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Post-discharge reassurance and support for patients and carers

posted 8 Nov 2018, 11:49 by Hollie Stirman
Agnieszka Belz  
Pharmacy Technician Carer Support Worker 

08 November 2018 

Agnieszka Belz is a Prescribing Support Pharmacy Technician at NHS Lothian.  Agnieszka was first introduced to Flo as part of her role as a Pharmacy Technician Carer Support Worker within the Edinburgh Carer Support Team.  The team recruited Flo to continue the conversation and provide patients with additional advice and signposting after being discharged from hospital.  Agnieszka employed Flo as a medication prompting tool and has shared her experiences of how Flo has motivated her patients to increase adherence with their medication during this key transition from hospital to home.

How did I hear about Flo?

I already had some knowledge that local clinicians were innovating with Flo across NHS Lothian.  They were experiencing really positive outcomes that were being demonstrated across various aspects of patient’s health.   I had identified a cohort of patients under my care, who would benefit from some support aimed at improving their adherence to their medication regime.  As I was searching for a tool to support this, Flo sounded like a great match as an opportunistic tool for the patients and carers I supported.   Therefore, the Edinburgh Carer Support Team chose to innovate with Flo to support unpaid carers in their roles relating to medication compliance.

Why did I want to use Flo?

My passion is to support patients and their carers with their medication during and after their hospital discharge, which can understandably be a difficult time.  So far I have learned that discharges, and the changes associated with leaving hospital, bring lots of anxiety and uncertainty to family members and friends.  Family and friends often undertake the role of unpaid carers and they shared with me some of the issues which they experience:

“ How will I remember to remind my loved one to take their new medication? 

“ Will I be able to leave the house without worrying that my loved one will take their medication or will I have to stay with him during medication administration times? ” 

Locally, I shared my idea with Elizabeth Payne, who was my line manager and the Project Development Manager at the time.  Elizabeth was more than happy to support me in implementing Flo as a remote medication prompt for my patients and their carers.

What stood out for me about Flo?

Probably that I could easily create a medication reminder prompts specific to the patient or carer’s individual needs, and even include additional advice for specific medications that was meaningful, e.g. “take out of the fridge”, or “take with full glass of water”, which for some patients is very important and makes adherence more likely.

What were the potential benefits of using Flo?

Once we began to introduce Flo to our patients, I found that there were many potential benefits for my patients and their carers, including:

  • Helping to prevent hospital readmission through the correct administration of medication
  • Safer use of medication due to improved compliance
  • The ability to provide updated information in the reminders when medication changed, or allowing me to make an opportunity to discuss their medication over the phone 
  • Improving independence with no need for a package of care with medication prompts upon discharge
  • Reduced stress for patients and their carers
  • Allowing patients and carers to take part in ‘out of house’ activities, for example carer going to work or on holiday
There were also additional benefits that became apparent for my own clinical practice:

  • I was able to learn more about certain medication regimens which in turn allowed me to provide enhanced care for patients. My learning came about from creating and agreeing the times for medication prompts with the patient and carer.  I found that the routine at home after discharge was different to that while in hospital, so I had to take patient’s lifestyle and habits into consideration.   When creating prompts for the specific agreed times, I had to consider how certain medication worked in relation to food and storage, for example if the medication required refrigeration, how long could it be left unrefrigerated to support the patient’s routine and compliance?  When working with one patient, I researched more about their medication storage, and found out that in certain quantities it was ok to store it at room temperature for number of days.   This meant that the patient could keep it together with other medication, having it all ready when Flo’s prompt arrived.  Identifying issues like this and applying the learning from it helped to improve other patients’ compliance.

What were my first steps with Flo?

One of the first protocols that I developed was aimed at supporting a specific patient who had been diagnosed with Parkinson’s disease, and her sister who lived with her and acted as her carer.  Due to the nature of the condition, the times that the patient’s medication needed to be administered are very specific; if patients with Parkinson’s Disease do not receive their medication on time, their ability to manage their symptoms may be lost.  Therefore I had to consult with the Parkinson’s Nurse in the Western General Hospital for additional input to ensure that the protocol design was accurate.  I decided to use a general medication reminder protocol, and then was able to personalise the protocol for this patient matching Flo’s interactions with the patient’s medication regime.  I found that integrating Flo was quick and easy to manage, and I received great support from the Flo team.