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COPD patient avoids A&E and acute admissions through self-management with Flo

posted 22 Oct 2016, 02:21 by Philip O'Connell   [ updated 26 Oct 2016, 02:09 by Hollie O'Connell ]
Blythe Bridge Surgery  
Tean and Blythe Bridge Primary Care  

Ann Hughes  
Practice Nurse 

25 October 2016 




Flo Helps COPD Patient with a High Frequency of Acute Admissions  
to Self-Manage and Stay Well 

Chronic Obstructive Pulmonary Disease (COPD) describes a number of conditions including emphysema and chronic bronchitis.  It is a condition where the airways become inflamed and the air sacs in your lungs are damaged causing the airways to become narrower making it harder to breathe in and out. 

COPD patients are usually on a variety of medications to manage their condition including ‘rescue medication’ for use at home during an exacerbation.  Patients typically have a COPD self-management plan, agreed with their clinician, advising them what action and/ or medication to take, according to their symptoms.  Delay in identifying exacerbations and taking action, including using the correct rescue medication, can lead to emergency admission to hospital. 

As a consequence, patients often need to be seen in the primary care setting to have checks and to review their treatment along with seeking reassurance and advice.  These visits can often be difficult for patients as their poor breathing can lead to reduced mobility and having to sit in waiting rooms can expose patients to the risk of further infection.  Florence (Flo) can be a very valuable tool to help patients with COPD self-manage at home and can reduce the need for as many surgery visits, improve their compliance with medication, reduce overall anxiety and ultimately avoidable hospital attendances or admissions.



One patient who was helped in this way, is Pat who was on the 'Admission Avoidance Care Plan Scheme', Pat had had four attendances at A&E via 999 and had been supported by 'Hospital at Home'.   As well as two hospital stays during a three month period. Pat had also attended the GP surgery on many occasions for rescue medication. 

In order to help Pat better cope with her COPD I decided to introduce her to Flo to provide support and guidance.  Pat was equipped with an oxygen saturation monitor and a thermometer to take home to use when prompted via Flo, in conjunction with her COPD Management Plan. 

Flo prompts Pat to send in her oxygen saturation level and will then advise her what further steps, if any, are necessary depending on this information, using parameters set by the clinician.  Flo also coaches patients through the correct use of rescue medication, if it is deemed appropriate according to symptoms reported.  In my experience, when the need arises for a patient to use rescue medication, this can make them panic and take everything just hoping that this will alleviate their symptoms.  Flo ensures patients take the right amount, of the right medication at the right time.

Importantly Flo has given Pat more confidence to self-manage leading to an improved quality of life.

The daily recording of oxygen saturation levels and the guidance from Flo have reassured Pat.

By enabling Pat to self-manage her COPD, if her oxygen level is low she knows to check her temperature, and if this is fine then she knows she doesn't need take any further action.

Flo has had a marked impact in reducing surgery visits and preventing exacerbations from reaching the point of needing to call 999 and hospital admission;
Indeed Pat has not attended A&E since she was introduced to Flo on August 2nd 2016 and her only contact with the surgery has been an occasional telephone call from us to check that all is well.  Since using Flo she has not had to use her steroids (prednisolone) and has not collected her prescriptions for this. 

As Pat is now in control of her COPD it has allowed her to use her exercise bike and identify the difference between when her breathlessness is safe and when it isn't.  Along with this Pat is able to help her daughter with moving the plates and washing up at her porta cabin [cafe].  Pat commented on how her daughter has also recognised the change Flo has made to her life:

"My daughter said, there's something different about you mother.  I was a bit worried about you at first, but you've managed quite well."

When Pat was asked if there was anything she didn't like about Flo she replied: 

"The only thing I don't like is the fact that you might ring me to come off Flo"

After using flo

  • Not only has time been released in the GP surgery, but by motivating Pat to follow her COPD Management plan,  Flo has provided a significant cost saving.
  • Flo has given the patient the opportunity and motivation to improve her capability to self manage her COPD at home, and has demonstrated a reduction in her emergency admissions via an improved use of her prescribed rescue medication; allowing capacity to be focused on other areas of patient care.