & Holdgate, 2011; McDonald et al., 2016; Soysal, Aydin, Okudu, & Isik, 2016 Variation in measuring OH with regards to time of day, device, and position Need for more than one set of measurements OH is often not reproducible Nurses Knowledge: Vloet, Smits, Frederiks, Hoefnagels & Jansen (2002) Methods Descriptive survey study, convenience sample Knowledge of Orthostatic Vital Signs Survey developed by investigators Survey ed to 2,303 staff in direct patient care on a total of 31 patient care units at Christiana and Wilmington hospitals of the CCHS in Delaware. IRB approval was obtained from CCHS and University of Delaware. 2

3 Study Instrument Validity literature review, on line Lippincott Procedures, AHRQ and ENA practice guidelines, local experts and staff Flesch Kinkaid Readability scale grade level 7.1 Knowledge of Orthostatic Vital Signs Survey 15 multiple choice items Demographics role, service line, years of experience in this role, highest level of formal education Frequency of Ortho VS measurement Perception of Ortho VS measurement accuracy on unit Measurement device (sphygmomanometer or automatic machine) Ortho VS knowledge (8 questions) Sample 12% survey response rate (n=247) The majority worked on medical units or in emergency departments. 3

4 Demographics Service Line Demographics STAFF ROLE % Registered Nurse 80 Unlicensed Assistant Personnel 12 Student Nurse Extern 5 Other 3 YEARS OF EXPERIENCE % < 1 year years years years years 4 >20 years 14 Highest Level of Formal Education HIGHEST LEVEL OF FORMAL EDUCATION % Master s or Doctoral Degree 20 Bachelor s Degree 57 Associate s Degree 12 High School 7 Other 4 4

5 Frequency & Measurement Accuracy Measurement Device Sphygmomanometer: 3% Automatic BP Machine: 41% Both: 56% Knowledge Arm at Heart Level 68% correct 5

6 Knowledge Cuff Size Bladder Length: 34% correct Bladder Width: 54% correct Length 80% Width 40% (of arm circumference) 2017 UpToDate Position & Time Supine 48% correct Position & Time Supine to Sitting After the patient changes position from supine (flat on back) to sitting position, when should you re assess vital signs? 35% correct 6

7 Position & Time Sitting to Standing 34% correct Confirmation of Systolic OH When would postural or orthostatic hypotension be confirmed for the systolic blood pressure? 57% correct Confirmation of Diastolic OH When would postural or orthostatic hypotension be confirmed for the diastolic blood pressure? 80% correct 7

8 Summary of Results Most respondents did not know how to properly size the BP cuff and were uncertain of timing of BP measurements with position changes. 43% of respondents correctly identified abnormal orthostatic systolic BP findings (20 mm Hg drop). 80% of respondents were aware of abnormal orthostatic diastolic BP findings (10 mm Hg drop). Conclusions & Implications There are identified staff knowledge gaps about the proper procedure for measuring orthostatic vital signs. Further education is necessary. Confirming that published protocols are evidence based and up to date is imperative. Further research is needed. Limitations Convenience sample at one location Low survey response rate Survey needs further evaluation of validity and reliability Inability to determine if subjects used resources to answer survey Extent of orthostatic vital sign training varies across educational programs and settings heterogeneous sample Knowledge does not always match behavior 8

9 Thank you to our staff participants! 9

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