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1st Pan-Staffordshire Simple Telehealth Action Learning Event

posted 19 Jul 2018, 07:46 by Hollie Stirman   [ 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.