Agnes Munro

Earlier this year, after a period of deteriorating health, much to her surprise Agnes Munro, from Point in the Isle of Lewis, was diagnosed with cardiomyopathy and advanced heart failure.

After a period of treatment on the mainland she returned home and is now under the supervision of the NHS Western Isles nurse-led Heart Failure Service team in Stornoway, through the use of the Florence programme (or Flo as she is better known) for home health monitoring.

The Heart Failure Service team is a unique service, providing early diagnostic support and ongoing management of heart failure for those living with the condition in the Western Isles. The team operate on their own without an onsite cardiologist, and have excellent links and support networks with mainland centres so patients can easily be referred to specialist consultants for treatment, if required.

Agnes explained, “I have a new friend called Florence. As behoves us in these days of social media we contact each other by text only – the modern equivalent of a pen friend I suppose. It must seem weird then that Flo helps to keep me healthy and in fact helps to keep my blood pressure in check. This is even more peculiar because she’s a machine, in fact she’s just a phone!

“In order to improve my heart function, my blood pressure, heart rate and fluid intake need to be carefully monitored and the easiest way to check that this is within normal limits is to check my blood pressure and weight every day. This is where Flo comes in. I simply text these measurements in daily. If I don’t Flo soon reminds me.

“Debra Vickers, the local lead heart failure nurse, who correctly thought we’d get on famously, introduced Flossie or Flo as she prefers to be called. Although I call her a nag and bossy (Flossie, not Debra) in fact I’m now quite dependent on her, though her persistent texting early in the morning drives me mad. If I haven’t replied within an hour or so she texts me to tell me I haven’t texted her back! See what I mean about being bossy and a nag!

“The huge benefits of the system are that I’m reassured that any glitch will be noted immediately by the HF team without me having to run around, increasingly stressed, trying to make appointments. The other benefit is that having to record and report the measurements daily gives me complete control and motivates me to comply with the treatment. It also means that the temptation to cheat is removed. I like the reassurance of checking my BP when I increase the dose of my drugs.”

“When I go to clinic the information has been downloaded onto my record and is visible in graph form which is so helpful to the clinician and me in viewing my progress and seeing it at a glance instead of rifling through charts and written records. It is important...although it belongs to me, it is between us.

“Despite her nagging I love Florence and hope the system is extended to many more services... NHS Western Isles are undeniably good at adopting the latest technologies to the great benefit of patients.”

In fact the local Heart Failure team were one of the early adopters of Flo in the Western Isles and it has now become ‘business as usual’ as part of their service for both the nurses and many of their patients.

In particular, the team have found Flo particularly useful in helping to remotely manage the introduction of a new drug for heart failure, called Entresto.

Although potentially life changing, if the drug is not carefully introduced it can affect someone’s blood pressure and can make them feel dizzy or lightheaded. The team were also early adopters of this new drug and the first patient in Scotland to be prescribed it lives in the Western Isles.

Debra Vickers, NHS Western Isles Lead Heart Failure Nurse, said, “Named after Florence Nightingale, the Florence programme (Flo) is a web based text messaging clinical interface now being used to help people who have been prescribed this new drug by remotely monitoring their blood pressure as the new medication is introduced.

“This allows our Cardiac Nurse to log in via the internet and decide when it is appropriate to increase the amount, which may need to be done several times until the person is able to take the optimum dose.

“Florence (Flo) works by sending a reminder to the patient every day to check their blood pressure, using a small machine provided by the NHS. The nurse can then log in via the internet and check how the patient is getting on without the patient having to take time out for an appointment.

“Flo helps us to keep in touch with and offer an extra level of support to our patients and their families, both the nursing team and the patients find it easy to use and helpful. It was exciting for us to have one of our patients as the 1st recipient of a new HF drug in Scotland. The fact that we could keep an eye on the patient remotely was great, they have a full time job so it can be a hassle to attend regular follow up appointments to check their response to the drug, and we could do it all using Flo.”