Post-discharge reassurance and support for patients and carers

Agnieszka Belz  Pharmacy Technician Carer Support Worker 


Agnieszka Belz is a Prescribing Support Pharmacy Technician at NHS Lothian.  Agnieszka was first introduced to Flo as part of her role as a Pharmacy Technician Carer Support Worker within the Edinburgh Carer Support Team.  The team recruited Flo to continue the conversation and provide patients with additional advice and signposting after being discharged from hospital.  Agnieszka employed Flo as a medication prompting tool and has shared her experiences of how Flo has motivated her patients to increase adherence with their medication during this key transition from hospital to home.

How did I hear about Flo?

I already had some knowledge that local clinicians were innovating with Flo across NHS Lothian.  They were experiencing really positive outcomes that were being demonstrated across various aspects of patient’s health.   I had identified a cohort of patients under my care, who would benefit from some support aimed at improving their adherence to their medication regime.  As I was searching for a tool to support this, Flo sounded like a great match as an opportunistic tool for the patients and carers I supported.   Therefore, the Edinburgh Carer Support Team chose to innovate with Flo to support unpaid carers in their roles relating to medication compliance.

Why did I want to use Flo?

My passion is to support patients and their carers with their medication during and after their hospital discharge, which can understandably be a difficult time.  So far I have learned that discharges, and the changes associated with leaving hospital, bring lots of anxiety and uncertainty to family members and friends.  Family and friends often undertake the role of unpaid carers and they shared with me some of the issues which they experience:
“ How will I remember to remind my loved one to take their new medication? 
“ Will I be able to leave the house without worrying that my loved one will take their medication or will I have to stay with him during medication administration times? ” 
Locally, I shared my idea with Elizabeth Payne, who was my line manager and the Project Development Manager at the time.  Elizabeth was more than happy to support me in implementing Flo as a remote medication prompt for my patients and their carers.

What stood out for me about Flo?

Probably that I could easily create a medication reminder prompts specific to the patient or carer’s individual needs, and even include additional advice for specific medications that was meaningful, e.g. “take out of the fridge”, or “take with full glass of water”, which for some patients is very important and makes adherence more likely.

What were the potential benefits of using Flo?

Once we began to introduce Flo to our patients, I found that there were many potential benefits for my patients and their carers, including:

  • Helping to prevent hospital readmission through the correct administration of medication
  • Safer use of medication due to improved compliance
  • The ability to provide updated information in the reminders when medication changed, or allowing me to make an opportunity to discuss their medication over the phone 
  • Improving independence with no need for a package of care with medication prompts upon discharge
  • Reduced stress for patients and their carers
  • Allowing patients and carers to take part in ‘out of house’ activities, for example carer going to work or on holiday

There were also additional benefits that became apparent for my own clinical practice:

  • I was able to learn more about certain medication regimens which in turn allowed me to provide enhanced care for patients. My learning came about from creating and agreeing the times for medication prompts with the patient and carer.  I found that the routine at home after discharge was different to that while in hospital, so I had to take patient’s lifestyle and habits into consideration.   When creating prompts for the specific agreed times, I had to consider how certain medication worked in relation to food and storage, for example if the medication required refrigeration, how long could it be left unrefrigerated to support the patient’s routine and compliance?  When working with one patient, I researched more about their medication storage, and found out that in certain quantities it was ok to store it at room temperature for number of days.   This meant that the patient could keep it together with other medication, having it all ready when Flo’s prompt arrived.  Identifying issues like this and applying the learning from it helped to improve other patients’ compliance.

What were my first steps with Flo?

One of the first protocols that I developed was aimed at supporting a specific patient who had been diagnosed with Parkinson’s disease, and her sister who lived with her and acted as her carer.  Due to the nature of the condition, the times that the patient’s medication needed to be administered are very specific; if patients with Parkinson’s Disease do not receive their medication on time, their ability to manage their symptoms may be lost.  Therefore I had to consult with the Parkinson’s Nurse in the Western General Hospital for additional input to ensure that the protocol design was accurate.  I decided to use a general medication reminder protocol, and then was able to personalise the protocol for this patient matching Flo’s interactions with the patient’s medication regime.  I found that integrating Flo was quick and easy to manage, and I received great support from the Flo team.

Challenges and learning

The majority of patients/carers I supported were elderly, so the two most challenging aspects were to receive a reply to Flo’s first invite message and for the patient/carer to sign our local consent form.   I noticed that very often Flo would have been useful for the first week or two after a discharge from hospital.  The reason for this was to be able to offer the patient some support in getting used to a new medication routine for what is often short term, or to improve the likelihood of patients completing a course of treatment that had been started whilst they were in hospital.  Within my practice I found that ensuring compliance with these short term medication routines was sometimes difficult.

However, often I was not able to see the patient prior to their discharge.  Many patients’ carers would feel overwhelmed and it was quite stressful for them to think about arranging extra time to sign the local consent form.  For this reason, some patients or carers ended up not opting in and at the same time being able to benefit from Flo’s support.  Discharge from hospital is often a challenging time and understandably, patients and their carers need a quick, hassle free process, especially when starting with Flo as a short term, but important support tool.   I feel that if an introduction to Flo was made part of the pre-discharge process, patients and their carers would be more open to retaining the information, enabling more patients to benefit from Flo.

My successes with Flo

One of my patients increased her independence tremendously and became able to go out with her friends without having to rely on her sister (who was also her carer).  Previously the patient had to depend on her sister to remind her take her medication, but with Flo’s support she was able to develop the confidence to become more independent as she could rely on Flo to prompt her to take her medication on time, according to her strict regime.

One patient’s carer began to be able to go on holiday, with the reassurance that Flo was there acting as a medication prompt for the cared for person.  This would not have been possible before and brings many wider benefits to the carer.

One of my patients had previously experienced multiple hospital admissions due to the side effects associated with not being adherent to their medication regime.  On identifying the issue, being able to offer Flo’s support, resulted in the avoidance of further admissions as the patient was able to independently take their medication as prescribed.   This patient was not able to open and read a text message, however they found that just hearing the sound of Flo’s message coming through to their phone was enough to successfully prompt them to take their medication.

Patients and carers have also commented that using Flo as a medication prompt tool was very helpful for them:

Helpful to know someone is reminding them to take their medication even though he cannot open the messages, the message alert noise on his phone is enough to prompt him to take his meds.
We would be lost without it.
If the service was to stop reminding my father to take his medication, it would not take long for him to slip into his old ways of forgetting to take his meds at right times, and he would start taking them all at once if he forgot, rather than at set times/intervals. Hopefully this service will continue as it has been excellent for my father.
It would make things very difficult for us. I can remind my sister to take her medication as she sometimes does not hear her phone. If we do not get the text reminders, I would have to set my alarm on my phone for each time. As I have my own life to live, chances are she would miss a lot of her medication. 
The patient accidentally managed to delete Flo from their phone. I just messaged the pharmacy technician who set it up initially and she restarted the service for the patient which I was really grateful for. 

Summary

I found Flo was a great, supportive tool, while undertaking my previous role.   For those patients who were getting support from Flo, achieving independence would not have been so easy otherwise.   It has been wonderful to see people’s quality of life being improved thanks to Flo.

I used Flo mainly with elderly patients, but I think that it would be a great tool for busy, working people, or parents with children, to help them to remember to administer their medication at the right time. In both of these groups of people, the use of technology is already part of their daily life, so I think that a Flo medication prompt could be of great benefit to them.   Some examples would be patients on short term antibiotics, who need to take regime and storage into consideration, or patients who have never had to take prescribed medication before.

I am sure that if using Flo as a medication prompt was promoted in community pharmacies, it would be a great success.  At the same time patients’ confidence, adherence to their medication, and health could potentially improve.

Flo is much more than medication prompt tool.

If you would like more information please contact Agnieszka at Agnieszka.Belz@nhslothian.scot.nhs.uk

#NHS Lothian #Edinburgh Carer Support Team #TotallyUnique

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