Where it began with Flo:

Over the last 3 years, the team had been delivering a phone based service for their patients with an administrator calling mums post discharge from hospital, to see how they were getting on and to direct them to services new mums may find helpful.  Whilst looking for a sustainable approach to delivering this service that could meet the needs of their new mums in the changing climate, Helen Fidgeon (Senior Health Improvement Practitioner) discovered Flo. 

After reviewing outcomes delivered by other breastfeeding support teams who had recruited Flo, the team at Dudley were inspired to read how Flo was seen as a “Friend” to mums, and felt that this would offer a perfect transition from the current service which was highly regarded.  Flo’s persona was an incredibly important element to ensure that the personal touch appreciated by mums remained; the team understood that they could not replace the current phone service with “just: an automated messaging service”.

Next steps and implementation:

Once the decision had been made to move forward with Flo, the next step was to develop a robust business case to their Senior Management team capturing the team’s ideas and utilising evidence collated from the Simple Telehealth Community of Practice, which to their delight was approved.  Throughout the early stages of planning and implementation, the team worked alongside the Maternity and Health Visiting Service which proved to be key to the success of implementing Flo quickly.  The team also benefited from significant support via the Maternity Clinical Lead, who assisted with clinical governance assurance and ensuring that the aim of the new service, and how Flo would interact with mums, supported local hospital policies.

During the planning stages, the staff who had been identified as most appropriate to introduce mums to Flo were in fact 3rd party employees.  This presented the team with a challenge to comply with local Information & Governance policies.  However with the support of the senior team and their governance lead, this was quickly overcome and the team were able to continue their progress.

The team’s specific aim in using Flo was to increase both breastfeeding initiation and subsequent continuation rates for between 6 and 8 weeks, whilst still offering mums a personable approach to the support they needed.

The breastfeeding rates in Dudley are some of the lowest in the country, so it was particularly important for the team to be able to engage with pregnant ladies as early as possible.  It was felt that by integrating Flo into their service they would be able to reach out to pregnant women as well as mums who had recently delivered their babies.

Whilst increasing breastfeeding rates was the main aim of the pathway, rather than just concentrate on this alone, the team were keen to develop a holistic approach with antenatal protocols.  These protocols helped to build relationships between the team and mums in their care, whilst providing education about the changes their babies would go through during the first few days following birth.  Along with this, mums were signposted to the local support available to them.

Following their in depth review of the existing use of Flo for breastfeeding support across the Community of Practice, the team felt confident in developing their own local pathway.  At this stage the local administrator's knowledge and experience (gained from listening to new mums stories) became invaluable.  The team were able to integrate this knowledge into Flo's interactions to maximise the relevance and personal nature of the service.

Flo’s interactions were therefore designed around “Dudley Mums” experiences and their specific support needs which the team were able to identify following their discharge from hospital.  Finally all of the pathways developed by the team were reviewed and approved by the Maternity Clinical Lead ensuring compliance with local governance and hospital policies.

Introducing Flo to patients:

The task of introducing Flo was very much a team effort and to support the service, bespoke patient leaflets were developed with input from the whole service.

Ladies were identified and consented for Flo opportunistically via three routes, the first being Community Midwives who consented mums-to-be on to the antenatal pathway from 28 weeks onwards, secondly, post delivery the Maternity Infant Feeding Assistants (MIFA) discussed and consented new mums on hospital wards.  Both teams received training around the initial discussion to introduce Flo to patients, as well as patient consent.  Once the training was completed, the team were able to complete consent forms with mums across the community and wards, these were then passed on to the dedicated Flo administrator who would create a Flo record and enrol patients on to an appropriate pathway.

Lastly, mums were introduced to Flo via the antenatal clinic at the local hospital with a joint approach between midwives and the Flo administrator.  Midwives would lead the initial discussion in clinic, and then refer mums to a separate clinic area where the Flo administrator would take them through what to expect and to complete their consent form before finally enrolling them into the service.  Often mums attending the antenatal clinics would opt in at this stage if they had their mobile phone with them.  By utilising the Flo administrator for this initial face to face appointment, the team were able to provide a very personalised service antenatally whilst saving time in their clinical appointments.

Challenges:

After local testing within the team it became apparent that some of the testers with android handsets had been receiving automated notifications from the mobile network provider to warn against possible charges for messaging.

Flo is a free service for patients to use in the UK.  However with shortcode numbers often being used for promotional activities at premium rates, some providers inappropriately send out blanket notifications to their customers wherever any shortcode number is used, even in the case of Flo’s free to text shortcode.  The team identified this as a potential barrier to mums using the service, and to overcome this they incorporated guidance into their patient information leaflet to provide assurance that all interactions with Flo are free to patients in the UK.  They also ensured that the midwives and MIFA’s were made aware of the incorrect network shortcode notices so that it became part of the discussion with the patient during their initial contact.

Specifically for antenatal enrolment, the question of how the team would identify when a mum delivered needed to be addressed.  To tackle this, the team were able to use Flo to their advantage by creating a message within the antenatal pathway asking mum’s to share their baby’s birthday with Flo.  Flo then notified the Flo Administrator who could then easily assign the appropriate postnatal pathway to the patient.

The team created a variety of different postnatal pathways to support this approach, ensuring that mums were able to be assigned to an appropriate postnatal pathway for up to 5 days after giving birth.  Each pathway ensured that mums received educational messages which were relevant to the age of their new born baby.

Early in their journey with Flo, the administrator was only able to enrol patients from her desktop PC, which on some occasions resulted in mums who had consented to Flo experiencing a few days delay in receiving their opt in message.

This meant they were potentially missing out on some of the valuable early education and information about changes in their babies within their first few days.  To better support mums and to ensure they could be enrolled onto Flo as soon as possible, the team purchased a wi-fi enabled tablet which allowed the Flo administrator to have mobile access to Flo to enrol mums more quickly, and often within the clinic at the time of their initial contact.