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Shared Learning supports Best Practice: Implementation of Flo for BP Monitoring in Forth Valley

posted 18 Apr 2019, 04:20 by Hollie O'Connell
  
Colin McGregor  
eHealth Project Officer 


18 April 2019 


Colin McGregor is an eHealth Project Officer at NHS Forth Valley, and has taken a leading role in the expansion of Flo within Forth Valley.  Colin has recently taken some time to discuss his journey with Flo.

Why did we want to use Flo?

Here in NHS Forth Valley, we had 54 GP practices that all had slightly different processes around monitoring the blood pressure of their patients.  Most practices had adopted a light touch form of Home Monitoring by offering their patients a BP monitor to take home with them, and then write down their readings on a piece of paper to hand back into the practice at the end of the week.  This proved challenging for the practice as some patients either lost the piece of paper, or forgot to record their readings, which was subsequently delaying time for a diagnosis or any adjustments that were needed to their medication.

I first heard of Flo from Ann Allison, Technology Enabled Care Lead for Forth Valley.   I had come into post in December 2017, working with the TEC team helping to implement new ways of supporting patients to manage their conditions from home.  Ann’s enthusiasm about Flo sparked me to learn more, and I was impressed at how simple but effective Flo can be in managing a range of conditions.

How did we get started with Flo?

Working with our EPQI (Efficiency, Productivity, Quality and Innovation) team, we were able to create a plan of how we would offer Flo to services.  Due to local need and the strong evidence base that existed already, we decided to focus initially on Blood Pressure Monitoring within primary care and scale up from there.

Other health boards in Scotland who had already established the use of Florence were very happy to share their learning including processes and protocols.  With the potential to scope some regional work we decided to work closely with NHS Ayrshire & Arran to share learning across the two Health Boards.  This was massively beneficial in assisting us to develop our pathways, protocols and documentation.

Our protocols were slightly adapted versions of NHS Ayrshire & Arran’s BP monitoring protocols; Protocol 1 runs for one week for diagnosis or exclusion of hypertension, and Protocol 2 runs for 4 weeks to assist with titration of mediation for patients with an existing hypertension diagnosis.  We developed both protocols with the aim of assisting clinical decision making and reducing the number of appointments needed with clinicians, as well as helping patients feel more in control of their healthcare with helpful prompts to take their readings.

My efforts then turned to trying to engage some GP practices to become our pilot sites.  I attended a variety of meetings with both clinicians and practice managers to demonstrate and talk about Flo.   Five pilot sites came forward, although some still had concerns with regards to how effective they thought Flo would be for their practice.  We purchased 150 BP monitors and a supply of additional large cuffs to give to practices to help them get started.  We also built a helpful ‘practice pack’ which we would give out to practices, containing information for both clinicians and patients.  The packs contained a bundle of patient leaflets, a shared management plan and a clinician’s guide.

I provided practices with training sessions, which gave them information about Flo, how and why she works and how she could support patients to adhere to local clinician’s best practice in NHS Forth Valley.   During the training, I would give staff a run through of Flo, showing them how easy it was to navigate and to add a new patient.  I tried to make the training sessions last no longer than 1 hour, as it was a struggle to get any more time than this with busy clinicians. I feel that the best way to learn about Flo would be by starting your first 2 or 3 patients on a protocol and giving it a go.

How did we keep practices engaged?

We went live in our first five practices, and we were soon getting interest from others, so we decided to continue to work with practices more widely.   I was able to keep practices engaged by visiting them a few months after their go live date to iron out any teething issues.  I would also send out a monthly email to all practice managers to update them on progress with Flo across the Health Board, with an update of how many practices were live and how many patients had benefited in total.

What have we achieved with Flo’s help?

As of March 2019, Flo is currently offered to patients in 21 practices, and we have had over 200 patients interact with our BP monitoring protocols.

Feedback around Flo has been very positive, with one practice reporting they “saved 12 appointments after their first 9 patients.”

Patients have also found Flo very useful, with 100% of patients finding Florence easy to use and 91% saying that Flo helped them to more effectively monitor their blood pressure with helpful reminders.

Where next?

In recent months we have begun to use Flo to assist the Dietetics team with their weight management pathways and our Respiratory teams for COPD.  We are excited to continue working with Flo to ensure patients receive the best quality care through using innovative TEC solutions.

Ann Allison & Colin McGregor