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Paracentesis team “deliver the best, flexible care” for all of their patients with a little help from Flo

Bev Aram

Paracentesis Assistant Practitioner 

Bev Aram, paracentesis assistant practitioner, is part of the paracentesis nursing team at The Queen’s Medical Centre in Nottingham.  The team comprises of Bev and three other nurses, whose main role is to support patients with paracentesis, this can be during phases of exacerbation such as draining ascetic fluid as a form of symptom relief.  Bev recently got in touch to chat about how she and the team have introduced Flo to enhance the care that the team offer to their patients.

What was the service like before Flo? 

Previously, paracentesis care had been doctor led, and this meant that patients were experiencing long waiting times which made them unhappy with the service.  However, the nursing team took over a little over four years ago, which is when Flo was initially introduced.

Why did we want to use Flo?
We wanted to use Flo because she was really easy for us to access, and more importantly for patients to use.  Knowing that Flo was simple for the patients to use was important; if we could use it, then our patients could too!  Another important factor was how easy it was to explain to patients – keeping everything simple was the key for us!

How do we use Flo
We use Flo to help monitor weight gain in our patients when they’re at home; patients with ascites experience a build-up of fluid in the body, so increase in weight demonstrates that excess fluid is present and needing to be drained.  When we introduce patients to Flo, we weigh them prior to draining excess fluid, and then once again afterwards.  These measures give us a baseline to work with, especially with new patients.  We then take a look at a patient’s weight after the procedure and we tend to add around 5kg to this to give us a maximum weight for the patient to reach.

Patients start with Flo, and she sends prompts three times a week to remind them to send her their weight.  Once they reach the maximum limit we’ve set, they’re asked to get in touch and arrange to see the ascites team to have the fluid drained.

Personalised care for our patients:
We use the 5kg as an initial guide to try to make sure that we can intervene with patients before they reach the stage of being uncomfortable due to fluid build-up.  Sometimes, patients can become uncomfortable before this limit is reached, or the opposite where they reach the upper limit but still do not experience any discomfort.  We always makes sure to explain to our patients to get in touch in either of these circumstances, which allows us to adjust the maximum weight gain limit on a patient-to-patient basis allowing us to offer personalised care.  This is especially helpful if a patient starts using diuretics, as we can change the maximum limit accordingly.   We also make sure they know that the days and times that Flo asks them to send their weight in is flexible to suit them and their day to day lives.

Introducing Flo to patients: 

When we first talk to patients about Flo, we like to keep things nice and simple.  We find that people don’t want to be bogged down with too much information, especially when they’ve only recently been told about the implications of their condition.  We just tell patients that Flo is a tool that we offer to help them monitor their weight, and that the service is free to use – that always seems to be a winner with people!  We explain that Flo keep a record of their weight readings, and that they can use her to help keep track of their weight.

Flo’s unique persona 

While we do make sure patients know that Flo is an automated service, many of our patients refer to Flo affectionately as “she” or “her”, which gives the service a human touch.  Doing it this way helps patients to laugh with you, and makes the experience less scary and stressful.  For example, we explain to patients that if Flo doesn’t hear from them for a week or so, she has a bit of a wobble, and tells us to contact them to check everything is okay.  It’s important to make sure that patients know that Flo won’t reply to messages other than patients’ weight readings, so we ensure that they have a contact number for the nurses if they need to get in touch.

Challenges & Learning:
We had a few problems with some patients’ messages not being received by Flo, however this was a challenge with mobile network providers rather than Flo.  We got in touch with the Simple Shared Healthcare team and they were able to help us with this, they were able to work through a troubleshooting guide with us, so really the problem was an easy fix.

The other challenge we had was around engaging our patients.  Our patients range in age from their 30’s to 70 plus.  Some of those in the higher age bracket weren’t as comfortable with mobile phones, and some didn’t even have their own mobile.  We give these patients the option of having a relative who is happy to use their phone, receive messages from Flo on their behalf which enabled us to recruit Flo to help them.

Patients are sometimes also concerned about the number of texts they will receive from Flo – they expect to be getting reams of messages and having to send long replies.  When they find out it’s simply 3 messages a week, and that all they have to reply is “WT” followed by their weight, they all say “Oh is that it? That’s so much easier!”, and they are happy to sign up and try Flo.

What benefits do we see? 

Many of our patients tell us that they find Flo really helpful in keeping track of their weight.  From our perspective, this is great because we can see patients becoming more engaged with their health.  When they start on Flo, her prompts often lead to them starting to write down their weight, so they become more aware of their own health and better at managing it – as a clinician you think “Oh this is actually working!”  Some patients are even able to reduce the number of readings they send to Flo as their self-management improves!

For patients with new onset of ascites, we find that they are eager to use Flo, and many say things like “I didn’t realise I had all this fluid, but weighing myself with Flo has helped me to understand my condition and when I need to come in again”.

From our perspective, we find Flo very easy and very simple to use.  The great thing about Flo is that we can choose when to use it or not to, based on our knowledge of our patients.  As I said before, Flo really does allow us to deliver the best, flexible care for all of our patients.  Flo really has helped us to deliver high quality care to our patients, and I would recommend her to other clinicians out there.

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NHS NOTT Daily weight monitoring for ascites flow chartNHS NOTT Daily weight monitoring for ascites message schedule

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