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Florence Audit – Patient Engagement and Viability Longterm In Patients with Gestational Diabetes Background • Florence is an online platform designed for remote monitoring • It allows graphing of blood glucose readings in patients with GDM and eliminates the need for emailing in results which creates data protection complications • Patients should take one fasting reading a day and three post-meal readings (totalling 28 readings per week) • The aim of the audit was to determine whether patients are using Florence effectively • Data was collected from 34 women who used Florence during pregnancy following a Data Collection diagnosis of gestational diabetes • Identified from attendance of Post-Natal Clinic (6 weeks postnatal) between 7 February & 28 April 2023 Aims & Standards Identify interval between diagnosis & Standard: within 7 days dietitian review Identify interval between diagnosis & Standard: within 7 days starting Florence Identify interval between reviews & reason for said interval Standard: every 2 weeks Standard: should be performing 7 fasting blood glucose Identify average tests per week missed readings & 21 postprandial readings per week totalling 28 readings per week Results Interval </= 7 Measurement Average Range Interval > 7 days days 31 out of 32 Diagnosis-dietician review interval (d) 3.375 0 to 10 1 out of 32 (3.13%) (96.87%)* 23 out of 33 Diagnosis - starting Florence interval (d) 5.88 1 to 13 10 out of 33 (30%) (70%)** Duration of Florence use (Florence start date - delivery date) (d) 76.912 14 to 142 Average days between reviews 8.925 2.8 to 12.83 *2 patients did not receive a dietician review, both had had GDM in a previous pregnancy **1 patient engaged poorly following diagnosis and had an interval of 40 days which was excluded as deemed to be an anomaly Considerations • 30% of patients did not meet to standard interval from diagnosis to starting Florence • Specialist Diabetic Midwife was on leave for a significant proportion of the time from which the data was collected • Further research into whether this had an effect is required Explanation for Medical Reviews <14d • Explanation for medical reviews <14 days • High blood glucose readings -> most common • 4/23 due to missed readings • 5/23 due to missed & high readings High MissinMissingand Other Results Measurement Average Target Percent meeting target 24 out of 34 Average number of fasting readings/wk 6.412 7 (70.5%) 4 out of 34 Average number postprandial readings/wk 15.912 21 (11.76%) Total average readings/wk 22.35 28 4 out of 34 (11.76%) Number of missing readings - fasting 0.56 0 Number of missing readings - postprandial 5.09 0 Total missing readings/wk 5.65 0 Total Number of Blood Glucose Readings per Week 7 6 6 5 5 4 4 4 3 3 2 2 2 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 28 27 26 25 24 23 22 21 20 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 0 Days 4 6 2 1 3 4 1 5 1 1 1 0 0 1 1 0 0 2 1 0 0 0 0 0 0 0 0 0 Days Review • 70.5% of patients met the target for fasting blood glucose but only 11.76% met the target for postprandial • Most commonly undocumented meal: dinner • Difficult to determine accuracy of this is using Florence as often unclear which postprandial reading is being submitted • Discrepancies in documentation of blood glucose review • Examples of poor documentation: “blood glucose fine” or “blood glucose reviewed on Florence” • Documentation of missed reading unclear • Difficult to ascertain whether blood glucose not performed or not submitted on Florence • Inability to identify which meal a missed postprandial reading relates to • No marker on Florence as to which submission is which meal • Patients submit their readings at different times each day and evening meals can be submitted past midnight consequently registering as the next day Suggestions for Improvement • Florence Initiation • Ensure that there is a full-time member of staff with the ability to start patients on Florence or alternative app • Documentation • Creating a departmental standard for documentation • Mdocument blood glucose ranges and missing readingsow to record blood glucose reviews from Florence, including how to • Now implemented • Determining missing readings • Improvements in the system to ensure that readings are aligned to a certain meal, prompting patients to submit readings if missing • Ensuring patients are asked at review which meals they are missing and reasoning behind this (to be included in the departmental standard for documentation) • Accessibility • Florence is only operational in English resulting in the exclusion of a large patient group who do not speak English • Consider alternative apps so that more patients can use and benefit from the system • Threshold for Alerts • Creating individualised alerts could ensure more patients receive optimal reviews