K2 Hampton – an app which enables women with hypertension to remotely enter blood pressure and urine protein results from home and work – was introduced to the Pregnancy Assessment Unit in Northumbria Healthcare Trust following some funding through the LMS during the COVID-19 pandemic in line with the RCOG guidance for Management of Remote BP Monitoring. We caught up with the team to find out what they make of K2 Hampton and how both the trust and pregnant women are benefitting from its application.
In what ways has K2 Hampton benefitted your department?
K2 Hampton has made a huge impact in patient safety by providing women a robust, safe and reliable system. It has allowed collaborative working between patients and the Multidisciplinary team within Maternity with a reliable referral process of outpatient management of abnormal hypertension and proteinuria.
With remote management of BP it has in turn prevented footfall through The Northumbria Hospital, a COVID-19 hotspot environment during the national lockdown, ultimately putting patients first, ensuring their health and well-being from potential exposure to the coronavirus.
Have you seen a reduction in the number of appointments allocated to hypertension monitoring since Hampton was introduced in your department?
There has been a dramatic reduction in follow up appointments in Pregnancy Assessment Unit (PAU) from patients with Gestational Hypertension, without proteinuria, pre-eclampsia, and chronic hypertension.
Prior to the use of K2 Hampton, our local guidance for gestational hypertension required a face-to-face follow up BP/Urine check weekly either at PAU or Community Midwife (CMW). Now these particular patients are managed remotely from home on a weekly basis, taking responsibility by submitting their BP reading, and have a direct link/contact to PAU via the K2 system if an abnormal BP is registered or a new proteinuria in line with NICE recommendations.
In relation to the pre-eclampsia patients with an elevated Protein creatinine ratio (PCR), the follow-up appointments remain the same such as twice weekly Blood Pressure Profiles (BPP) in PAU. However, between their appointments the patient requires an interim BP check where K2 saves a face-to-face contact by providing a remote contact as non-patient facing with the patient submitting their reading to the system rather than a CMW or PAU midwife to check the patient’s BP offering ownership to their own well-being and shared care.
Finally, with the Chronic Hypertensive patients it reduces their contacts massively as early onset abnormal BP or predisposing hypertensive disorder requiring medication early in pregnancy, the pathway followed requires weekly readings where usually they would attend a community clinic to monitor their BP. Now K2 provides this remote management of their long-term BP while remaining in constant contact with the multidisciplinary team.
With outpatient management for all categories of Hypertensive disorders the woman has less hospital visits that are time consuming and often costly for some of Northumbria’s patients in lower socio-economic groups with consideration to the cost of the distance travelled to the Northumbria hospital and parking charges.
How have your women been responding to using K2 Hampton?
The patients have responded positively to the introduction of the K2 Hampton system. It has been empowering for the women to take responsibility for their own health and well-being, providing them with information for them to have an understanding of what is normal/abnormal and signs and symptoms they should be wary of. It has given them confidence to use their instinct in performing a self check at home if they are feeling unwell or experience a change in their clinical condition. They have been able to submit an interim BP or test their urine to observe for a new/increased proteinuria. This has occasionally led to referrals into PAU following a deterioration of a patient’s clinical condition.
From a professional experience, we get to build a good rapport with the women on K2 monitoring and have witnessed women having a better understanding of why they have been recalled due to normal/abnormal parameters and often are able to openly discuss their well-being in relation to their signs or symptoms and the risk/implications involved.
Do you feel confident when caring for a patient using Hampton?
Within PAU we had a group of core team midwives keen to introduce the new K2 remote monitoring system to our service and had the opportunity to dial in to a team’s meeting with a K2 representative to demonstrate the system prior to the implementation. This was beneficial and increased the team’s confidence in the initial set up and expectations. We would recommend this to any new users. As the team became more familiar with the system they have all become admin users to ensure when rotational staff come through or are new to the unit they can enrol a new user by sending the link providing some support and guidance of how to navigate the system. We have a nominated K2 Champion within the core team who follows up any discharges submitting the data required.
K2 has quickly become embedded into our daily administrative tasks, checking the system for any outstanding abnormal readings or any red flags. This is done on each change of shift, day and night. The red flags of any readings outside the normal range provide us a quick and efficient risk assessment tool in who we need to prioritise for recall to the unit for follow up or further intervention. When actioning a red flag this further solidifies patient safety that the appropriate care and treatment has been delivered as well as providing an electronic record of communication between the multi-disciplinary team.
We are auditing our use of K2 alongside the new ratio test. This is carried out fortnightly by our K2 Champion midwife. This ensures the patients are on the correct pathway. It works efficiently with the communication we keep as a combined file on the unit that consists of patients who are on home monitoring and who have had abnormal preeclampsia ratio tests.
How much time on average do you think Hampton saves per routine BP follow-up appointment in comparison to patients who are not using Hampton?
In line with Northumbria Healthcare Trust local pathway, I feel the Gestational Hypertensive patients benefit more in terms of the reduction in patient facing follow up. On average, each patient saves approximately 1-2 hourly weekly BP profile follow-up.
Consideration for the pre-eclampsia patients, although our local pathway remains to be twice weekly BP profiles in PAU, the interim BP Submitted every 48hours will save a midwifery contact appointment within the community setting whether it being at home or GP surgery. Patients who fall into the category Chronic hypertension save a weekly 20minute face-to-face contact with a CMW in a GP surgery.
Finally, those who have an increased BMI who are not candidates for home monitoring if their arm circumference exceeds 42cm need to attend the PAU for a face-to-face contact depending on their clinical condition and which pathway they are following. BP machines of a larger cuff would benefit both patient and health care providers given the clientele we see within The Northumbria and rising rates of women having elevated BMI.
How can you see Hampton enhancing the care you provide in the future?
In terms of Northumbria Healthcare Trust moving towards paper light and implementing an electronic record for maternity patients, I would hope K2 Hampton system is here to stay long term. We have been able to secure a further 12months contract.
Additionally, whilst exploring and navigating the electronic record of K2 I have noticed the extra services available to us. I would like to see K2 used in the community clinics with all multidisciplinary professionals submitting patients BP readings when they are attending either a CMW or consultant clinic. All disciplines could use this as an effective communication tool of shared care between patient and professional. This could guide all healthcare providers if any referral or follow-up is required.