Helping to stub out smoking
Helping smokers to give up is one of the biggest and most stubborn challenges for NHS services up and down the country.
Smoking rates in England have fallen considerably since the 1960s but the decline in smoking has lost momentum in recent years.
Over eight million people in England still smoke and it causes more than 80,000 deaths each year.
Kicking the habit has enormous health benefits and those who give up before the age of 45 have a life expectancy close to that of people who have never smoked.
In Bolton, a primary care stop smoking service was established in 1999 that has, to date, helped more than 4,500 people in the area to give up smoking.
This has involved the use of community quit groups, one-to-one support and GP and pharmacy services.
But somewhat surprisingly, smokers admitted to hospital were found to be missing out on the same level of support offered to smokers in the community.
Creating a new service
The Bolton Stop Smoking Service is now working with the Royal Bolton hospital to address this problem, using the NICE guidance on brief interventions and referral for smoking cessation to develop a new service.
Now, any patient who smokes and is admitted to the Royal Bolton hospital is flagged up and offered advice and support to encourage them to take up smoking cessation services.
The service is delivered by the acute trust in two phases. The first phase, Level 1, ensures that the patients who smoke are easily identified by hospital staff and have a ‘smoking cessation sticker' placed on their records, before being offered brief advice to give up smoking.
Hospital staff attend a three-hour hospital training session prior to offering advice. During the training, staff are given information on what literature to hand out to patients and under what circumstances patients should be referred to stop smoking services.
The second phase, known as Level 2, is designed to ensure that any smokers, who are motivated to quit, receive nicotine replacement therapy (NRT). All hospital staff involved in level 2 of the service have to complete an additional 6-hour training session. This training explains in detail the range of medications available to people wanting to quit smoking.
When a patient who is receiving NRT is discharged, the hospital notifies the local Stop Smoking Service, and they in turn send on a receipt of the discharge to the patient's GP so that they can continue to receive prescriptions for NRT from their GP.
Patients can choose during the hospital assessment to opt out of ongoing intensive support after discharge, but there is an agreed minimum follow up call made at four weeks after the recorded quit date.
On average the hospital generates about 275 level 1 referrals and 294 Level II referrals each year.
To date, 961 episodes of NRT have been prescribed, with just under half of the patients on the therapy successfully giving up smoking, 48 per cent.
The creation of the service has also seen 1,329 members of staff trained up at the hospital to carry out the smoking cessation service.
The success of the programme has led to it being submitted to NICE's shared learning database, an initiative set up to help people share their experience of putting NICE guidance into practice with their colleagues in the NHS, local authorities and more widely.
Project lead Gary Bickerstaffe, Health Improvement Specialist at Bolton PCT, says: “Back in 2000 we started to realise the potential that secondary care could have in the developing smoking cessation services.
“Given that so many people present at hospital with smoking-related health problems or go for some other reason but are still smokers, it was obvious that it was both appropriate and necessary to develop a stop smoking pathway that started at the hospital and also linked into community services.”
The strength of NICE guidance
“Initially there was very little guidance around to help guide this work but as NICE started to produce specific guidance on smoking and public health we used it to ensure we had developed our service thus far in line with the guidance recommendations.
“We increasingly started to use it as credible guidance to initiate work with clinicians and nursing staff to help us further develop in areas where we the pathway was underdeveloped.
“Now we continually look to NICE guidance around smoking cessation including areas such as brief advice, brief interventions and service delivery to ensure that we are embedding the practices in line with best practice and a recognised strong evidence base.
“This gives us a very firm footing particularly within healthcare services who acknowledge the strength of NICE guidance.”
Tracey Holliday, a Stop Smoking Specialist for Pregnancy and Hospitals at NHS Bolton, adds: “We have over the last 8 years or so helped many thousands of patients to access stop smoking support in hospital. Many of whom will now avoid smoking related disease or who will have been helped to avoid further events caused by continuing smoking.
“We also now have a system that hospital staff can employ with their patients who smoke. Previously staff could only give simple advice to stop. But now they can initiate a range of options from advice, referral through to actually getting involved with helping them quit there and then. This does help staff to feel that they are able to do their job much more effectively.”
You can find out more about the work of the Bolton Smoking Cessation Service and other examples of shared learning by searching the online database.
Submit your own example by filling out a simple online entry form. All entries will be considered for NICE's annual Shared Learning Awards, which will take place at the NICE annual conference on 15-16 May 2012.
All of NICE's guidance on smoking cessation can be found on NICE pathways, an online tool for health and social care professionals that brings together all related NICE guidance and associated products in a set of interactive topic-based diagrams.
13 September 2011