Florence, or Flo for short, is a simple but effective messaging system that is enhancing the care of patients with diabetes living in North Derbyshire who are referred to the Derbyshire Community Health Service (DCHS) Community Diabetes Team.
The Community Diabetes Specialist Nurses (DSNs), Michelle Denyer, Beth Cooper, Joanne Hulme and Clare Reynolds, are at the forefront of this development, embracing technology to extend the reach of the service and more importantly strengthen the relationships that exist between patient and clinician in the pursuit of improved patient outcomes and the promotion of patient self-care.
The DSNs will be the first to agree that the road to success can often be challenging but it has been because of their hard work, dedication and vision that Flo is growing across Derbyshire with evidence continuing to emerge from patients, that they are managing their diabetes better than before.
The DSN’s work alongside the Derbyshire Florence System Administrator in developing clinical and non-clinical protocols to suit the needs of their patients whilst broadening the available resources that the community diabetes team has to engage with patients about their condition.
Promoting Patient Self care
For a patient with diabetes, testing their blood sugar levels regularly at home is often recommended as it is an important tool in managing their treatment plan and preventing the development and exacerbation of long-term complications.
Michelle, for instance, identified patients who demonstrated poor compliance with glucose testing and control to use Florence. Florence offered the patient timely prompts to test their glucose level regularly as well as giving patients a quick and convenient way of sharing their readings with Michelle.
“Patients that test their levels regularly, can judge how well they are reaching their overall treatment goals and get a greater understanding of how diet and exercise affect their blood sugar levels. I find these gentle reminders are very effective because when I talk to patients they tell me how well they are doing.”
Medication is another important part of a patient’s treatment plan. Some patients worry and become very anxious about medication, particularly if they are newly diagnosed with diabetes and concerned about establishing new routines and behaviors. Florence is ideally placed to remind patients to take their medication.
“I have seen some very positive results for patients; helping them to remember their medication which in turn has improved their diabetes control.”
The team continues to use Florence to enhance diabetes management and it has changed the way care is delivered. They have found that it can reduce the number of patient appointments. Notably there has been a reduction in follow-up appointments for newly diagnosed patients when Florence supports the remote monitoring of patients’ blood glucose levels. Florence allows for earlier clinical intervention and guidance without the need for an appointment. As time goes on patients become more relaxed and energized learning to control their condition without feeling like the condition is controlling them.
A Patient’s Experience
A North Derbyshire patient was having difficulty controlling her Type 2 Diabetes. For months the situation continued and resulted in frequent clinic appointments to try and bring her condition under control.
Following all the initial advice and guidance and as a result of the condition still being out of control the clinical team was forced to consider medication as an intervention. The patient was also referred to the Community Diabetes Team where she met with one of the Specialist Diabetes Nurses, and agreed to use Flo.
After a short period of time the Specialist Diabetes Nurse was really encouraged by the readings that the patient was sending to her. Over the coming months the patient continued to make progress, monitoring her own blood glucose and finding that with small changes to her lifestyle she was taking control of her diabetes.
The patient returned to her doctor for a review of her condition. The doctor was able to see significant progress had been made and decided to postpone the use of medication indefinitely.
The patient is happy to have avoided the need to take medication for what could have been a prolonged period.
The avoidance of medication has successfully avoided an annual cost of just under £1,000 per year for the type of treatment that was considered.
Patient Quote
“Even though I know it’s only a computer, I feel very supported by my texts from Flo”
Set-up and monitoring patients
Once a protocol (support for the shared clinical management plan) has been applied to a patient, Florence delivers the agreed messages to the patient as scheduled. Each of the diabetes nurses now only needs to monitor the patient’s progress and can intervene in a timely manner, making minor adjustments to the patient’s protocol as the patient’s condition changes.
“Individual target ranges can be set for patients’ glucose levels and the diabetes nurses are alerted automatically by ‘Flo’ if a patient’s glucose levels are out of range; this has helped to reassure patients as they are signposted back to the community diabetes team or their GP practice should they feel they need more support or feel particularly unwell, and because of the early intervention the number of follow-up appointments has been reduced.”
Final thoughts
The DCHS Community Diabetes Team feel that the Florence system has the potential to be used in other local health community settings to deliver real improvements to the lives of patients and enhance the delivery of care as a whole.
(E022) Type 2 Diabetes BG Results Insulin DCHS protocol flow chart
(E022) Type 2 Diabetes BG Results Insulin DCHS protocol message schedule
