Background Orthostatic Hypotension (OH) is a drop of ≥20?mmHg systolic blood pressure (BP) and/or diastolic 10?mmHg within 3 minutes of orthostatic stress.¹ OH seems highly prevalent in advanced cancer. Comorbidities and anti-hypertensives increase OH risk and falls risk. Consequently cancer patients in palliative settings are high fall risks.²

Objectives BP and OH measurement practices and post-fall interventions were audited amongst in-patients with advanced cancer.

Methods A retrospective analysis of four consecutive months of cancer admissions to a specialist palliative care unit was conducted. Data was obtained from 168 non-randomly selected clinical records. Information recorded included: demographics, falls risk assessment, falls occurrence, BP and relevant medications. The audit was against standards for current institutional clinical policies.

Findings Of 168 admissions, 136 (81%) had the Falls Risk Screening Tool completed. 143 of them (85%) had BP recorded, while 25 (15%) did not. There were 7 falls during the first week post-admission. Post-fall, 5 had BP measured; 2 did not. Only 1 of the 7 who fell had OH measured.

Conclusions During the audit period none of clinical standards were fully completed. There were 7 falls in one week and only 1 had the required OH measurement conducted. Some admission tools were misinterpreted or were ambiguous. Review of institutional admission tools could increase compliance and clinical standard adherence, especially if tailored for a palliative care cohort. OH may be underdiagnosed.

References

1. . Chambers JC. Should we screen hospice inpatients for orthostatic hypotension?PalliativeMedicine 2005;19(4):314–8.

2. . Stone CA, Lawlor PG, Kenny RA. How to identify patients with cancer at risk of falling: a review of the evidence. Journal of Palliative Medicine 2011;14;(2):221–230.