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Maternity Network proves a hit with Midwives

posted 29 Nov 2018, 06:20 by Hollie O'Connell

30 November 2018 

The Maternity Members Network was developed this year as an environment for clinicians to collaborate and share best practice developed locally through Flo’s implementation.  The network hosts quarterly calls facilitating members of the wider Simple Telehealth Community of Practice to come together for one hour to share and discuss their experiences, outcomes, ideas or queries to support their maternity patients.   The role of peer to peer conversations cannot be underestimated in igniting innovation; being able to chat to a like minded clinician who has already, or may be planning to introduce Flo into their pathway is a valuable part of any clinical redesign, and one that has underpinned the spread of pathways across the Community of Practice so far.

Each call sees a featured pathway or a team sharing their experience of introducing Flo to their patients around a specific maternity patient cohort.  Previous featured teams or pathways have been greatly received by the members of the network and the calls provide a foundation for further clinical collaboration and peer to peer learning. 

The network has so far heard from Janette, Antenatal and Newborn Screening Lead/ Senior Midwife Sonographer from City Hospitals Sunderland, part of the original team who developed the Pregnancy Induced Hypertension (PIH) and Gestational Diabetes Mellitus (GDM) pathways; to read more please click here.  Based on robust early evaluation, these pathways have spread beyond the North East and have now been adopted in several maternity units as a result of the teams innovation and commitment to innovation.  Karen McKillop and Ayleen Austin, both Midwives at County Community Hospital within NHS Highlands, also shared their experiences with Flo as a support to Foetal Movement Awareness for their Mum’s to be.  The aim of the pathway was to help women to be more aware of their babies movements.  NHS Highland’s foetal movement pathway was developed inline with current guidance practiced locally.  The team also incorporated bite size messages into Flo’s protocol that shared health promotion advice and also clinic appointment reminders.   The pathway commenced when mums to be reached 16 weeks of their pregnancy with Flo interacting through to 38 weeks.  50% of the team’s current caseload were being supported by Flo; patients fed back:
  • 82% of women said that Flo helped them become more aware of their baby’s movements
  • 92% of women felt that Flo’s messages helped them to attend their appointments 
  • 93% of women confirmed that they would recommend Flo to other women in the same circumstances

The calls begin with an overview of the previous call, which is an opportunity for those who were unable to attend, to receive an update and request more information if required.  This is then followed by a short update on new maternity pathways developed within the Community of Practice since the last call.  The focus is then handed over to the featured team, for them to share their experiences, outcomes and any challenges they have overcome so far.  There is also the opportunity for members to ask any questions or request more detailed information. 

The discussions are open to the group and are not limited to the featured team or pathway, any ideas or thoughts around maternity related conditions are welcomed.  The discussions on the call are a really good opportunity to collaborate with clinicians that may be in a similar position, but may be working in another part of the country.

Since the Maternity Members Network began a forum within the members section of our website, www.simple.uk.net has been developed to allow community members to leave questions or request for more information on specific maternity pathways.  This ensures that you do not have to wait until the next call to be able to ask your question and allows the conversation to continue.

Florence joins her third NHS Test Bed programme

posted 5 Nov 2018, 01:49 by Hollie O'Connell   [ updated 6 Nov 2018, 00:34 ]

05 November 2018 

We are delighted to announce that after a successful pilot with heart failure patients, Florence has been chosen to be part of the NHS Test Beds programme at Royal Stoke University Hospital.

Florence's heart failure protocols, along with two other digital technologies will now be scaled up with the aim of further reducing A&E admissions of patients with chronic long-term heart failure through learning to self-manage their condition.

#NHS England #WMAHSN #NHS Test Bed #TotallyUnique

Evaluation of the use of Florence within NHS Highland

posted 25 Jul 2018, 01:05 by Hollie O'Connell

Joanna Gilliat 
TEC Project Support Manager 

Flora Jones 
TEC Project Support Officer 

25 July 2018 

NHS Highland covers a huge geographical area in the north of Scotland, much of it rural and very remote.   The Technology Enabled Care (TEC) team in NHS Highland has been using Florence since November 2015, and has enrolled over 2400 patients on Florence since then.  Patients with long term conditions such as COPD, Heart Failure and Diabetes are supported to self-manage by Florence, and patients with hypertension are diagnosed with Florence’s help, but that’s just the tip of the iceberg.  The essence of the approach to Florence in the Highlands has been innovation, with the TEC team responding to needs identified by clinicians, and developing a diverse range of Florence protocols.   In fact, NHS Highland probably has the most innovative range of Florence protocols of all our users. 

Keen to provide evidence of Florence’s effectiveness, the TEC team undertook a significant evaluation exercise early in 2018, resulting in a report on the “Evaluation of the use of Florence within NHS Highland” covering use of Florence to support patients with;
  • Asthma, 
  • Irritable Bowel Syndrome (starting the low FODMAP diet),
  • COPD,
  • weight issues,
  • suspected hypertension,
  • borderline personality disorder (attending a STEPPS class). 
In addition, a set of individual evaluation summaries of a further 16 Florence protocols were produced.
The evaluation methodology included;
  • analysis of usage statistics,
  • responses to evaluation questions included in the Florence protocols,
  • responses to evaluation surveys sent out by post,
  •  informal comments from clinicians,
  •  case studies,
  •  interviews with patients and clinicians.

Perhaps the most successful protocol developed by NHS Highland to date has been one used with severe Asthma patients, which has not only improved patients’ self-management and engagement with specialist services, but has also reduced A&E visits, hospital admissions and the need for outpatient appointments.  The protocol is also being used to objectively measure patients` response to biologic therapies and to monitor patients during steroid weaning.

That’s just one of NHS Highland’s innovative uses of Florence.   So – take a look at the evaluation reports and get a flavour of how Florence is being used to benefit patients in this remote and rural area.


“Go Flo Fridays” celebrated at Great Western Hospital

posted 20 Jul 2018, 07:19 by Hollie O'Connell   [ updated 20 Aug 2018, 06:06 ]

23 July 2018 

Great Western Hospitals’ Maternity Departement have recently celebrated their first anniversary with Flo helping expectant mums to monitor their blood pressure during pregnancy.  Both parents and hospital staff met in the delivery suite to celebrate and discuss the experiences with Flo during their pregnancies.  Local newspaper, The Swindon Advertiser, was invited to attend, and Flo and the staff at GWH were recognised for their achievements by being featured online by the newspaper. 

Flo has been received very well by staff and patients at GWH.   Sarah Feeney, used Flo during her pregnancy; 

It was a fantastic experience and I didn’t have to come to hospital as frequently as before, when the weather was bad I didn’t have to come in, and I was a lot less anxious at home when I was taking my blood pressure. It made me feel quite empowered to be able to do my blood pressure at home. ” 

Dr Nusrat Fazal, who has led Flo’s introduction over the past two years has been recognised for her work by being awarded the ‘Great Western Hospital Staff Excellence Award for Innovation in Practice’ at the award ceremony held on 22nd June 2018, as well as winning a poster competition at the Bristol Quality and Safety Conference, and being named runner-up for the best presentation at the South Western Obstetrical and Gynaecological Society Meeting 2018.  Nusrat led on the “Go Flo” project, which aimed to raise awareness of Flo across the organisation.  As part of this, when Flo was first introduced to the department, staff took part in “Go Flo Fridays” to promote Flo with expecting mums.

Nusrat commented;  

 Patient feedback is absolutely fantastic and we’ve had no adverse outcome. Midwives said how it gave them more confidence in safer monitoring and how to manage time more efficiently by replacing face-to-face appointment with FLO. ” 

Using Flo has also helped the maternity department to improve capacity.  So far, since the introduction of Flo 600 hospital appointments have been saved, with an estimated reduction in costs at GWH by around £67,000 a year.
Anne Webb, midwife at GWH has found using Flo to be fantastic for both patients and staff: 
Flo enables pregnant women to self monitor their blood pressure at home, which means less appointments for them at the hospital or with the community midwives. Using Flo saves with childcare, car parking costs, taking time off work. And everyone likes using their phone even if isn't for facebook!
Read the full article, or for more information contact Dr Nusrat Fazal: nusrat.fazal@nhs.net

Click image to enlarge

1st Pan-Staffordshire Simple Telehealth Action Learning Event

posted 19 Jul 2018, 07:46 by Hollie O'Connell   [ updated 19 Jul 2018, 09:05 ]

19 July 2018 

The 21st June 2018 delivered the first Pan-Staffordshire Simple Telehealth Action Learning Event at Yarnfield Park Conference and Training Centre.  The day focussed on igniting collaboration between local organisations and sharing the breadth of pathways now embedded across Staffordshire.   An important part of the day was to connect Staffordshire clinicians with wider members of the Simple Telehealth Community of Practice, open discussions around current and proposed pathways, share best practice, and offer the potential for future collaboration with organisations also innovating with Flo nearby.  The event was well attended by members of various local organisations, who were welcomed by Lisa Taylor from Simple Shared Healthcare (SSHC), before enjoying an afternoon of sharing best practice.

Professor Ruth Chambers OBE, Clinical Chair & Staffordshire STP’s Clinical Lead for Technology Enabled Care Services, opened the afternoon highlighting her vision for the role of TECs in meeting the changing needs within today’s NHS.  Ruth discussed common infrastructure challenges surrounding TECs applications, including purchasing costly equipment, technical infrastructure, patient access to broadband, and interoperability within NHS systems.  Professor Chambers highlighted to the audience examples of Flo as a sustained example of TECs where patients and clinicians are able to use everyday technology that is already accessible.  Ruth also shared copies of “Making Digital Healthcare Happen in Practice”1 amongst attendees.  The workbook is a practical guide containing advice and suggestions to improve ease of implementation with TEC solutions. 

Following on from Ruth, Lisa Taylor and Karen Moore from SSHC led a session “Making eHealth a Reality - Learning from the Simple Telehealth Community of Practice” discussing key lessons learned from delivery at scale, plus an overview of the Simple Telehealth Community of Practice and an update around the outcomes from Flo’s breadth of use nationally.

We were delighted to welcome Ann Hughes, a Practice Nurse and Clinical Telehealth Facilitator working in Staffordshire to share her insights.  Ann was accompanied by one of her patients, Michelle, who uses Flo to support her weight management following a diagnosis of diabetes.  Ann explained that Flo’s relationship with Michelle encouraged a feeling of support between face to face appointments and extended the impact of her discussions with Michelle which were held in the practice.  Michelle also explained that she enjoyed receiving Flo’s messages as it made her feel less alone and offered a feeling of support, so much so that when Michelle’s initial protocol came to an end, Michelle asked Ann if she could continue.  Michelle’s weight has now stabilised from an upward trend and Flo continues to support her with moving to her next phase of beginning to lose weight.

From hearing speakers on the day discuss examples of the impacts made around reduced HbA1c and anxiety, Michelle chatted about expanding her interactions with Flo to focus also on these areas.  Ann provided a wealth of knowledge from a practice nurse perspective and also through her facilitator role focussing on overcoming barriers that can present in primary care with a pragmatic approach to common perceived challenges.  Ann addressed a common question from clinicians around how they should introduce Flo to their patient, explaining that Flo is simply part of the normal nurse to patient conversation, and importantly that she describes Flo as an extension of her care, not an alternative.  Ann’s message to clinicians is to start small and build up confidence, reminding us that 

If you’re confident, your patient will be too ” 

Ann has shared her approach to implementing Flo in her RCNi Primary Health Care Journal column “Being tech savvy-enhances the care you give”.  Ann has also co-authored “You too can be a digital practice nurse champion” for June’s edition of Practice Nurse; which is available to view online for subscribers.

Kath Lloyd, Service Development Manager for Therapies and Health Sciences, and Vic Deakins, Head of Therapies and Health Sciences, both from Powys Teaching Health Board (PTHB) joined us via Skype and spoke to attendees about their learning from their first 18 months implementing Flo in Powys.  Vic and Kath discussed their approach to balancing shared learning from across the Simple Telehealth Community of Practice to use to engage with their clinical teams, then taking this learning into the development of local pathways.

This approach was used in the development of new pathways such extending the impact of their local diabetes education programme, motivating adherence to the pulmonary rehabilitation programme and reinforcement of strategies incorporated within “Confident Strides”, a local falls prevention programme. Vic and Kath have shared their insights in a recent blog available here

Cath O’Connor and Nicky Harrison, from Sheffield Teaching Hospitals Foundation Trust (STHFT), shared experiences from within their different clinical areas. Cath, a Clinical Specialist Respiratory Physiotherapist talked through her service evaluation to assess the feasibility of Flo’s support to patients who had experienced a recent hospital admission due to an acute exacerbation of their COPD as part of an existing early pulmonary rehabilitation programme.  To support this, Cath developed an interactive pathway to incorporate elements of support, motivation and engagement to ultimately increase patient adherence to their pulmonary rehabilitation exercise programme.  Cath explained that Flo’s role in being able to reassure patients, when appropriate, that it is safe to exercise based on their real time symptoms overcame common patient anxiety that exercise will trigger an exacerbation of their COPD, a known barrier to compliance.   Cath also commented that by Flo maintaining a connection once patients were at home, patients reported a sense of accountability to their clinician to complete the programme which motivated them to follow the programme.  Cath explained that the study concluded that Flo was found to be feasible in clinical practice and acceptable to service users and has submitted for publication; more detailed results show that:
  • Patients found Flo acceptable. 
  • Patients felt safe, supported, motivated to exercise
  • Patients felt more confident about self-managing their health. 
  • Some patients developed new skills in sending text messages that they now use in other areas of their lives, reducing their isolation.
Flo makes me do it, because I know I have to send in the values following exercise.
Oh she’s lovely! I can’t wait for her ringing me up in the morning!
To find out more about Cath’s work with Flo please click here.

Nicky Harrison, Community Matron from STHFT, followed on from her colleague Cath, sharing the story of a patient with poorly controlled diabetes that had ultimately resulted in the development of significant comorbid factors that had eventually led to the amputation of both of his legs.  Nicky explained that the patient’s character was known to be very private, and that overtime he had become disengaged with his healthcare needs.  Daily visits by his Community Matron to ensure that he took his medication had become a challenge and sometimes not even possible as the patient wouldn’t answer the door.  

The team reviewed the patient and identified issues around the personal importance of his privacy, the patient feeling disengaged due to him experiencing a reduced sense of control, and the impact of spiraling comorbidities relating to his diabetes.   The team also recognised that an alternative approach was required to support the worsening challenge of ensuring that the daily visits by his Community Matron were actually resulting in an improvement in his health.  The patient was introduced to Flo as an intervention to try to break this cycle, supporting the patient to regain some control via an approach that was more acceptable to him and opened up an opportunity for the patient to feel more involved and less out of control.  As a result, the patient’s HbA1c has now reduced from 120 to 64, Nicky also commented that his cholesterol has also reduced.  Nicky described how, because the patient is understandably feeling better than he had been, he is able to get out and about more and becoming less isolated as a result.   This demonstrates how Flo’s interventions can provide the opportunity to take a holistic approach to patient care and offer a tool for clinicians to unlock challenges with complex patients.

Dr Rauri Clark, Consultant Nephrologist at City Hospitals of Sunderland, presented via video call to share his experience of Flo’s role in helping to titrate medication, specifically tacrolimus, prescribed for patients following renal transplant surgery to help to reduce rejection of the transplanted organ.  Patients who have undergone transplant typically leave hospital a week later with several different medications, with different interactions, so ensuring a patient receives the correct dose is a vital element of patient safety.  Rauri led a trial including 14 patients, who received interactions with Flo around their dose adjustment, with the added motivation of patients being asked to reply to confirm they had read Flo’s message.  Flo had been recruited to provide an alternative to the existing approach of staff telephoning patients which demonstrated a 50% saving in clinical time.  Often patients were unavailable when staff phoned, requiring repeated attempts or the conversation became prolonged without adding an value from the interaction.  The pathway has now been successfully scaled up at Freeman Hospital in Sunderland, all 650 patients at the hospital were offered Flo, with 83% acceptance rate.  Rauri now plans to further share his learning to expand this model for tacrolimus titration to other hospitals in the area.

Our final speakers on the day were
 Iain Trayner, TECS Lead NHS Western Isles, and Morag Hearty, Programme Manager Lanarkshire Telehealth Programme, who also joined via video. Iain gave us an overview of how Flo was addressing issues of rurality for heart failure patients in the Western Isles.  Flo allows patients to monitor their condition at home, reducing the number of non-value add face-to face appointments, and lengthy journeys that would be required to visit their clinician for routine monitoring.  Furthermore, when patients do have to visit their clinician, both parties find that the clinical contact is more meaningful as the patients monitoring data is easily accessible, demonstrating how Flo can be beneficial to both patients and clinicians.  To hear more about NHS Western Isles’ use of Flo in various areas, please take a look at this video, or for an insight into a patient’s perspective of using “Bossy Flossie” for heart failure, please click here.

Morag then spoke to attendees specifically to share NHS Lanarkshire’s approach to both scale up and sustainability of use.  Morag explained that Flo was now implemented across 77 out of 104 GP practices across the region, as well as a further 36 groups in other areas across health and social care.   Morag also discussed NHS Lanarkshire’s Scale-Up BP Programme, which has seen over 2000 patients access Flo to be able to monitor their blood pressure at home, with evaluation demonstrating a saving of around 7000 practice appointments. To read more about Lanarkshire’s journey with Flo, please click here.

Singapore fact-finding mission focuses on pioneering digital care in South Lanarkshire

posted 22 May 2018, 05:56 by Hollie O'Connell

22 May 2018 

South Lanarkshire’s award-winning Telehealth team have been recognised by a Singapore fact-finding mission team for their experience and successful adoption of digital health and care.  To share experience and knowledge, the team from Singapore visited South Lanarkshire.  You can read how the visit went in this press release.

Flo showcased in #NHS70

posted 11 May 2018, 07:46 by Hollie O'Connell   [ updated 30 May 2018, 08:27 ]

11 May 2018

Fab news for Flo as she's recognised in the top NHS70 Innovations for her use in long term conditions such as COPD, asthma and diabetes.

Flo actively supports the model of patient self-care management and compliance, while also delivering productivity gains for services, enabling larger caseloads to be managed within existing resources. "  


Flo and respiratory pathways – An overview of growth and diversification

posted 1 May 2018, 03:02 by Hollie O'Connell   [ updated 19 Jul 2018, 09:07 ]

03 May 2018 

We’ve seen steady growth in respiratory innovation with Flo since 2012; 2017 demonstrated a 75% increase on use from 2012!  The largest growth in respiratory use continues to be within COPD patient cohorts, but asthma and pulmonary rehab usage have both more than doubled over the intervening years.  We have also seen some new innovative pathways begin to develop for bronchiectasis and interstitial lung disease.

As the largest area of use within respiratory conditions, we have seen some really positive outcomes through improved understanding, management and control of the condition and its symptoms.  Flo supports the patient to self-manage their condition at home according to their existing clinical management plan, ensuring avoidable exacerbations are minimised and that if their condition was to deteriorate, any clinical intervention can take place as early as possible to avoid the patient’s condition worsening to a point where more intensive intervention, and perhaps even an acute attendance or admission is the only option.

It’s great to hear from patients whose lives have been improved by Flo, and we are excited to share some of the success stories we have seen:
  • John Stalker, a patient from Hamilton, began using Flo to help him better manage his COPD.  John had a total of 11 hospital admissions before starting on Flo, but in the 10 months since this has significantly reduced to only one.  John had previously sung and played guitar in local clubs, and although not able to sing for long periods of time, he now can now play guitar again and he feels that this is a “vital outlet” for him.  To read about John in more detail, please look here
  • Pat is a patient whose life has been improved by using Flo to help her manage her COPD.  Similar to John, Pat was calling 999, and attending A&E and her GP surgery quite frequently due a lack of confidence in understanding the symptoms that her COPD brought on.  Pat was introduced to Flo to help her manage her condition, and Pat says that Flo has given her a new lease of life.  Read more about Pat, and watch a short film about her journey here
  • Shirley also found that using Flo could help her to improve both her control of her COPD and her quality of life.  Take a look at this video to hear Shirley’s feedback.  This video also includes Maggie Whitmore, a Practice Nurse from Furlong Medical Centre in Stoke-on-Trent, describing her experiences with Flo.  As you will hear, Flo has also helped to reduce the number of doctor’s appointments required by patients at the practice by a significant amount resulting in increased capacity delivering faster access for patients at the practice.

A common theme that emerges from patients living with COPD is the challenge of managing their symptoms; understanding what is normal, and when action needs to be taken.  This is where Flo’s gentle guidance and reassurance builds confidence to follow their clinical management plan, reducing anxiety and motivating them to take the most appropriate action should they need to, helping to ease pressure on emergency and out of hours services.

Patients with poorly controlled asthma often report that they forget to take their preventer inhaler as prescribed; therefore Flo being able to gently prompt patients is a common application proven to be very effective either as a short term intervention until the habit is formed, or for longer term use with appropriate cohorts.  Patients with asthma are also supported to more closely manage their condition according to the guidance relating to their peak flow in the patient’s action plan.  Flo’s use with asthma represents one of our most mature pathways, seeing this usage included in the NHS England Advice and Interactive Messaging (AIM) project, and also as part of the group of protocols produced in conjunction with WMAHSN.

Flo is used to support children who have asthma; often parents interact with Flo on their child’s behalf to help them to look after their healthcare needs.  This not only helps to ensure that children are taking their inhalers as prescribedbut also supports and reassures their parents as well.  You can hear a bit more about this from Dr John Alexander in this video.

More recently, NHS Highlands have been using Flo to help patients to self-manage their asthma.  A consideration for NHS Highlands is the rurality of the area.  Patients sometimes have to travel quite long distances to attend asthma clinics, and should they experience severe exacerbations of their conditions then emergency support may also be quite a distance away which can be a major risk.

Kyle Mackay is a patient with asthma, who suffered a severe asthmatic attack.  Luckily for Kyle, he was staying at a friend’s house which was half an hour closer to the hospital than he would have been at home.  However, had he not been at his friends, this added distance could have had some serious consequences for him.  Following this, Kyle’s respiratory nurse recommended that he try using Flo to support him with his asthma management.  Kyle has found that using Flo has made him more aware of his condition, and he now feels that his breathing is more stable.  You can hear more from Kyle about his experiences with Flo in this video.  Corinne Clark, who is a respiratory nurse featured in this video has also written a blog about her time using Flo, which you can take a more detailed look at here.

Similar to Flo’s COPD pathways, asthma pathways help patients to become more aware and knowledgeable of their asthma, helping to improve stability and reduce severe flare-ups.  This has the potential benefit of reducing the need for emergency care and possible admissions, helping to ease some pressure on local services.

“All Together Better Sunderland” work towards improving patient’s understanding
NHS Sunderland were able to secure funding from NHS England’s New Care Models Programme to produce patient information leaflets for use with Flo.  The leaflets cover a broad range of conditions, but COPD & Asthma specific leaflets are available.  The leaflets are a resource that any member of the Simple Telehealth Community can use, to find out more, please click here.

New and emerging respiratory use 
We continue to see new and exciting Flo developments within the respiratory field, here are a few interesting examples of the developments that have been going on recently:
  • Powys Teaching Health Board (PTHB) are using Flo to give patients who are taking part in pulmonary rehab extra support and motivation during their treatment.  Flo interacts with patients for four weeks, encouraging them to complete exercises between sessions, and has demonstrated to be improving compliance and long term outcomes.  Flo also asks review questions at 3 months (exercise compliance) and 6 months (have patients had further admissions or GP appointments).  PTHB has received positive feedback from patients so far, and hopes to roll out the pathway across the whole of Powys. 
  • PTHB, Shropdoc & The Health Foundation Have been working in conjunction with Barchester Care Homes to create monitoring protocols for care home residents with COPD and asthma.  The protocols are designed so that care home staff can take readings and reply to Flo on the patient’s behalf, with Flo sending advice back to staff.  The aim of these protocols is to ensure timely and appropriate access for patients to the Specialist Respiratory team or GP, as well as providing reassurance both residents and the care home staff.

For more information on integrating Flo within respiratory services please contact lisa.taylor@simple.uk.net

East Midlands Regional Network Meeting - December 2017

posted 8 Feb 2018, 01:09 by Hollie O'Connell

Simple Shared Healthcare 

08 February 2018 

Firth Park Library played host to the December Regional Network Session dedicated to supporting the use of Flo, which enables attendees to share their experience and ideas, as well as promoting best practice in their areas. 

The day began with Lisa Taylor and Karen Moore sharing developments across the wider Simple Telehealth community, including the latest additions to www.simple.uk.net, such as example pathways, case studies & blogs and emerging outcomes from across the UK.  Lisa and Karen also highlighted the development of supported clinical networks across the community to enable the sharing of best practice regardless of geographical location; the first of these being maternity care focused with the inaugural national special interest group call set for February 2018.

Focus: Early pulmonary rehabilitation management of patients with Chronic Obstructive Pulmonary Disease following acute exacerbation in Sheffield 

Cath O’Connor, Clinical Specialist Physiotherapist in Sheffield, discussed her service evaluation of the implementation of Flo in early pulmonary rehabilitation management of patients with Chronic Obstructive Pulmonary Disease following acute exacerbation.  Cath focused on patients who had experienced acute exacerbations of COPD (AECOPD), and were taking part in Early Pulmonary Rehab (EPR).  In Sheffield, 1 in 3 patients admitted to hospital with AECOPD is readmitted, despite often being asked to participate in EPR; patients may not be receiving the support they require to successfully complete EPR, and this may be a factor in the number of readmissions.  Cath, with some support from Karen, developed a pathway supporting this cohort of patients, which focused on symptoms before and after exercise to understand how the patient felt.  Results from the evaluation showed that:
  • Patients found Flo acceptable
  • Patients felt safe, supported, motivated to exercise. 
  • Patients felt more confident about self-managing their health. 
  • Some patients developed new skills in sending text messages that they now use in other areas of their lives, reducing their isolation.

Focus: Community Neurology Team – Improving adherence to physiotherapy in Stroke, MS, Parkinson's Disease and Head Trauma

Following on from Cath, Ed Rimmer, a Physiotherapist within the Community Neurology Team at Nottinghamshire Healthcare Foundation Trust, discussed his plans for a project integrating Flo across several pathways.  The team currently manages patients with a wide variety of conditions, including stroke, MS, Parkinson's Disease and head trauma.  Given the range of conditions and the varied demographic of their patients, a diverse multidisciplinary team of healthcare professionals has developed.  The team recognise that their patients can experience condition led challenges to adhere to prescribed medication and rehabilitation, noting the adverse effect that this reduced adherence has on the recovery of their patients. 

Therefore, Ed is leading the development of pathways aimed to support an improvement in both motivation and adherence to treatment.  Ed hopes that Flo will also help patients to improve their confidence and ability to self-manage, reducing reliance on the team.  The plan is to recruit a minimum of 20 patients over the course of 6 months, and then evaluate with both staff and patients with results informing the recruitment of more patients going forward.
Focus: Virtual Wards in Sheffield

The session was led by Rebekah Matthews, Integrated Pathway Manager, who gave an overview of Sheffield Teaching Hospitals implementation of Virtual Wards and the “Okay to Stay” plan.  The Virtual Wards demonstrated a decrease in admissions over winter months in 2015/16, leading to a pilot project being launched during winter 2016/17 aiming to improve the integration of health and social care, as well as reduce the number of inappropriate admissions.  Patients over the age of 65 who scored the highest on the frailty index were targeted, and through the combined use of a person-centred care plan, the “Okay to Stay” plan & Virtual Wards unnecessary admission were again avoided.  Patients on Virtual Wards are typically offered Flo to support awareness, both to the patient and clinicians of vital signs.  The combination of being able to monitor patients remotely, and Flo’s prompt advice motivates patients to seek appropriate intervention at the right time, and that any admission that occur are necessary and appropriate.

NHS England: Stoke-on-Trent rated Outstanding for diabetes services with Flo

posted 6 Feb 2018, 02:30 by Philip O'Connell   [ updated 6 Feb 2018, 02:34 ]

NHS Stoke-on-Trent 
Clinical Commissioning Group 

5 February 2018 


Flo cited in latest "Outstanding" rating by NHS England for Services for patients with diabetes in Stoke-on-Trent.

“Because lifestyle is key to control of most adult diabetes it is a real partnership between clinicians and each patient. Education is vital, as a patient who is properly informed about their condition can more effectively take control and manage it.”

Stoke-on-Trent and North Staffordshire are recognised as leaders in the way new technology is being used to help patients monitor and control a number of conditions including diabetes.

Florence (or Flo) is a locally developed mobile phone based platform. It allows clinicians to communicate securely with patients to remind them to monitor their readings and take medication. It can issue advice and raise the alarm if a patient’s condition deteriorates.  It can reduce the number of unnecessary appointments for patients whose conditions are stable, leaving more time for clinicians to focus on those who are struggling.

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