Shared learning database

Bolton Primary Care NHS Trust
Published date:
July 2008

A project at the Trust to ensure hospital patients were routinely offered advice and support regarding smoking cessation.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

To ensure hospital patients were routinely offered advice and support regarding smoking cessation. 1. Ensure there was ability within a hospital setting to act on a patient's desire to attempt smoking cessation. 2. Ensure that any practice was sustainable and also constantly and widely available. 3. Ensure that the service in hospital 'joined up' with primary care services to ensure continuity of service between the two.

Reasons for implementing your project

There was a fragmented, infrequent and non-standardised approach to offering advice and support to people presenting at hospital. Given that a hospital-setting deals with large numbers of people each year from a variety of backgrounds and with varying heath needs and in many cases are open to interventions around their health, it was an obvious gap in service provision that the hospital could not advise or support people adequately to attempt to quit smoking. Also, as there was very little smoking cessation intervention, it was considered to be a public health failing that such a large and health-motivating environment was not used to promote the health benefits of smoking cessation. As well as patients, it was also known that a large number of staff smoked and this could also be tackled.

How did you implement the project

1. Training being delivered and referral process being made apparent and available,especially in pre-operative assessments, quickly produced a large amount of referrals to the local Stop Smoking Service. 2. Staff also seemed to be making quit attempts that they may not otherwise have considered or had time for. 3. Outpatient referral capacity was quickly improved but inpatient access to smoking cessation support was not available. The Level II pathway ensured a reasonable level of support was available to them also. Patients admitted to hospital for a variety of reasons, are now routinely offered support to stop smoking. 4. The hospital is increasingly working with primary care on public health and increasingly taking a role in delivering public health messages and practices alongside its secondary care role.

Key findings

Hospital staff were and indeed still are, regularly consulted for their input on smoking cessation practices from design of forms and training to training delivery and update planning and delivery. Each training session is evaluated to indicate if the training meets their needs and expectations. The number of referrals at Level I have been recorded from receipt at the Stop Smoking Service. Level II referrals again are all recorded at the Stop Smoking Service and within hospital patient notes. Verbal feedback from patients themselves has been very positive and they view the practices as being of value and importance to them. Costs of hospital practices involving supply of NRT have been obtained from pharmacy purchase and dispensing records.

Key learning points

As there are now many known learning points and many still emerging, there is an additional document uploaded with this preliminary explanation to more fully describe these.

Contact details

Gary Bickerstaffe
Health Improvement Specialist (Health Promoting Hospitals)
Bolton Primary Care NHS Trust

Secondary care
Is the example industry-sponsored in any way?