SMOKING CESSATION PILOT

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SMOKING CESSATION PILOT

• NEWSAM CENTRE
• WARD 2 AND 3 FORENSIC SERVICES
• Helen Hartley
• Michael Dixon
• Mark Lester
• Denise Hobson

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INTRODUCTION

• Studies show that of patients in mental health
  units
• 70 smoke
• 50 are heavy smokers
  (smoking more than 20 cigarettes per day)
• This compares to approximately 26 of the general
  population.
• (Meltzer H. et al 2003)

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Leeds PFT going smoke-free

• Leeds Partnerships NHS Foundation Trust went
  smoke-free January 2007
• Route to go smoke-free
• Stopping smoking working group established inc
  estates, smoking cessation service, medics,
  pharmacy, nursing, TCCC, unions, risk management
  dept.
• Smoking shelters
• No smoking signs
• CD on smoking literature produced
• NRT available on all community and inpatient
  units (patches and gum)

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Perceived worries about going smoke-free

• Increased risk of violence
• Fire hazard
• Nursing time required for escorting patients
• Impact on staff breaks
• Lack of knowledge about NRT
• Time required to speak to patients about quitting

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And what actually happened..

• No increased violence
• occasions of smoking in bedrooms but no increase
  in fires
• Escort patients at set times
• Breaks ask lynn?
• Address with training advice sort where needed
• Time required to speak to patients

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Training of staff

• lunchtime talk to doctors about prescribing NRT
• Lunchtime talk to pharmacy
• level 1 training offered to wards but only
  taken up by 2 out of 4 sites
• Level 2 training 20 trained after running 2
  course (4 offered)
• Dissemination of NRT prescribing guidelines
• Letter sent to all wards offering help of Leeds
  smoking cessation services

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BEFORE CSIP PILOT

• Assessing smoking status put on standard
  admission form
• Discussed with forensic directorate manager
  ward managers
• Discussion between Leeds stop smoking service and
  pharmacy
• Involved level 2 advisor in forensic service
• Identify link persons on respective wards and set
  up working group
• Audit of ward staff about current stop smoking
  services offered
• Wrote CSIP protocol

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Work of CSIP pilot group

• Met on a weekly basis for a month
• Poster display
• Leaflets available on wards
• Ward administrator responsible for upkeep of
  displays/leaflets
• Advertised pilot to staff and patients
• Level 1 training provided again for staff

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CSIP PILOT - Planning

• JANUARY 2008 commenced a pilot drop in group at
  the Newsam Centre, on wards 2 and 3, forensic
  wards.
• Offering smoking cessation advice and support
• Using the Smoking Cessation In Practice document
  as a toolkit to deliver a sustainable system.
• Involved one smoking cessation nurse, trained
  smoking advisor from forensic wards and one
  pharmacist

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CSIP Pilot - Planning

• Pilot to run for 8 weeks then to be reviewed.
• Same day, same time each week to promote
  familiarity .
• Same advisors running group again to promote
  familiarity.
• Tea, coffee and biscuits available.
• Informal, relaxed environment

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CSIP Planning

• Audit
• Part 1 numbers seen at drop-in group
• - quit at 4 weeks
• Part 2 audit of no. of patients who had
  smoking status assessed on wards before and after
  pilot

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Results (1)

• Part 1 - Forensics
• 9 people
• 6 service users
• 3 staff
• 3 people still on smoking cessation therapy (2
  staff, 1 service user) 33

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Results (2)

• Reviewed pilot after 4 weeks and decided to
  extend it to an acute day hospital
• Discussed with their team manager
• Time split as follows
• 2-3pm forensic drop-in
• 3-4pm day hospital drop-in
• Ward staff informed smoking advisor about which
  people needed to be seen

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Results (3)

• Part 1 Day Hospital
• 8 people
• 7 service users
• 1 staff member
• 4 people still on smoking cessation therapy (3
  service users, 1 staff member) 50

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Results (Part 1)

• Forensics
• 9 people
• 6 service users
• 3 staff
• 3 people still on smoking cessation therapy (2
  staff, 1 service user) 33

• Day Hospital
• 8 people
• 7 service users
• 1 staff member
• 4 people still on smoking cessation therapy (3
  service users, 1 staff member) 50

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Results from Wards (Part 2)

• January (before)
• 35 patients
• Smokers 94
• Non-smokers 6
• Offered advice 74
• Given NRT 8

• April (after)
• 35 patients
• Smokers 94
• Non-smokers 6
• Offered advice 82
• Given NRT 25

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Post pilot

• To run level 1 smoking cessation course at Day
  Hospital
• Provided CO monitors to 4 inpatient sites
• To continue visits to forensics and day hospital
  on a Monday pm
• To continue providing Level 1 2 training course
  
• To provide yearly update courses for level 2
• To try to keep any discharged patients in contact
  with Smoking Cessation Service

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Conclusions

• Forensic patients challenging group to get to
  stop smoking
• Day Hospital patients may be more mentally well
  and ready to give up smoking
• Future work will involve providing smoking
  cessation support to other day hospitals in the
  Trust using trained advisors

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AND TODAY..

• New planner designed and in use.
• New posters.
• Referral pads.
• Level 2 training planned.
• Update training available for advisors.
• Level 1 training available for the trust.
• Work to start with Learning Disabilities.
• Working in partnership with Leeds PFT and the
  Nutritional and Physical Wellbeing Team.
• And lots more!