Nonpharmacologic Management of Orthostatic Hypotension in Inpatient Rehabilitation: A Quality Improvement Initiative.

PROBLEM: Orthostatic hypotension (OH) prevents many patients with stroke from fully engaging in rehabilitation therapy, slowing progress during a key stage of poststroke recovery.

AVAILABLE KNOWLEDGE: During inpatient rehabilitation, patients with ischemic stroke frequently experience OH, which can significantly limit participation in therapy. Conservative management of OH entails nonpharmacological measures like compression garments, physical countermeasures, and oral hydration.

DESIGN

A multidisciplinary team (nursing, physicians, and therapists) developed a protocol for managing OH with nonpharmacological interventions based on a literature review. This protocol was specifically designed for patients recovering from ischemic stroke in an inpatient rehabilitation unit.

STRATEGY: The protocol included the application of compression stockings, abdominal binders, increased oral fluid intake (water), and physical exercises to manage symptomatic OH.

RESULTS

Fifteen of 22 episodes of OH were successfully managed with nonpharmacological interventions, allowing patients to engage in therapy.

INTERPRETATION: This quality improvement initiative created a standardized, effective protocol for managing OH in patients with ischemic stroke that all members of the team could enact without physician input, minimized missed therapy sessions, and improved participation in rehabilitation.