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Single Point of Access reduces need for home visits
Sheffield Teaching Hospitals
NHS Foundation Trust
Jayne Stocks
Clinical Lead Assistive Technology
Jeanette Deslandes
Telehealth Nurse
Joanne Sellers
Health Care Assistant
15 August 2017
In Sheffield Flo has been recruited to optimise community resources and support patients to self-manage their long-term condition(s) better. SPA nurses triage patient contacts where they are being supported via Flo.
SPA nurses have a wealth of telephone triage experience and are usually able to deal with the presenting situation over the phone and only request community nurse visits where clinically necessary. Flo is well positioned to integrate into the SPA model with patient’s contacting the SPA as prompted by Flo should their condition deteriorate.
Role of the Telehealth Team:
The team facilitate the Telehealth pathway and help clinicians within Sheffield Teaching Hospitals Community Services to use the pathway with Flo. Flo is currently used within community services; however, there are emerging opportunities to expand this to acute pathways in the future.
Flo is currently being used by the District Nursing and Community Matron teams to enable patients to self-monitor their long term conditions; for example to send prompts and reminders to take insulin or other medications. The community falls teams: Integrated Care Team Therapy (ICT Therapy) and Assessment & Rehabilitation Centre (ARC) also use Flo to send prompts and reminders to help patients follow their exercise plan.
The Telehealth Team role also includes administration of the Flo system which enables us to keep clinical access to the system up to date.
Role of the Telehealth Team:
The team facilitate the Telehealth pathway and help clinicians within Sheffield Teaching Hospitals Community Services to use the pathway with Flo. Flo is currently used within community services; however, there are emerging opportunities to expand this to acute pathways in the future.
Flo is currently being used by the District Nursing and Community Matron teams to enable patients to self-monitor their long term conditions; for example to send prompts and reminders to take insulin or other medications. The community falls teams: Integrated Care Team Therapy (ICT Therapy) and Assessment & Rehabilitation Centre (ARC) also use Flo to send prompts and reminders to help patients follow their exercise plan.
The Telehealth Team role also includes administration of the Flo system which enables us to keep clinical access to the system up to date.
CASE STUDY ONE
An 83-year-old patient with type 2 diabetes recently commenced with Flo following a referral from their community nurse team. The patient had recently started on insulin and a course of steroids following a recent hospital admission. While in hospital, the patient was taught how to self-administer their own insulin and following this was discharged into the care of the community nurse team for them to provide on-going support with self-administration and monitoring at home.
The patient’s Diabetic Specialist Nurse (DSN) felt that the patient’s insulin dose would need to be reviewed and as the patient was on a reducing dose of steroids, the insulin dose needed to be titrated accordingly to ensure the best outcome for the patient.
Initially community nurses were visiting the patient twice a day to supervise the patient’s self-administration of their insulin, as well as monitoring the patient’s blood sugar levels. The community nurses were gradually able to reduce the number of visits as the patient became more confident. At this point the patient began to receive phone call prompts from the community nurses, but soon after they were referred to Flo for on-going support.
Following referral, our Telehealth Nurse visited the patient to explain how Flo could support them and agree with the patient their shared management plan. On the same visit, the Telehealth Nurse was able to set Flo up and the patient opted in, Flo was now ready to provide ongoing support for the patient by recording and offering advice according to the patient’s blood sugar readings along with prompts to take their insulin as prescribed.
Following referral, our Telehealth Nurse visited the patient to explain how Flo could support them and agree with the patient their shared management plan. On the same visit, the Telehealth Nurse was able to set Flo up and the patient opted in, Flo was now ready to provide ongoing support for the patient by recording and offering advice according to the patient’s blood sugar readings along with prompts to take their insulin as prescribed.
The patient was supported by Flo for just over a month. In that time, the patient felt that they were more confident in managing their insulin regime.
The patient’s evening blood sugars did remain high during this time. Initially these increased levels caused Flo to prompt the patient to phone the SPA (Single Point of Access, a service that manages patient referrals), and each time the patient phoned the SPA the patient felt that their anxiety levels increased demonstrating the importance of providing the patient with a clear self-management plan at home.
Through the readings sent to Flo, we were able to establish that the patient needed a review by the Community Diabetic Specialist Nurse. The patient’s DSN gave the patient further guidelines on their diabetes management and provided the patient with information about who to contact, and when, if they were concerned.
Both the patient and DSN felt that the patient had gained confidence in their diabetes management, resulting in the patient being able to self-manage without the need for further support from Flo, which was a great success!
The outcome from the patient’s experience with Flo was that
The community nursing team have been able to empower the patient to self-manage their insulin regime with the help of Flo, and this has resulted in a reduction of nurse visits to the patient yet an overall increase in the amount of interaction and support the patient had with their diabetes.
Through the readings sent to Flo, we were able to establish that the patient needed a review by the Community Diabetic Specialist Nurse. The patient’s DSN gave the patient further guidelines on their diabetes management and provided the patient with information about who to contact, and when, if they were concerned.
Both the patient and DSN felt that the patient had gained confidence in their diabetes management, resulting in the patient being able to self-manage without the need for further support from Flo, which was a great success!
The outcome from the patient’s experience with Flo was that
- The patient now feels confident in taking their own blood sugar readings
- The patient now feels confident in administering their insulin
- The patient’s sense of independence has improved
- The patient’s awareness of, and ability to manage their diabetes has improved
The community nursing team have been able to empower the patient to self-manage their insulin regime with the help of Flo, and this has resulted in a reduction of nurse visits to the patient yet an overall increase in the amount of interaction and support the patient had with their diabetes.
CASE STUDY TWO
The community nurse team were asked to visit a 65-year-old patient who had a history of Alzheimer's disease and over the previous 6-9 months had been frequently forgetting to take their insulin at home. The patient had been on a pre-meal insulin regime, which they were beginning to struggle to maintain. The patient’s concordance with their medication had been deteriorating, and as a result their HbA1c had increased over this period. Due to this, the patient’s daughter had been phoning to prompt them to take their insulin, however this was difficult for her to do regularly.
The district nurses were asked by the Diabetic Specialist Nurse to visit the patient to supervise a new twice daily regime, and to check the patient's blood glucose levels to titrate the doses of insulin. Within two weeks the nurses felt that the patient was managing well with the new regime, and they referred them to the Florence Telehealth Team. The team suggested that the patient should receive twice daily messages via Flo to check that they were continuing to manage their diabetes. The patient was set up with Flo to prompt them twice daily to take their insulin, as well as to request twice daily blood sugar readings, twice a week.
Initially, the patient was anxious about using their mobile phone, particularly around sending in readings in to Flo. However, following a discussion with their daughter, the team was able to reassure the patient that they would not need to reply to the twice daily prompts to take insulin, and that their daughter could support them to send in the blood sugar readings twice a week. The patient continues to use Flo, self-managing even with a titration in the dose of insulin.
Flo can improve medication concordance, as well as support remote monitoring so that both patients and clinicians can feel confident that the patient has the right support in place when it is needed.
The community nurse is able to review the blood sugar readings on a regular basis, with a view to liaising with the Diabetic Specialist nurse if it is required.
For this patient, community nurse interventions have been reduced. There is no longer the need to phone the patient twice a day, the independence of the patient has also increased and the patient is compliant with their treatment regime.
CASE STUDY THREE
The District Nursing Service was asked to visit a 41 year old patient who required supervision to self-administer their insulin and take blood glucose readings to monitor their diabetes. The patient had ongoing problems with anxiety and depression, and was finding it increasingly difficult to remember to take their insulin twice daily. The patient was reviewed by the Diabetic Specialist Nurse, who was concerned that they were forgetting both doses of insulin as a result the patient’s blood sugars were elevated, leading to further complications. The patient was referred to the district nurse service for once daily supervision of self-administration of insulin, initially for 7 days. Following the week of supervision, the patient was referred to the Florence Telehealth Team and in the meantime, the district nurses used phone calls to prompt the patient to take their insulin once a day until Flo was set up. The referral for Flo included monitoring blood glucose twice a day, and to have twice daily prompts to take their insulin and to confirm to Flo once this was completed.
On the second day of being supported by Flo, the patient’s blood sugar was outside of the parameters set by their clinician and the patient was prompted to contact the Single Point of Access (SPA). The patient phoned into SPA as requested and following which they were triaged and reviewed by a GP, and given antibiotics for a chest infection.
The patient continues to use Flo to monitor their diabetes. The readings captured by Flo indicate when the patient has missed any doses of insulin, and when their blood sugars are outside of the acceptable parameters. Importantly, this information is available to the patient’s Community Matron, which enables efficient review of the patient’s care management plan.
The outcome for this patient is that they are once again independent with their insulin administration, and the community nurses no longer have to phone the patient to prompt them to administer their insulin. The patient continues to have support from the Community Matron and Diabetic Specialist Nurse, who find the patient’s reading captured by Flo is valuable in aiding their clinical decision making with regards to the patient’s ongoing care.
CASE STUDY FOUR
A 65 year old patient with Type 1 Diabetes and ongoing mental health issues was finding it increasingly difficult to manage their diabetes. In April 2016 the community nurses were phoning to prompt the patient to self-administer insulin and to take blood sugar readings. The patient was then referred to the Florence Telehealth Team to help support them in monitoring their blood sugars regularly via Flo. The patient’s blood sugars were erratic, with two admissions in the past 12 months for hyperglycaemia, as well as two paramedic calls for hypoglycaemia in the same time period.
The patient now uses Flo prompt and motivate them to monitor their blood sugar levels, as well as receiving regular support from the Community Matron. The Community Matron is able to view the readings the patient sends to Flo, and then liaise with the Diabetic Specialist Nurse to inform the continuing management of the patient’s diabetes.
Flo has helped the patient to increase their independence, by prompting them to take their readings at times convenient to them. Flo also enables the clinicians managing the patient’s care to view the readings regularly, allowing visits and phone calls to be better timed to meet the patient’s needs. Flo supports both patients and clinicians with diabetes management by providing individualised, patient centred care.
# Sheffield Teaching Hospitals # Single Point Access #SPA # Diabetes
Mental health; Flo reinforces coping techniques
Kathryn Sumner
Safe Care Lead / CBT Therapist 26 June 2017
Gateshead Talking Therapies offers a confidential service to people wishing to overcome problems triggered by feeling low, depressed, stressed or anxious focussing on helping people experiencing mild, moderately severe and first onset severe problems. The team specialises in working with people aged 16 or over who have recently developed a problem and helping them to understand it, and prevent it from becoming more severe and disrupting their lives. As well as offering a selection of courses and 1:1 therapy providing interventions recommended by NICE for a range of mental health difficulties – such as anxiety, depression, trauma, stress, bereavement, low self esteem and other emotional issues.
Upon GP or self-referral, the team delivers therapies according to identified needs including Cognitive Behaviour Therapy (CBT), Cognitive Analytical Therapy (CAT), Eye Movement Desensitisation and Reprocessing (EMDR), Interpersonal Therapy (IPT), Mindfulness, Primary Care Mental Health and short courses and Supported Self Help (4-6 weeks).
The team identified that they could extend their reach to support clients after of face-to-face appointments by recruiting Flo as one of the team. Flo’s personal feel was well placed to interact with patients to consolidate the techniques discussed previously and provide a real time nudge to put them into action.
Victoria Rathour, Primary Care Mental Health Worker with Gateshead Talking Therapies Service part of South Tyneside NHS FT has shared some recent case studies from her clients that have been introduced to Flo.
Victoria Rathour, Primary Care Mental Health Worker with Gateshead Talking Therapies Service part of South Tyneside NHS FT has shared some recent case studies from her clients that have been introduced to Flo.
CASE STUDY ONE Not feeling alone, overcoming worry and low self-esteem A client was referred to the Gateshead Talking Therapies experiencing worry and low self-esteem following a relationship break up. These feelings were being exacerbated by some challenging family relationships, especially the client’s sister who she had struggled to build a relationship with as she was in touch and worked with her ex partners’ old girlfriend. The team identified that extended reach support via Flo could extend the team’s support to the client once she had gone back to her daily life after their appointment. The team discussed Flo, and how she may be able to help at the client’s first appointment. Victoria Rathour as the client’s Primary Care Mental Health Worker gave the client Flo’s service information leaflet that had been developed by the team and used this as a basis to explain how Flo could help. The client left the appointment ready to receive Flo’s first message later that day once she had returned home. How Flo helped Flo’s timely interactions supported the client to help identify her own coping strategies and to start to rationalise her own thoughts, particularly around the low self-esteem and worry that she had been experiencing and discussing with the team. The client fed back that by receiving Flo’s messages it made her feel she that she wasn’t the only one suffering from mental health problems which was a significant milestone towards her recovery. The client explained that she found Flo, "very helpful and often looked forward to receiving texts from Flo" When the time came for the client to be discharged, she was in recovery having started to implement the tools and techniques advocated by the team and Flo to improve her self-esteem issues, and she began to make positive changes in her life. The client was very pleased with the service and stated that she may be interested in joining further courses or groups in the future. | CASE STUDY TWO Putting best practice care into practice The team received a referral for a client who was a full time carer for her daughter and was hoping to develop techniques to help her overcome the depression and anxiety that she had been experiencing. The client was finding herself mentally and physically drained from looking after her daughter, and was feeling an extreme amount of pressure and stress from having to liaise with other professionals to ensure that her daughter was receiving the treatment she needed. At the client’s first appointment with the Gateshead Talking Therapies Team, Flo was introduced to extend the impact of the tools and techniques that had been discussed at the appointment to support the client in developing and using her coping strategies once she left the appointment and was back in her caring role. For the client, Flo would be able to regularly interact with her to bring to life the themes discussed at the previous appointment, gently motivating her to reflect and put into practice what she had learned and feel supported and not alone. The client found Flo very helpful and enjoyed receiving her messages. In particular the client found the messages learning about mindfulness useful, and appreciated Flo’s prompts and encouragement to use the coping strategies that she knew she had, but didn’t always use when she needed too. This real time intervention was able to extend the best practice care delivered by the team into the client’s everyday life. Upon being discharged from the team, the client was in recovery and had started really picking up on mindfulness techniques and making plans of activities to do with her husband outside of being a carer for her daughter, which was something she really valued. |
Liverpool Health Trainers and home blood pressure monitoring
Sharon Poll
Liverpool CCG - GPN Lead
30 May 2017
Hypertension case studies
CASE STUDY 1
Patient X was referred to their Health Trainer via their GP practice. The patient had been experiencing strain from their overall health issues combined with a high blood pressure reading which may have been making the patient feel worse.
The patient’s GP identified an opportunity for the patient to be introduced to Flo to facilitate the collection of short term home blood pressure readings. The patient’s GP was keen to understand if there was any change in the patient’s blood pressure at home from that recorded at the surgery to inform a diagnosis or exclusion of hypertension, and to ensure the most appropriate treatment plan was arranged for the patient.
The Health Trainer provided the patient with a hypertension diagnosis shared management plan, and explained to them how Flo would prompt them to send in their blood pressure and also offer advice dependent upon the patient’s reported readings as agreed with their GP. These readings would then be reviewed at the surgery to inform on-going treatment.
The patient left their appointment with their Health Trainer reassured and enrolled onto Flo, awaiting their first request for their blood pressure reading.
Upon further review of the patient’s blood pressure readings, their average blood pressure was within the normal range compared to readings taken solely at the practice, and a diagnosis of hypertension was excluded by the GP.
The Health Trainer commented that having the time to discuss Flo and how she can support the patient’s on-going treatment plan was useful. The patient reported that on the day he had his blood pressure taken in surgery, his shirt had been tight and he was anxious which may have impacted on a false high reading. Using Flo provided the patient with reassurance that their real time home blood pressure readings could be reviewed to provide data for an accurate diagnosis without the impact of external influences brought about by attending the surgery.
The Health Trainer commented;
Patient X was referred to their Health Trainer via their GP practice. The patient had been experiencing strain from their overall health issues combined with a high blood pressure reading which may have been making the patient feel worse.
The patient’s GP identified an opportunity for the patient to be introduced to Flo to facilitate the collection of short term home blood pressure readings. The patient’s GP was keen to understand if there was any change in the patient’s blood pressure at home from that recorded at the surgery to inform a diagnosis or exclusion of hypertension, and to ensure the most appropriate treatment plan was arranged for the patient.
The Health Trainer provided the patient with a hypertension diagnosis shared management plan, and explained to them how Flo would prompt them to send in their blood pressure and also offer advice dependent upon the patient’s reported readings as agreed with their GP. These readings would then be reviewed at the surgery to inform on-going treatment.
The patient left their appointment with their Health Trainer reassured and enrolled onto Flo, awaiting their first request for their blood pressure reading.
Upon further review of the patient’s blood pressure readings, their average blood pressure was within the normal range compared to readings taken solely at the practice, and a diagnosis of hypertension was excluded by the GP.
The Health Trainer commented that having the time to discuss Flo and how she can support the patient’s on-going treatment plan was useful. The patient reported that on the day he had his blood pressure taken in surgery, his shirt had been tight and he was anxious which may have impacted on a false high reading. Using Flo provided the patient with reassurance that their real time home blood pressure readings could be reviewed to provide data for an accurate diagnosis without the impact of external influences brought about by attending the surgery.
The Health Trainer commented;
" Florence totally sorted this out as the patient was more relaxed and not rushed doing it at home. The patient now feels far more reassured. "
CASE STUDY 2 Patient X with uncontrolled hypertension was referred to their Health Trainer by their GP to use Flo. The aim was to support the patient in improving compliance with their hypertensive medication and for education and motivation to adopt a healthier lifestyle in support of gaining better control of their blood pressure. On meeting the patient, the Health Trainer discussed Flo and how she can support the patient’s on-going treatment plan. The patient was quickly enrolled onto an 8 week programme with Flo supported by a shared management plan and guidance on how to take home blood pressure readings. The Health Visitor offered to create a Personal Health Plan for the patient, however the patient was keen to follow Flo’s programme and to make the necessary lifestyle changes. Over the 8 weeks since being introduced to Flo, the patient’s blood pressure control has significantly improved
The patient was thankful for Flo’s additional support and commented that Flo was " a real help to him and kept him on track " and explained to his Health Trainer how he could see the improvements in his blood pressure and the difference it was making for him. Importantly, the patient is now also more aware of the importance of taking his medication as prescribed and aims to continue to make further lifestyle improvements. | CASE STUDY 3 Patient X was referred to her Health Trainer by her practice nurse. The patient’s blood pressure was remaining high regardless of prescribed medication aimed to control it. The nurse had identified using Flo as a tool to compliment the care already being given, helping to motivate and educate the patient to adopt a healthier lifestyle in support of gaining better blood pressure control. Flo was discussed with the patient and the Health Trainer explained what the patient could expect over the next week of home blood pressure monitoring. A demonstration of how to use the blood pressure monitor was provided and a shared management plan was agreed with the patient. The Health Trainer explained the risks associated with high blood pressure and provided brief information regarding how lifestyle improvements can help to control and reduce high blood pressure. The patient visited her GP a few days later and through a discussion around her blood pressure realised she should have been taking three tablets rather than two. The patient’s GP advised her to increase her medication to the prescribed dosage, and to continue to report her blood pressure to Flo for a further two weeks. With the patients improved medication adherence, the GP could review the impact of the new dosage. On review and after increasing her medication to the prescribed dose the patient’s average week reading was 151/98 mmHg. The patient continued to take her blood pressure at home and send them to Flo for a further two weeks. Based on the patient’s reported home blood pressure readings via Flo, the GP was able to intervene earlier upon identifying that the patient’s blood pressure medication needed to be increased; the GP subsequently requested that the patient continue to send Flo her home readings for a further week. At the patient’s last review, the benefits of leading a healthy lifestyle were recapped, and information on the Health Trainer service was provided for any help or support to make lifestyle changes. The patient’s average blood pressure at the end of the home monitoring via Flo had fallen to 118/84 mmHg and the GP was now confident that her antihypertensive medication had been titrated accurately. |
Podiatry team prevent deterioration and exacerbations with Flo
Pennine Care
NHS Foundation Trust
Clinical Specialist Podiatrist
19 May 2017
(E029) Flo helps diabetic patients care for their feet
Flo has been supporting patients with diabetes to care for their feet in-between routine clinic visits in Oldham, using her friendly persona to motivate patients to undertake daily foot checks and subsequently providing patients with the capability to identify if, and when, their feet need to be seen by the Specialist Team.
Debra Drury, a Clinical Specialist Podiatrist at Oldham Podiatry Department recently took some time to tell us how Flo is being used to help their patients with diabetes care for their feet.
"We had heard about Flo through Michelle Flint, who is leading the project in Oldham, and quickly identified an opportunity to support our patients to self care in-between face to face consultations. We hoped that Flo could help our patients to identify problems with their feet that need our intervention and empower them to seek support sooner, thereby avoiding further deterioration.
What was the challenge?
We know that keeping feet healthy can be difficult for patients with diabetes. Often patients don’t realise that there is a problem until it has deteriorated as patients can have a loss of sensation in their feet. In this case, any break in the skin can develop into a foot ulcer and exacerbate quickly, compromising the patient clinically and elongating the treatment plan required. Sometimes we ask patients ‘How long have you had this wound?’, and they’ll answer ‘8 weeks’, meaning that we are now dealing with a more complex wound that will take longer to treat and have a greater impact on the patient’s lives. This is very common, patients don’t always recognise the importance of looking after their feet and often think they can put a plaster on and sort it out themselves.
Where did we focus?
Active self care is so important for patients with diabetes. Many of our patients are gentlemen over the age of 50 who we find can be less engaged and motivated to take on board the foot health education that we have been providing in clinic. As a team we recognise the importance and actively educate our patients so that they feel confident in their foot care at home. However, it has proved challenging to generate sufficient engagement for patients to enable them to understand that the condition of their feet needs close attention by them in-between appointments, or even to acknowledge the importance of just attending their routine foot clinic appointments.
We provide paper based education for our patients to take away, however the impact of this is limited and it becomes apparent that it does not always result in helping our patients to become motivated to self care. We often find it screwed up in their wound dressing bags ourselves when they come in for their appointments! Therefore we looked to Flo to engage with our patients outside of clinic appointments to provide them with the motivation and capability to self care effectively.
Flo interacts with our patients every evening to remind them to check their feet for any change or damage, along with offering regular advice and information pertinent to their foot care. We recognised that most patients use their mobile phone regularly, and so we know that Flo is in their pocket rather than in the bottom of a bag! It’s also reassuring to know that Flo’s messages are recorded on the patient’s phone enabling patients to look back on them at anytime should they need a recap. The reinforcement that Flo provides around the importance of attending clinic for regular foot checks is also really important, to support an increase in the patient’s motivation and ability to self care in-between.
Here at Oldham Podiatry Department we operate a two tier system: high risk and routine. When we discharge patients from the high risk clinic to the routine clinic, some patients tell us that they can feel vulnerable, even though they are under shared care where the patient is seen weekly or fortnightly by the high risk team alongside routine follow up with podiatry. This feeling can be present especially if the patient has had a long-standing foot ulcer and built up a close rapport of trust with specialist staff or if they have had amputation.
Using Flo offers additional support in this transition, patients still have a link to us via Flo which increases patient’s confidence and that feeling of being supported.
What do patients think?
Recently we’ve had a lovely handwritten letter from a gentleman that describes how his feet have “ never been as good as they are now ”. The patient goes onto explain how he now applies his cream on at 7 o’clock when Flo tells him to! Self care can be challenging, and we strive to ensure that we support our patients effectively so that they feel confident and motivated to engage regularly in their foot care; that’s what Flo is helping us to teach them.
Click image to enlarge
Another patient who Flo has helped is Shane.
Shane explained that for him, it was Flo’s friendly, daily message that motivated him to pay more attention to his feet. Shane didn’t actually use the word 'nagging', but almost! Shane said that Flo’s reminders to check his feet were useful and he soon found that he was acting on Flo’s prompt in real time. One day, whilst doing his daily foot check, Shane discovered that a wound had developed. Although Shane choose to not contact the Podiatry Team immediately, when he got his next message a day later from Flo reinforcing his self care advice, Shane thought " I'd better do something about it ”. Flo’s regular reinforcement was important in making sure that Shane was motivated to take the necessary action and contact us to review his wound before it got any worse.
Shane explained that for him, it was Flo’s friendly, daily message that motivated him to pay more attention to his feet. Shane didn’t actually use the word 'nagging', but almost! Shane said that Flo’s reminders to check his feet were useful and he soon found that he was acting on Flo’s prompt in real time. One day, whilst doing his daily foot check, Shane discovered that a wound had developed. Although Shane choose to not contact the Podiatry Team immediately, when he got his next message a day later from Flo reinforcing his self care advice, Shane thought " I'd better do something about it ”. Flo’s regular reinforcement was important in making sure that Shane was motivated to take the necessary action and contact us to review his wound before it got any worse.
You can hear Shane discussing his experience in this video.
We’ve now introduced Flo for patients who have undergone nail surgery to support them to self care for their wounds post discharge. Flo is helping patients to identify any deterioration sooner and motivate them to seek help earlier before the symptoms worsen. This is a younger patient cohort so Flo has proved very popular with this group, fitting even more easily into their lifestyles.
Moving forward, we hope that even more patients with diabetes are introduced to Flo. We’ve had patients who’ve come into clinic and given us anecdotal feedback that their feet are in a much better condition, so now our next step is to collect robust clinical evidence to support this. We’ll be reviewing all of our Flo patients to establish a picture of their condition before Flo and what it’s been like since, regarding ulceration and their presentation at clinic. I am passionate about taking this forward, because I have seen that Flo is of real benefit to our patients.
"
“Even if Flo is helping just a quarter of the patients we have on our caseload, that’s massive, it's really is massive.”
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E029_ Oldham Podiatry Diabetic Foot messagesE029_ Oldham Podiatry Diabetic Foot chart
#Diabetes #Podiatry #Pennine Care
Significant reduction in clinical contacts as Patient's Mental Health is stabilised with Flo.
South Tyneside
NHS Foundation Trust
Helen Thompson
Safe Care Lead
15 May 2017
Patient's mental health is transformed after Flo's help to improve medication adherence
Helen Thompson, Safe Care Lead and Jan Gorman, Health Care Support Worker from the Learning Disabilities Service at South Tyneside NHS Foundation Trust discusses how intervening with Flo has regained the independence of one of their patients with mild learning difficulties, resulting in their mental health stabilising and removing the need for continuing home visits from their team and the number of Consultant Psychiatrist appointments required. “Fred” was an individual with mild Learning Disabilities who had also experienced a decline in his mental health. Due to this decline, Fred was on the active caseloads of both his Consultant Psychiatrist and Community Learning Disabilities Nursing Team in South Tyneside. Emerging from this increased clinical input were concerns regarding Fred’s adherence to his medication regime, the cause of an ongoing decline in his mental health. Before using Flo, Fred required several home visits from a Health Care Support worker to prompt him with regards to his medication compliance, and at the time the Community Nurse was also visiting him more often than would normally be required. In conjunction, Fred’s Consultant Psychiatrist was also offering more regular appointments as a result of symptoms of low mood. Despite these additional face-to-face interventions, Fred continued to have fluctuating compliance with his medication regime and associated symptoms due to this non-compliance. Therefore, the Community Nursing Team felt that Flo would offer Fred an opportunity to receive supportive messages to help guide him towards taking his medication more regularly as prescribed. The team hoped that Flo would help to reduce the symptoms that Fred was experiencing associated with his non-compliance and would maintain his independence, so he would not need to continue receiving the now regular face-to-face interventions. Following the introduction to Flo's unique persona, Fred was signed up to a protocol designed to support him to improve his medication adherence. This involved Fred having three messages from Flo each day at key times, reminding him of the need to take his tablets as prescribed. | With Flo’s helpful reminders, Fred began to change his behaviour to become more complaint with his medication and as a result he started to make good progress, with his compliance improving over a period of several months. During the time that Flo was helping Fred, Community Nurse and Health Care Support Worker visits were able to be gradually reduced. It wasn’t long before Fred also needed less Consultant Psychiatry appointments, with the improvement in his medication compliance resulting in his mental health becoming more stable. Now Fred no longer needs Flo to remind him to take his medication – which is a huge success! Flo has gently helped Fred to establish his own regular routine for taking his medication on time. The impact of this improved medication adherence stabilised Fred’s mental health, resulting in him no longer being an open case to Community Learning Disabilities Nursing or his Health Care Support Worker. Fred now only has his annual outpatient visit to the Psychiatry team for monitoring purposes and is otherwise independently self-managing without any additional intervention required, delivering long term, sustainable benefits. |
Intermittent Claudication with Flo motivates patients and increases clinic capacity
Mairi Ross
Vascular Physiotherapist
10 May 2017
(SCO NHS NHI) Patients feel less isolated and more motivated to improve Intermittent Claudication with Flo's help
Intermittent Claudication (IC) is a symptom of peripheral arterial disease (PAD) where pain is experienced in the main muscle groups of the leg when exercising and walking. Patients with IC need to push further into their leg pain when exercising and walking to gain any benefit from physiotherapy – this develops the collateral circulation allowing the blood to follow a natural bypass to the affected muscles and therefore reducing the pain felt thus increasing the pain free walking distance.
NHS Highland (NHSH) is the largest Health Board in Scotland covering 32 500km2 serving a population of 320,000. 2.3% of adults over the age of 16 will be affected by IC – this equates approximately to 4,420 adults in NHSH. The geography of this area is one of the biggest challenges to delivering patient care. A large number of patients are very remote and rural, making the journey to Inverness long and tiring. If we can treat and assess these patients in their homes then the geography challenge will no longer be an issue.
With an ever-increasing population there should be no need to review clinically stable claudicants especially if telehealth can be used for remote monitoring.
“If we can treat and assess this cohort of patients in their homes, then the geography challenge will no longer be an issue bringing great benefit to patients and clinicians alike whilst deriving greater value from NHS resources and creating clinic capacity for patients who do require face-to-face review.”
The opportunity for us to use Flo to enable us to remotely gather information regarding their condition and ability, and also to encourage and motivate these patients to continue with their exercise regime and daily walking went live with IC patients in Jan 2016. At the patient’s initial assessment, they undergo a treadmill test measuring the pain onset distance (POD), maximum walking distance (MWD) and the reason for having to stop walking. Patients are then given a home exercise programme and advised to push into their pain level a little more than they normally would. Some of these patients will attend a weekly exercise class at Raigmore Hospital (Inverness). Patients who consent are enrolled with Flo at the end of the initial physiotherapy assessment, The session is extended by 15 minutes to allow for the actions below:
| Flo’s Interactions with our IC Patients Patients receive regular interaction with Flo’s friendly persona around key elements involved in their treatment plan. This helps to educate and motivate patients to become more confident and engaged with their self care, examples include:
Patients are then re-assessed after 3 months when they repeat the initial treadmill test. |
Early pulmonary rehabilitation - Sheffield Teaching Hospitals NHS Foundation Trust increase adherence and safety for patients
Cath O'Connor
Clinical Specialist Respiratory Physiotherapist
Jayne Stocks
Clinical Lead Assistive Technology
Katie Biggs
Lead Trial Manager CTRU
30 March 2017
'Making Change Happen' National Showcase; Early pulmonary rehabilitation following AECOPD
Click image to enlarge
Community resources optimised as Flo helps clinicians to deliver care "right first time" through Single Point of Access
Jayne Stocks
Clinical Lead Assistive Technology
Janice Renner
Nurse Adviser
30 March 2017
'Making Change Happen' National Showcase; Single Point of Access
This poster was presented as a Community Care workshop at the national 'Making Change Happen' 2017 conference in Stoke-on-Trent.
#SPA #Single Point of Access #Sheffield Teaching Hospitals #24 hour service
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