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Getting started with Flo

posted 28 Feb 2018, 13:33 by Hollie O'Connell   [ updated 28 Mar 2018, 02:00 ]

Raigmore Hospital 
NHS Highland Health Board 



Christine Taylor 
Clinical Nurse Specialist, Chronic Pain Service 


01 March 2018 


When I began to work with NHS Highland’s Chronic Pain Team, there was an existing Pain Management Group which ran for 6 weeks at a time for 3 hours every Wednesday.  Flo was supporting patients after they had attended the sessions to consolidate the learning and motivate them to integrate the techniques into their self-care. 

Due to the rural geography across the Highlands, part of my new role was to lead a “Distance Pain Management Plan” using a workbook alongside telephone support to try and help my patients implement some of the self-care strategies that we talk about, with the aim of patients improving their quality of living with chronic pain.


Where the idea started 
I had one patient who had been on the Distance Pain Management Plan for a year when I met him, on average this is twice as long as most patients.  The patient was very socially unsupported and became dependent on my calls, often waiting for them each month as a crutch for a chat.  This patient stood out to me as someone who would really benefit from increased support in between my monthly calls with him.  This would provide him with extra guidance and motivation to put in place some of the strategies that we discuss.  The frequent interactions with Flo around his pain management would be perfect; perhaps the patient would no longer be able to say, "I forgot to set a goal or listen to my relaxation CD" and I could really start to help him get on track with Flo’s help.  I spoke to my colleagues from the weekly groups who helped to get me started.  I was really excited at this point as I started to see how Flo could really unfold and start to fill a gap. 

One of the known challenges with the Distance Pain Management Plan is the patient taking those initial steps to improving their self-care after we first met in week one.  At this point it’s really important for patients to start taking actions, such as setting their baseline targets and incorporating key strategies into their lifestyle.  However very often when I called back one month later less than 50% of patients had actually put these plans in place, and were unfortunately experiencing the same pain level.

My aim with Flo was to really maximise the first month’s engagement with the patient and therefore keep them to the 5-6 month plan target, rather than what for many was becoming 7-8 months (or longer).  The Distance Pain Management Plan is more likely to be effective if patients put it into practice with support, so Flo seemed ideal for this.  The plan also gave me the opportunity to help more people as patients were achieving their pain goals quicker.
How did I get started?I contacted Joanna Gilliatt from our local TEC Team who was fabulous, and helped to agree the protocol most suitable for my cohort of patients.  Having never done anything like this before I was pleasantly surprised as to how easy it was.  Joanna kept me right with creating the content including how and why Flo would interact and also helped with any questions I had.  Joanna and I had 3 meetings and we were able to progress everything else via e-mail so it fitted into my part-time work and was very flexible to put together.

We found poor phone signal in some areas a little challenging along with some patients who were already on the plan being a little resistant, they could no longer say "I forgot" and had become used to my phone contact.  However with reassurance that Flo was there to support them in between they soon came on board.  New patients however were very accepting of the idea.


“My Friend” Flo
The one thing some patients comment at the start of using Flo is "will it feel cold and mechanical", but often after a month or two they feel that Flo has become a "friend" and tell me they actually look forward to her prompts.

Most importantly for me and my patients is the ease of use and the difference that Flo is making to keep patients on track.  Flo has also helped highlight which patients feel the plan is not for them earlier; when faced with Flo’s prompts they have a choice to make about taking part or not which was something that had not occurred to me.

I decided to use Flo to find out how patients felt about her; if prompts were too often, too few or just right.  So far all responses have been positive including comments of "doing things so as not to let Flo down" and "as memory and concentration poor a great help".  The Distance Pain Management Plans last for 6 months on average so I have only had feedback from 5 patients so far, but as of yet I have had no negative reviews.  My original patient who was the source of thought for starting with Flo would not take part, but I feel over the next year I will see benefits for me and my patients and hope that it becomes routine for all patients to start Flo automatically at the start of their plan.

To anyone thinking that Flo could benefit their work - try her out!  The TEC team were a fabulous help and resource. I had minimal computer experience and have never done anything like this before but got it off the ground easily.