Shared learning database

Bolton Primary Care NHS Trust & Bolton NHS Foundation Trust
Published date:
September 2011

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

Reasons for implementing your project

Originally there was a fragmented, infrequent and non-standardised approach to offering advice and support to smokers within hospital. Given that hospital settings deal with large numbers of people each year from a variety of backgrounds, with varying heath needs and often are open to interventions around their health, it is an obvious gap in service provision if a hospital cannot 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 a large and health-promoting environment such as a hospital was not extensively used to promote the health benefits of smoking cessation. In addition to this, it was also known that staff smoke and this should 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. This 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. 3. Outpatient referral capacity was quickly improved but inpatient access to smoking cessation support was not initially available. The Level II pathway ensured a reasonable level of support was made available to inpatients. Patients admitted to hospital for a variety of reasons, are now routinely offered advice and 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 and health promotion practices alongside its usual secondary care role.5. The practice provides practical support to implement a smoke free hospital site policy.

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

There are now many known learning points and many still emerging, there is an additional document uploaded with this preliminary explanation to enable us to more fully describe these. Practice sharing resources are available also.

Contact details

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

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