Patient 1 was a 77 year old with type 2 diabetes. The patient lived in a residential care home, and their diabetes was difficult to control, with blood glucose (BG) readings anywhere between 2mmol and 30mmol being recorded.
This poor control led to the patient being hospitalised for a total of four weeks from 14th August 2017, while various methods were attempted to control their BG. The patient’s HbA1c in June 2017 was 8.4%.
Upon discharge and returning to the residential home, it was requested by the hospital that the patient’s blood glucose be monitored four times a day, and these readings continued to fluctuate. To counteract high blood glucose levels, the home was advised to administer quick acting insulin.
The diabetes specialist nurse visited the care home and found that the patient’s care plan was very complicated, and felt somewhat uneasy about this.
The patient’s blood glucose before going bed was around 2.4mmol, and this rose to between 24-30mmol in the morning – no explanation could be found for this as the patient had no access to food during the night time.
As of 18th September, the patient’s blood glucose remained unstable, leading to an ambulance being called out and a subsequent hospital admission on 20th September.
The patient began a basal bolus regime, which meant that the patient was having 4 injections daily – not particularly ideal for a patient of this age. At this point, the DSN spoke to the patient’s son about having a mobile phone to use with Florence, and also spoke to the care home about telehealth.
The patient was set up on Flo via a telephone call, and the patient’s son did the initial text confirmation to opt in. The patient was put on to a simple protocol which asked for readings and recorded them.
This enabled the DSN to remotely monitor the patient’s blood glucose levels, and contact the care home to provide advice and support when necessary.
The care home staff reacted positively to the use of Florence, as they felt reassured that a clinician was checking the patient’s readings remotely. From the clinician’s perspective, using Flo has created time savings, as they can now log into Florence and check the patient’s readings.
If the readings are within range the DSN nurse doesn’t need to contact the home, whereas before this was necessary to find out what the readings were.
On the other hand, if the DSN sees that the readings are too high or low, they can intervene in a timely manner, and avoid further ambulance call outs or hospital admissions for the patient.
There have been no further admissions or ambulance call outs to the patient to date.
Main benefits:
- Reduction in contact time resulting in increased capacity for clinician
- Timely intervention by clinicians helping to avoid admissions and ambulance call outs
- Patient and care home staff felt reassured
- Improved blood glucose control
- Improved long term prospects due to improvement in control of blood glucose, and possible future savings associated with this
