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Smoking: acute, maternity and mental health services [PH48]

Measuring the use of this guidance

Recommendation: 1

Provide information for planned or anticipated use of secondary care Who should take action? Health and social care practitioners and managers in primary care, including GPs, health visitors and midwives. Health and social care practitioners in acute, maternity and mental health services, including community services, drug and alcohol services, outpatient and pre-admission clinics. Managers of secondary care admissions and pre-admission assessment services. What action should they take? Provide everyone with verbal and written information and advice about the smokefree policy before their appointment, procedure or hospital stay. This should convey: the short- and long-term health benefits of stopping smoking at any time[1] the risks of secondhand smoke that all buildings and grounds are smokefree (see recommendation 11) the types of support available to help them stop, or temporarily abstain from, smoking before, during and after an admission or appointment (see recommendations 3 and 4) the different pharmacotherapies that can help with stopping smoking and temporary abstinence, where to obtain them (including from GPs) and how to use them. Before a planned or likely admission, work with the person to include the management of smoking on admission or entry to the secondary care setting in their personal care plan. Provide information for relatives, carers, friends and other visitors explaining why the hospital is smokefree and giving information about local stop smoking services.

What was measured: Proportion of institutions that provided written information to elective patients about the institutions smokefree policy before their hospital stay.
Data collection end: May 2016
51%
Area covered: UK
Source: British Thoracic Society. Smoking cessation audit report.


Recommendation: 2

Identify people who smoke and offer help to stop

What was measured: Proportion of patients that had smoking status recorded in their notes.
Data collection end: January 2015
48%
Number that met the criteria: 123 / 290
Area covered: Local
Source: Sohal et al. (2016) Preparing for Completely Smoke-Free Mental Health Settings: Findings on Patient Smoking, Resources Spent Facilitating Smoking Breaks, and the Role of Smoking in Reported Incidents from a Large Mental Health Trust in England. International Journal of Environmental Research and Public Health 2016 VOL 13.

What was measured: Proportion of patients that received stop smoking advice.
Data collection end: January 2015
73%
Number that met the criteria: 72 / 98
Area covered: Local
Source: Sohal et al. (2016) Preparing for Completely Smoke-Free Mental Health Settings: Findings on Patient Smoking, Resources Spent Facilitating Smoking Breaks, and the Role of Smoking in Reported Incidents from a Large Mental Health Trust in England. International Journal of Environmental Research and Public Health 2016 VOL 13.

What was measured: Proportion of patients with smoking status recorded.
Data collection end: May 2016
73%
Area covered: UK
Source: British Thoracic Society. Smoking cessation audit report.

What was measured: Proportion of people who smoke who received advice on how to stop.
Data collection end: May 2016
5.6%
Number that met the criteria: 153 / 2716
Area covered: UK
Source: British Thoracic Society. Smoking cessation audit report.


Recommendation: 6

Advise on and provide stop smoking pharmacotherapies Who should take action? Stop smoking advisers and other healthcare practitioners who advise on, supply, or prescribe, pharmacotherapies. What action should they take? Advise people who smoke that licensed nicotine-containing products and other stop smoking pharmacotherapies help people to stop smoking and reduce cravings. Emphasise that nicotine is not the major cause of damage to people's health from smoking tobacco, and that any risks from using licensed nicotine-containing products or other stop smoking pharmacotherapies are much lower than those of smoking. Recommend and offer: licensed nicotine-containing products (usually a combination of transdermal patches with a fast-acting product such as an inhalator, gum, lozenges or spray) to all people who smoke[5] or varenicline[6] or bupropion as sole therapy as appropriate. Do not offer varenicline or bupropion to pregnant or breastfeeding women or people under the age of 18. Varenicline and bupropion can be used with caution in people with mental health problems[7]. Encourage people who do not want (or do not feel able) to stop smoking completely (including pregnant or breastfeeding women) to use licensed nicotine-containing products to help reduce cravings to smoke during their stay or visit. If stop smoking pharmacotherapy is accepted, ensure that it is provided immediately. The person should remove nicotine replacement therapy (NRT) patches 24 hours before microvascular reconstructive surgery and surgery using vasopressin injections. When people are discharged from hospital ensure they have sufficient stop smoking pharmacotherapy to last at least 1 week or until their next contact with a stop smoking service. Encourage people who are already using an unlicensed nicotine-containing product (such as unlicensed electronic cigarettes) to switch to a licensed product[8]. Advise the person of local policies on indoor and outdoor use of unlicensed nicotine-containing products. See also NICE guidance on varenicline (NICE technology appraisal guidance 123) and smoking cessation services (NICE public health guidance 10).

What was measured: Proportion of patients that smoke who were offered licensed nicotine replacement therapy (NRT) to help them abstain from smoking whilst inpatients.
Data collection end: May 2016
4%
Area covered: UK
Source: British Thoracic Society. Smoking cessation audit report.


Recommendation: 10

Provide leadership on stop smoking support Who should take action? Directors and senior managers in publicly-funded secondary care services. What action should they take? Assign a clinical or medical director to lead on stop smoking support for people who use, or work in, secondary care services. The designated lead should ensure: an organisation-wide smokefree policy is in place (see recommendation 11) the organisation has an annual improvement programme for stop smoking support given to people who use, or work in, secondary care services stop smoking support (for patients and staff) is promoted and communicated effectively (see recommendation 12) to initiate a cultural change within the organisation referral and support pathways are part of the organisation's service plan hospitals have an on-site stop smoking service staff in secondary care services deliver stop smoking support to help people stop, or temporarily abstain, from smoking, in line with the recommendations in this guidance the quality of stop smoking services continues to improve progress and outcomes in each clinical area are monitored, for example, recording of individual smoking status (including at the time of giving birth), the number of referrals, uptake of interventions, prescribing of stop smoking pharmacotherapies, 4-week quit rates, training of staff performance monitoring and feedback on outcomes is provided to all staff.

What was measured: Proportion of institutions that had identified a senior medical leader for their smoking cessation service.
Data collection end: May 2016
26%
Area covered: UK
Source: British Thoracic Society. Smoking cessation audit report.


Recommendation: 14

Provide stop smoking training for frontline staff Who should take action? Organisations providing training in smoking cessation and temporary abstinence such as the National Centre for Smoking Cessation and Training (NCSCT). Royal colleges, medical, midwifery and nursing schools, undergraduate and postgraduate training providers. Healthcare professional training schools. Local education and training boards. Public health commissioners, health and wellbeing boards, clinical commissioning groups. Directors, managers and healthcare professionals in medical, surgical and maternity hospitals and clinics. Directors and managers in mental health services, including drug and alcohol treatment services. Managers of stop smoking services. Health Education England. What action should they take? Ensure relevant curricula for frontline staff include the range of interventions and practice to help people stop smoking, as outlined in this guidance. Ensure all frontline staff are trained to deliver advice around stopping smoking and referral to intensive support, in line with recommendations 1 and 2. They should know what local and hospital-based stop smoking services offer and how to refer people to them. Ensure online training can be completed and updated annually as part of NHS mandatory training (for example, training provided by the NCSCT). Ensure all frontline staff are trained to talk to people in a sensitive manner about the risks of smoking and benefits of stopping. Ensure all staff who deliver intensive stop smoking support are trained to the minimum standard described by the NCSCT (or its equivalent), with additional training that is relevant to their clinical specialism. Ensure all staff are provided with information about smokefree policies and instructions about their roles and responsibilities in maintaining a smokefree work environment. They should be advised on what action to take in the event of negative responses to smoking restrictions.

What was measured: Proportion of institutions that offered smoking cessation training to frontline staff.
Data collection end: May 2016
44%
Area covered: UK
Source: British Thoracic Society. Smoking cessation audit report.



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