To ensure hospital inpatients who smoke are identified and subsequently routinely offered advice and support regarding smoking cessation. That inpatients are offered evidence based approaches to quitting or temporary abstinence. This specifically supports guidance set out in PH48 Smoking Cessation in Acute, Maternity & Mental Health Settings but also cuts across several other NICE guidance including: PH1; PH 10; PH 26; PH 14 PH45 PH 48.
Aims and objectives
Reasons for implementing your project
How did you implement the project
2. Staff also seemed to be making quit attempts that they may not otherwise have considered.
3. Outpatient referral capacity was quickly improved but inpatient access to smoking cessation support was not initially available. The Level II pathway offers an adequate level of support to inpatients who cannot access community based services whilst admitted. Patients admitted to hospital for a variety of reasons, are now routinely offered advice and support to stop smoking or abstain.
4. The hospital is increasingly working with the Local Authority on public health and increasingly taking a role in delivering public health and health promotion practices alongside its usual secondary care role.
5. The practice also provides practical support in implementing a smoke free hospital site policy. As this pathway utilizes existing hospital staff, costs were minimal other than the time spent in training. Given that a patient who stops smoking is often discharged sooner and less likely to be re-admitted it is likely to be a cost effective practice to implement.
The number of referrals at Level I are recorded when received at the Stop Smoking Service. Level II referrals again are all recorded at the Stop Smoking Service and within hospital patient case notes. Data from pharmacy also alerts us to where stop smoking pharamacology has been prescribed which can be matched against referrals to see which patients have not been offered behavioural support through the pathway. Costs of hospital practices involving supply of NRT have been obtained from pharmacy purchase and dispensing records.
Actual costs are difficult to determine but a recent evaluation put pharmacology costs at approximately £3000-£5000 per year for about 250 patients put on a supported quit attempt. There are approximately 25 referrals into the Stop Smoking service each month. These are from a fairly restricted number of but high priority aras such as cardiology and respiratory. The overall quit rate of the Level II referred paitients is about 40-45%. Given the cost effectiveness data provided by NICE this looks to offer a very cost effective service.
Verbal feedback from patients themselves has on the whole been very positive and they view the practices as being of value and important to them.
Key learning points
2. Put in place safeguards against smoking cessation pharmacotherapies being prescribed independently of some behavioural support as this does not follow the evidence base and will not be cost effective.
3. Dedicated training is required to equip hospital staff with the skills, knowledge and confidence to intervene in patients smoking (Such training is unlikely to be appropriately delivered in less than three hours).
4. Buy-in from senior management and pharmacy will ease implementation of a pathway as these can be significant barriers otherwise.
There are many known learning points and many still emerging, there is an additional document uploaded with this preliminary explanation which offers a more descriptive methodology of the level II pathway itself.
Some of the staff Level II training sessions and clinical staff update sessions received sponsorship from pharmaceutical companies. This usually involved supplying refreshments and product information on training and pharmacology update sessions.