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Single Point of Access reduces need for home visits

posted 15 Aug 2017, 03:32 by Hollie O'Connell

Sheffield Teaching Hospitals 
NHS Foundation Trust 


Jayne Stocks 
Clinical Lead Assistive Technology 

Jeanette Deslandes 
Telehealth Nurse 

Joanne Sellers 
Health Care Assistant 


15 August 2017 



The Single Point of Access (SPA) is a one stop shop for referrals between Sheffield Teaching Hospitals' acute and community services.  SPA is an appointment-booking service 
working in partnership with social workers, mental health nurses and out of hours services, facilitating discharges and avoidance of hospital admissions where possible.

Made up of 50 Administrators, 13 Nurse Advisors, Social Care Managers and a Business Management Team, Sheffield’s SPA Contact Centre is located at Community House, Northern General Hospital Campus and opens 0800 to 2200 hours, seven days a week (out-of-hours cover is provided by the GP Collaborative).

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.

 


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. 

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 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.